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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

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Published on: February 16, 2011

Goal Concordant Care: A Cross-Sectional Study Evaluating Correlates of Concordant Care and Association With

Kaitlyn R Julian¹, Jeffrey W Kwong¹, Chelsea Leversedge²

¹University of California, San Francisco, USA.

Hand (New York, N.Y.)

|September 26, 2024

Abstract

Background:

The concordance between patient and physician goals has been associated with improved outcomes in many chronic diseases. The purpose of this study was to evaluate the association between goal concordant care, patient satisfaction, and patient experience and to analyze factors associated with goal concordant care in hand and upper extremity surgery.

Methods:

New patients who were 18 years or older were invited to participate. Goal concordant care was defined as the patient's previsit treatment goal matching the primary treatment received. The χ² tests were used to evaluate the association between goal concordant care and patient satisfaction and patient experience. We conducted univariable logistic regression to evaluate variables for their association with concordance and multivariable logistic regression for variables that were significantly associated in the initial analyses to evaluate their aggregate influence on concordance.

Results:

In total, 169 patients enrolled. The rate of goal concordant care was 62%; concordance was not associated with patient satisfaction or experience. Age, sex, English proficiency, health literacy, education level, employment and relationship status, pain self-efficacy, symptom duration, functional disability, and patient-centered decision-making were not associated with concordant care. Patients with annual income less than $50,000 had significantly higher odds of goal discordant care.

Conclusion:

Patients with lower income had more than 3 times the odds of receiving discordant care. However, discordant care was not associated with patient satisfaction or experience. Further studies on other pertinent outcomes are needed in orthopedic surgery (eg, treatment adherence). Known care disparities based on socioeconomic status may be mediated through care discordance and should be investigated.

Keywords:

anatomy diagnosis equity fracture/dislocation hand health disparity socioeconomic status wrist

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