Cunningham Chinazo O, Li Xuan, Ramsey Kelly, Sohler Nancy L
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Med Care. 2007 Mar;45(3):264-8. doi: 10.1097/01.mlr.0000250294.16240.2e.
In studies examining the use of human immunodeficiency virus (HIV) health services, researchers often use subjects' self-reported measures. Agreement between a subject's self-reports and medical records in marginalized populations is uncertain, yet important to understand, as this population is disproportionately affected by HIV.
We sought to examine agreement between self-report and medical record health care utilization measures. Using a cross-sectional study, we studied 428 unstably housed HIV-infected adults in New York City. Self-reported data were collected from Audio Computer-Assisted Self-Interviews, and medical record data from health care providers' and facilities' ambulatory medical records. Agreement for a 6-month period was compared for ambulatory visits (0, 1, >or=2), HIV medications (antiretroviral therapy, opportunistic infection prophylaxis), whether CD4 counts and viral loads were performed and their values (CD4: <200, 200-500, >500 cells/mm; Viral load: undetectable, detected).
Agreement between self-report and medical records was 55.2% (kappa=0.12) for visits, and 68.2-79.1% (kappa=0.27-0.48) for medications. Agreement on whether laboratory tests were performed was 62.3-65.7% (kappa=0.11-0.14), whereas agreement on laboratory values was 77.6-79.3% (kappa=0.52-0.70). Most disagreement resulted in greater number of self-reported visits, use of medications, and laboratory tests compared with medical record data.
Among HIV-infected marginalized individuals, agreement between self-report and medical records was poor for ambulatory visits, poor to fair for medication use, and poor for laboratory tests performed. However, agreement for CD4 count value was substantially better. These findings have implications on health services research in marginalized populations that relies only on self-report or medical record data. This study underscores the importance of understanding how self-reported and medical record data are correlated in marginalized populations.
在研究人类免疫缺陷病毒（HIV）健康服务的使用情况时，研究人员经常使用受试者的自我报告测量方法。在边缘化人群中，受试者的自我报告与医疗记录之间的一致性尚不确定，但理解这一点很重要，因为该人群受HIV的影响尤为严重。
我们试图检验自我报告与医疗记录中医疗保健利用测量方法之间的一致性。通过一项横断面研究，我们对纽约市428名居住不稳定的HIV感染成年人进行了研究。自我报告数据通过音频计算机辅助自我访谈收集，医疗记录数据来自医疗保健提供者和机构的门诊医疗记录。比较了6个月期间门诊就诊（0次、1次、≥2次）、HIV药物治疗（抗逆转录病毒治疗、机会性感染预防）、是否进行了CD4细胞计数和病毒载量检测及其数值（CD4：<200个细胞/mm³、200 - 500个细胞/mm³、>500个细胞/mm³；病毒载量：检测不到、检测到）的一致性。
门诊就诊的自我报告与医疗记录之间的一致性为55.2%（kappa = 0.12），药物治疗的一致性为68.2% - 79.1%（kappa = 0.27 - 0.48）。关于是否进行实验室检测的一致性为62.3% - 65.7%（kappa = 0.11 - 0.14），而关于实验室检测数值的一致性为77.6% - 79.3%（kappa = 0.52 - 0.70）。与医疗记录数据相比，大多数不一致情况表现为自我报告的就诊次数、药物使用次数和实验室检测次数更多。
在HIV感染的边缘化个体中，门诊就诊的自我报告与医疗记录之间的一致性较差，药物使用情况的一致性为差到中等，实验室检测的一致性较差。然而，CD4细胞计数数值的一致性要好得多。这些发现对仅依赖自我报告或医疗记录数据的边缘化人群健康服务研究具有启示意义。本研究强调了了解边缘化人群中自我报告数据与医疗记录数据如何相关的重要性。
