Evidence of self-report bias in assessing adherence to guidelines
Evidence of self-report bias in assessing adherence to guidelines
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DOI：
10.1093/intqhc/11.3.187
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发表时间：
1999-06-01
影响因子：
2.6
通讯作者：
Ross-Degnan, D
中科院分区：
文献类型：
--
作者：
Adams, AS;Soumerai, SB;Ross-Degnan, D
目标。评估自1980年以来在实践指南依从性研究中使用自我报告方法的趋势，并确定反应偏差对自我报告作为护理质量衡量标准的有效性的影响。我们使用1980年至1996年期间定义的搜索词进行MEDLINE搜索。纳入的研究评估了临床医生对实践指南、官方政策或其他循证建议的依从性。在同时包含自我报告（如访谈）和客观依从性衡量标准（如医疗记录）的研究中，我们比较了自我报告率和客观依从率（以坚持百分比衡量）。反应偏倚的证据被定义为自我报告的依从性显著超过5%水平的客观测量。我们确定了326项指南依从性研究。使用自我报告来衡量依从性的研究从1980年的18%增加到1985年的41%。在同时使用自我报告和客观测量的10项研究中，8项支持在所有自我报告测量中存在反应偏倚。在37个比较中，有87%的患者自我报告的依从率超过了客观的依从率，导致依从性的中位数高估了27%（绝对差异）。尽管自我报告可以提供有关临床医生对指南建议的了解的信息，但它们存在偏见，不应作为指南依从性的唯一衡量标准。
Objective. To assess trends in the use of self-report measures in research on adherence to practice guidelines since 1980, and to determine the impact of response bias on the validity of self-reports as measures of quality of care.Methods. We conducted a MEDLINE search using defined search terms for the period 1980 to 1996. Included studies evaluated the adherence of clinicians to practice guidelines, official policies, or other evidence-based recommendations. Among studies containing both self-report (e.g. interviews) and objective measures of adherence (e.g. medical records), we compared self-reported and objective adherence rates (measured as per cent adherence). Evidence of response bias was defined as self-reported adherence significantly exceeding the objective measure at the 5% level.Results. We identified 326 studies of guideline adherence. The use of self-report measures of adherence increased from 18% of studies in 1980 to 41% of studies in 1985. Of the 10 studies that used both self-report and objective measures, eight supported the existence of response bias in all self-reported measures. In 87% of 37 comparisons, self-reported adherence rates exceeded the objective rates, resulting in a median over-estimation of adherence of 27% (absolute difference).Conclusions. Although self-reports may provide information regarding clinicians' knowledge of guideline recommendations, they are subject to bias and should not be used as the sole measure of guideline adherence.