Functional assessment of older patients in the emergency department: comparison between standard instruments, medical records and physicians' perceptions

Alejandro Rodríguez-Molinero, María López-Diéguez, Ana I Tabuenca, Juan J de la Cruz, José R Banegas, Alejandro Rodríguez-Molinero, María López-Diéguez, Ana I Tabuenca, Juan J de la Cruz, José R Banegas

Abstract

Background: We evaluated the accuracy of physician recognition of functional status impairment in older emergency departments (ED) patients. In particular, we evaluated the accuracy of medical records (a comparison of the information in the medical record with the functional status based on proxy interviews), and the accuracy of physician knowledge (a comparison of the information obtained from the responsible physician with the functional status based on proxy interviews).

Methods: Cross-sectional study on 101 frail older patients selected at random from among those attending ED, their ED physicians, and respondents. The study was conducted at ED in four general university teaching hospitals in a city, from July through November 2003. Functional data shown on patients' medical records were compared against functional data obtained from respondents (family members), using Kendall's Tau-b statistic. In addition patients' Katz Indices (which assesses six basic activities of daily living--basic ADL) based on interviews with ED physicians were compared against those obtained from respondents, using the coefficient of concordance weighted kappa (kappa). Each patient and his respondent were paired with a single physician.

Results: The correlation between information on dependence for basic ADL obtained from medical records and that furnished by respondents, was 0.41 (95% CI 0.27-0.55). Concordance between the respective Katz Indices obtained from physicians and respondents was 0.47 (95% CI 0.38-0.57).

Conclusion: Older subjects' functional status is not properly assessed by emergency department physicians.

Figures

Figure 1
Figure 1
Concordance (κ coefficient) between patients' functional status (Katz Index) reported by physicians and that reported by respondents, according to the number of basic activities of daily living (basic ADL) 'mentioned in the medical record. Bars correspond to the 95% confidence intervals (95% CI) of κ. The broken line highlights the fact that there is no overlap between the 95% CI for 0 and for 2 or more basic ADL. The sample sizes (n) for each basic ADL subgroup are shown beneath the bars.

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