What is the concordance between the medical record and patient self-report as data sources for ambulatory care?
What is the concordance between the medical record and patient self-report as data sources for ambulatory care?
复制标题
DOI：
10.1097/01.mlr.0000196952.15921.bf
复制
发表时间：
2006-02-01
期刊：
影响因子：
3
通讯作者：
Kahn, KL
中科院分区：
文献类型：
--
作者：
Tisnado, DM;Adams, JL;Kahn, KL
背景资料：护理质量评估的有效性依赖于数据质量，但鲜为人知的是，相对完整性和有效性的数据源，用于评估quality of care.Objectives：我们评估了门诊病历和患者调查数据之间的一致性。水平的一致性，项目类型的变化，数据源之间的分歧来源，并影响护理质量评估efforts.Design和Subjects：这是一项观察性研究，包括1270例患者从39个西海岸医疗机构抽样，至少有以下之一：糖尿病、缺血性心脏病、哮喘或慢性阻塞性肺病或腰痛。测量：来自两个数据源的项目被分组为4个概念域：诊断、提供的临床服务、咨询和转诊以及药物使用。我们呈现了项目和领域级别以及所有项目组合的总体一致性、Kappa、敏感性和特异性。结果：我们发现调查和医疗记录之间总体上具有良好的一致性，但领域内和领域间存在很大差异。最差的一致性是在咨询和转诊领域，最好的药物使用领域。患者能够报告具有良好的敏感性，难忘的items.Conclusions：质量评级可能会在不同的方向不同，这取决于所使用的数据源。必须根据研究目标和资源考虑分析护理组成部分和整体质量的最合适数据源。我们建议从多个来源收集数据，以最准确地描述患者和提供者的医疗护理体验。
Background: The validity of quality of care assessments relies upon data quality, yet little is known about the relative completeness and validity of data sources for evaluating the quality of care.Objectives: We evaluated concordance between ambulatory medical record and patient survey data. Levels of concordance, variations by type of item, sources of disagreement between data sources, and implications for quality of care assessment efforts are discussed.Design and Subjects: This was an observational study that included 1270 patients sampled from 39 West Coast medical organizations with at least 1 of the following: diabetes, ischemic heart disease, asthma or chronic obstructive pulmonary disease, or low back pain.Measures: Items from both data sources were grouped into 4 conceptual domains: diagnosis, clinical services delivered, counseling and referral, and medication use. We present total agreement, kappa, sensitivity, and specificity at the item and domain-levels and for all items combined.Results: We found good concordance between survey and medical records overall, but there was substantial variation within and across domains. The worst concordance was in the counseling and referrals domain, the best in the medication use domain. Patients were able to report with good sensitivity on memorable items.Conclusions: Quality ratings are likely to vary in differing directions, depending on the data source used. The most appropriate data source for analyses of components of and overall quality of care must be considered in light of study objectives and resources. We recommend data collection from multiple sources to most accurately portray the patient and provider experience of medical care.