CONCORDANCE OF SELF-REPORTED DATA AND MEDICAL RECORD AUDIT FOR 6 CANCER SCREENING PROCEDURES
CONCORDANCE OF SELF-REPORTED DATA AND MEDICAL RECORD AUDIT FOR 6 CANCER SCREENING PROCEDURES
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DOI：
10.1093/jnci/85.7.566
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发表时间：
1993-04-07
期刊：
影响因子：
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通讯作者：
LAMPERT, DI
中科院分区：
文献类型：
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作者：
GORDON, NP;HIATT, RA;LAMPERT, DI
背景资料：自上次癌症筛查以来的自我报告数据通常用于确定个人是否应该进行定期筛查，并监测对早期癌症检测指南的遵守情况。目的：在Kaiser Permanente医疗保健计划内进行的一项研究中，我们检查了自我报告的信息和医疗记录文件的一致性，这些信息和医疗记录文件是关于早期癌症检测的六种程序的最近情况和原因的。我们还评估了基于这两个来源的人群水平筛查率估计值的一致性。方法：数据来自779名男性和女性完成的邮寄问卷或电话访谈。这些随机选择的研究参与者（431名女性和348名男性）的数据与他们的病历中获得的信息进行了比较，这些参与者在过去5年中一直是健康计划的成员。评估了关于每项手术是否在过去2年内完成的源间一致性，并将医疗记录用作金标准。为了评估患者自我报告的准确性，我们还计算了敏感性、假阳性和假阴性结果以及Kappa统计量。结果如下：自我报告的数据和医疗记录文件之间的一致性更大的程序，产生一个测试报告（乳房X线检查，巴氏涂片，粪便潜血试验，乙状结肠镜检查）比那些产生医生的笔记（临床乳腺检查和直肠指检）。Kappa统计显示了类似的模式。自我报告数据的敏感性为90%以上的乳房X光检查，临床乳腺检查，巴氏涂片，粪便潜血试验和近80%的乙状结肠镜检查和直肠指检。但除大便潜血试验和乙状结肠镜检查外，假阳性率均在40%以上。对于所有六种程序，过去2年内估计的人群水平筛查率将显著较高（P
Background: Self-reported data about the interval since last cancer screening are often used to determine whether individuals are due for periodic screening and to monitor adherence to guidelines for early cancer detection. Purpose: In a study conducted within the Kaiser Permanente Medical Care Program, we examined the concordance of self-reported information and medical record documentation about recency of and reasons for six procedures for early cancer detection. We also assessed the concordance of population-level estimates of screening rates based on these two sources. Methods: Data were obtained from a mailed questionnaire or telephone interview completed by 779 men and women. The data from these randomly selected study participants (431 women and 348 men), who had been members of the health plan for the previous 5 years, were compared with information obtained from their medical charts. Intersource agreement about whether each procedure was done within the last 2 years was evaluated, with the medical record used as the gold standard. To assess the accuracy of patient self-reporting, we also calculated sensitivity, false-positive and false-negative results, and Kappa statistics. Results: Concordance between self-reported data and medical record documentation was greater for procedures that generated a test report (mammogram, Pap smear, fecal occult blood test, and sigmoidoscopy) than for those generating a physician's note (clinical breast examination and digital rectal examination). Kappa statistics showed a similar pattern. Sensitivity of self-reported data was more than 90% for mammogram, clinical breast examination, Pap smear, and fecal occult blood test and nearly 80% for sigmoidoscopy and digital rectal examination. However, false-positive results were above 40%, except for fecal occult blood test and sigmoidoscopy. For all six procedures, estimated population-level rates of screening within the past 2 years would have been significantly higher (P