What outcomes matter to patients?

Abstract

OBJECTIVE: This study estimates the relative value to patients of physical, mental, and social health when making treatment decisions. Despite recommendations to use patient preferences to guide treatment decisions, little is known about how patients value different dimensions of their health status. DESIGN: Cross-sectional data from quasi-experimental, prospective study. SETTING: Forty-six primary care clinics in managed care organizations in California, Texas, Minnesota, Maryland, and Colorado. PATIENTS: Consecutive adult outpatients (n = 16,689) visiting primary care providers. MEASUREMENTS AND MAIN RESULTS: Medical Outcomes Study 12-Item Short Form (SF- 12) health-related quality of life and patient preferences for their current health status, as assessed by standard gamble and time trade-off utility methods, were measured. Only 5% of the variance in standard gamble and time trade-off was explained by the SF-12. Within the SF-12, physical health contributes substantially to patient preferences (35%-55% of the relative variance explained); however, patients also place a high value on their mental health (29%-42%) and on social health (16%-23%). The contribution of mental health to preferences is stronger in patients with chronic conditions. CONCLUSIONS: Patient preferences, which should be driving treatment decisions, are related to mental and social health nearly as much as they are to physical health. Thus, medical practice should strive to balance concerns for all three health domains in making treatment decisions, and health care resources should target medical treatments that improve mental and social health outcomes.