Self-rated health: patterns in the journeys of patients with multi-morbidity and frailty

Abstract

Rationale, aims and objectives: Self-rated health (SRH) is a single measure predictor of hospital utilization and health outcomes in epidemiological studies. There have been few studies of SRH in patient journeys in clinical settings. Reduced resilience to stressors, reflected by SRH, exposes older people (complex systems) to the risk of hospitalization. It is proposed that SRH reflects rather than predicts deteriorations and hospital use; with low SRH autocorrelation in time series. The aim was to investigate SRH fluctuations in regular outbound telephone calls (average biweekly) to patients by Care Guides.

Methods: Descriptive case study using quantitative autoregressive techniques and qualitative case analysis on SRH time series. Fourteen participants were randomly selected from the Patient Journey Record System (PaJR) database. The PaJR database recorded 198 consecutively sampled older multi-morbid patients journeys in three primary care settings. Analysis consisted of triangulation of SRH (0 very poor - 6 excellent) patterns from three analyses: SRH graduations associations with service utilization; time series modelling (autocorrelation, and step ahead forecast); and qualitative categorization of deteriorations.

Results: Fourteen patients reported mean SRH 2.84 (poor-fair) in 818 calls over 13 ± 6.4 months of follow-up. In 24% calls, SRH was poor-fair and significantly associated with hospital use. SRH autocorrelation was low in 14 time series (-0.11 to 0.26) with little difference (χ(2) = 6.46, P = 0.91) among them. Fluctuations between better and worse health were very common and poor health was associated with hospital use. It is not clear why some patients continued on a downward trajectory, whereas others who destabilized appeared to completely recover, and even improved over time.

Conclusion: SRH reflects an individual's complex health trajectory, but as a single measure does not predict when and how deteriorations will occur in this study. Individual patients appear to behave as complex adaptive systems. The dynamics of SRH and its influences in destabilizations warrant further research.

Keywords: evaluation; health services research; patient-centred care.