Research Activities, March 2014
Older patients and caregivers differ in their assessments of the quality of chronic illness care
There is a growing recognition of the need to improve the quality of chronic illness care. Caregivers who often accompany patients to physician office visits are well-positioned to provide additional information on the quality of patients' chronic illness care. However, their perspective has rarely been studied. Typically, caregivers are asked to evaluate the quality of patients' care as a proxy respondent when a patient is unable to respond. A new study suggests that older patients with chronic illnesses and their caregivers can differ in their assessments of the patient's quality of care.
Researchers compared patients' self reports and their caregivers' independent ratings of the quality of chronic illness care, and found that the agreement between patients and caregivers was low. Patients who were following a more complex treatment plan (i.e., taking many medications) or having more difficulty following a treatment plan were less likely to agree with their caregiver about the quality of care. Patient-caregiver dyads had greater agreement on objective questions (such as "when I/patient received care for my/his/her chronic illness over the past 6 months, I/patient was given a copy of my/his/her/treatment plan" than on subjective questions (such as "when I/ patient received care for my/his/her chronic illness over the past 6 months, I/patient was satisfied that my/his/her care was well organized").
The researchers believe that for some patient-caregiver dyads, the caregiver's report may be more accurate than the patient's report. This may be particularly true for caregivers who are providing substantial support in managing the patient's health care or for patients with cognitive impairment.
Included in the study were 247 patient-caregiver dyads. All patients were enrolled in the Guided Care intervention, which was designed to enhance the quality of health care for high-risk older adults by integrating a specially trained registered nurse into primary care practices. Quality of care was assessed using the Patient Assessment of Chronic Illness Care, a validated measure of patients' perceptions of the quality of chronic illness care. This study was supported, in part, by AHRQ (HS17650, HS14580).
See "Do older patients and their family caregivers agree about the quality of chronic illness care?" by Erin R. Giovannetti, Ph.D., Lisa Reider, M.H.S., Jennifer L. Wolf, Ph.D., and others in the International Journal for Quality in Health Care 25(5), pp. 515-524, 2013.