How valid are medical records and patient questionnaires for physician profiling and health services research? A comparison with direct observation of patient visits
How valid are medical records and patient questionnaires for physician profiling and health services research? A comparison with direct observation of patient visits
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DOI：
10.1097/00005650-199806000-00009
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发表时间：
1998-06-01
期刊：
影响因子：
3
通讯作者：
Jaen, CR
中科院分区：
文献类型：
--
作者：
Stange, KC;Zyzanski, SJ;Jaen, CR
目标。本研究旨在确定衡量门诊医疗服务交付的最佳非观察性方法。作为对初级保健实践内容的多方法研究的一部分，研究护士直接观察了138名执业家庭医生的连续患者就诊情况。使用直接观察清单、医疗记录审查和患者出院问卷收集所提供服务的数据。对每个医疗服务进行病历复核和患者出院问卷调查，与直接观察比较，计算敏感性、特异性和Kappa统计量。八名研究护士间的互译信度采用Kappa统计对录像访问和医疗记录的单独样本进行计算。共观察了4454名患者的就诊情况。75%的患者归还了出院问卷。研究护士通译者的信度普遍较高。大多数服务的病历和病人出院问卷的特异性都很高。医疗记录对健康习惯咨询的敏感性较低，对体检、实验室检测和免疫接种的敏感性中等。患者出境问卷对健康习惯咨询和免疫接种的敏感性为中至高，对体检和化验服务的敏感性为可变。用于衡量不同医疗服务提供情况的病历和患者问卷的有效性因服务而异。本报告可用于选择最佳的非观察性方法来测量特定门诊医疗服务的提供情况，用于研究和医生分析，并使用这些常用措施来解释现有的卫生服务研究。
OBJECTIVES. This study was designed to determine the optimal nonobservational method of measuring the delivery of outpatient medical services.METHODS. AS part of a multimethod study of the content of primary care practice, research nurses directly observed consecutive patient visits to 138 practicing family physicians. Data on services delivered were collected using a direct observation checklist, medical record review, and patient exit questionnaires. For each medical service, the sensitivity, specificity, and Kappa statistic were calculated for medical record review and patient exit questionnaires compared with direct observation. Interrater reliability among eight research nurses was calculated using the Kappa statistic for a separate sample of videotaped visits and medical records.RESULTS. Visits by 4,454 patients were observed. Exit questionnaires were returned by 75% of patients. Research nurse interrater reliabilities were generally high. The specificity of oth the medical record and the patient exit questionnaire was high for most services. The sensitivity of the medical record was low for measuring health habit counseling and moderate for physical examination, laboratory testing, and immunization. The patient exit questionnaire showed moderate to high sensitivity for health habit counseling and immunization and variable sensitivity for physical examination and laboratory services.CONCLUSIONS. The validity of the medical record and patient questionnaire for measuring delivery of different health services varied with the service. This report can be used to choose the optimal nonobservational method of measuring the delivery of specific ambulatory medical services for research and physician profiling and to interpret existing health services research studies using these common measures.