Agreement between self-reports and medical records was only fair in a cross-sectional study of performance of annual eye examinations among adults with diabetes in managed care

作者：Beckles Gloria L A^*; Williamson David F; Brown Arleen F; Gregg Edward W; Karter Andrew J; Kim Catherine; Dudley R Adams; Safford Monika M; Stevens Mark R; Thompson Theodore J

来源：Medical Care, 2007, 45(9): 876-883.

DOI：10.1097/MLR.0b013e3180ca95fa

• agreement
• diabetes mellitus
• self-report
• medical records
• quality indicators

Background: Despite consensus about the importance of measuring quality of diabetes care and the widespread use of self-reports and medical records to assess quality, little is known about the degree of agreement between these data sources.
Objectives: To evaluate agreement between self-reported and medical record data on annual eye examinations and to identify factors associated with agreement.
Research Design and Subjects: Data from interviews and medical records were available for 8409 adults with diabetes who participated in the baseline round of the Translating Research Into Action for Diabetes (TRIAD) Study.
Measures: Agreement between self-reports and medical records was evaluated as concordance and Cohen's kappa coefficient.
Results: Self-reports indicated a higher performance of annual dilated eye examinations than did medical records (75.9% vs. 38.8%). Concordance between the data sources was 57.9%. Agreement was only fair (kappa coefficient = 0.25; 95% confidence interval, 0.23-0.26). Nearly two-thirds (64.6%) of discordance was due to lack of evidence in the medical record to support self-reported performance of the procedure. After adjustment, agreement was most strongly related to health plan (chi(2) = 977.9, df =9; P < 0.0001), and remained significantly better for 3 of the 10 health plans (P < 0.00001) and for persons younger than 45 years of age (P = 0.00002).
Conclusions: The low level of agreement between self-report and medical records suggests that many providers of diabetes care do not have easily available accurate information on the eye examination status of their patients.

• 出版日期2007-9