Skinner Katherine M, Miller Donald R, Lincoln Elizabeth, Lee Austin, Kazis Lewis E
Center for Health Quality, Outcomes, and Economic Research (CHQOER), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA.
J Ambul Care Manage. 2005 Apr-Jun;28(2):102-10. doi: 10.1097/00004479-200504000-00002.
Researchers have frequently relied on case identification using clinician-based screening as the standard. This study evaluates a self-administered screening questionnaire developed for use in the Veterans Health Study. We compared concordance between elderly patients' reports of selected chronic illnesses and the medical record. The purpose of this study was to determine the feasibility of using a self-report screening questionnaire for case identification in an outcomes study of elderly respondents. Reports of the presence of selected chronic illnesses were compared in a sample of patients (N=402) receiving outpatient care between 2 data sources, patient self-report and medical record, to determine overall concordance in 5 common chronic conditions (hypertension, adult-onset diabetes mellitus, chronic low-back pain, osteoarthritis of the knee, and chronic lung disease). Discordance between the 2 data sources varied by condition. Differences in reporting were small for diabetes and hypertension, intermediate for chronic lung disease, and larger for osteoarthritis of the knee and chronic low-back pain, where the chart did not identify substantial proportions of cases reported in the questionnaire. Use of patient-reported screening questionnaires, which are self-administered, is a valid, cost-efficient method to identify some chronic illnesses. Using medical records alone may result in underestimation of some symptom-based conditions.
研究人员经常将基于临床医生筛查的病例识别作为标准。本研究评估了一种为退伍军人健康研究开发的自我管理筛查问卷。我们比较了老年患者所选慢性病报告与病历之间的一致性。本研究的目的是确定在老年受访者的结局研究中使用自我报告筛查问卷进行病例识别的可行性。在一个接受门诊治疗的患者样本（N = 402）中，比较了两个数据源（患者自我报告和病历）中所选慢性病存在情况的报告，以确定5种常见慢性病（高血压、成年型糖尿病、慢性下腰痛、膝关节骨关节炎和慢性肺病）的总体一致性。两个数据源之间的不一致情况因疾病而异。糖尿病和高血压的报告差异较小，慢性肺病的差异中等，膝关节骨关节炎和慢性下腰痛的差异较大，病历中未识别出问卷中报告的相当一部分病例。使用自我管理的患者报告筛查问卷是识别某些慢性病的一种有效、经济高效的方法。仅使用病历可能会导致对某些基于症状的疾病估计不足。
