Hinami Keiki, Alkhalil Ahmad, Chouksey Sonam, Chua Jacquelin, Trick William E
Department of Medicine, John Stroger Hospital, Chicago, IL, 60612, USA.
Collaborative Research Unit, Cook County Health and Hospitals System, Chicago, IL, USA.
Qual Life Res. 2016 Sep;25(9):2239-43. doi: 10.1007/s11136-016-1261-2. Epub 2016 Mar 15.
Standardized measures of physical symptoms predict mortality and healthcare utilization, but clinicians remain uncertain about how to apply them in routine clinical care. Recognizing the tendency for physician documentations to routinely underestimate symptom burden, we assessed whether or not severity was an important dimension of symptom assessments that may determine their usefulness in clinical encounters.
Retrospective cohort study using data from audio computer-assisted self-interviews augmented by chart review of patients from a primary care clinic of an urban health system.
We sampled 145 patients who completed the Memorial Symptom Assessment Scale (MSAS) short form-physical symptom severity measurement-before their primary care visit. Most were women (60 %), and non-Hispanic black (59 %), and many responded in Spanish (19 %). All but three reported > 1 symptom. Overall, 79 % of elicited symptoms were not documented in physician notes from the same day. Severe symptoms were more likely to be documented [MSAS mean (95 % confidence interval): documented 2.2 (1.9, 2.4) vs. undocumented 1.8 (1.7, 1.9)].
Documentations reflect usual patient-clinician communications that prioritize severe symptoms, while standardized instruments target their comprehensive assessments. Among the many validated instruments, those eliciting the severity of physical symptoms may simultaneously help clinicians with prioritization and risk assessments.
身体症状的标准化测量可预测死亡率和医疗保健利用率，但临床医生对于如何在常规临床护理中应用这些测量方法仍不确定。鉴于医生记录往往会习惯性地低估症状负担，我们评估了严重程度是否是症状评估的一个重要维度，这一维度可能决定其在临床诊疗中的有用性。
采用回顾性队列研究，数据来自音频计算机辅助自我访谈，并通过对城市卫生系统一家初级保健诊所患者的病历审查进行补充。
我们对145名患者进行了抽样，这些患者在初级保健就诊前完成了纪念症状评估量表（MSAS）简表——身体症状严重程度测量。大多数患者为女性（60%），非西班牙裔黑人（59%），许多人用西班牙语回答（19%）。除三人外，所有患者均报告有超过一种症状。总体而言，79%的引发症状未记录在同一天的医生笔记中。严重症状更有可能被记录下来[MSAS均值（95%置信区间）：记录的为2.2（1.9，2.4），未记录的为1.8（1.7，1.9）]。
记录反映了通常的医患沟通情况，这种沟通将重点放在严重症状上，而标准化工具则针对全面评估。在众多经过验证的工具中，那些能够引出身体症状严重程度的工具可能同时有助于临床医生进行优先级排序和风险评估。
