Health-related quality of life and the physician–patient alliance: a preliminary investigation of ultra-brief, real-time measures for primary care
Many psychometrically sound measures exist but feasibility makes real-time use difficult. This study validates two ultra-brief, patient-rated instruments, the Wellness Rating Scale (WRS) and the Provider Alliance Scale (PAS).
The WRS and the EuroQol visual analogue scale (EQ VAS) were completed by patients in a primary care practice (n = 97) and a non-clinical sample of graduate students (n = 122). The WRS and the Patient-Completed Health Outcome Measures Information System-Global 10 (PROMIS) were completed by patients in a primary care setting (n = 305). The WRS and PROMIS were also administered to graduate students (n = 158). The PAS and the Patient Physician Working Alliance were administered to a primary care sample of 40 and a retrospective sample of students (n = 228).
The WRS generated reliable scores, with coefficient alphas ranging from .83 to .91. Bivariate correlations between the WRS and the EQ VAS (r = .55–.75) and PROMIS (r = .64–73) indicate moderate-to-strong concurrent validity. The larger coefficients were with patient samples. Construct validity was evidenced by higher levels of distress for chronic conditions as well as for clinical samples. The PAS achieved an alpha of .94 for the primary care sample and .87 for the retrospective sample and bivariate correlations (r = .61–.72) indicate moderate-to-strong evidence of concurrent validity.
The WRS and PAS demonstrate sufficient reliability and validity to move to the next phase of research: a randomized clinical trial comparing the use of real-time feedback from the two measures to treatment as usual targeting outcomes of chronic disease patients.
KeywordsPROM Patient-centered care Patient–provider alliance Health-related quality of life EQ-5D VAS PROMIS
The authors would like to thank Peak Vista reception staff, Carmen Rodriguez, Ruben Martinez, and Reem Muayad, and behavioral health providers Eric Attard and Sharon Glocker for their invaluable assistance in data collection, scoring, and storage.
Compliance with ethical standards
Conflict of interest
Duncan is a co-holder of the copyright of the Partners for Change Outcome Management System (PCOMS) instruments. The measures are free for individual use but Duncan receives royalties from licenses issued to organizations. The web-based application of PCOMS, BetterOutcomesNow.com, is a commercial product and he receives profits based on sales.
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