Koller Kathryn R, Wilson Amy S, Asay Elvin D, Metzger Jesse S, Neal Diane E
Alaska Native Tribal Health Consortium, Anchorage, AK, USA
Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
J Prim Care Community Health. 2014 Jul;5(3):160-5. doi: 10.1177/2150131913517902. Epub 2014 Jan 7.
The gold standard for health information is the health record. Hospitalization and outpatient diagnoses provide health systems with data on which to project health costs and plan programmatic changes. Although health record information may be reliable and perceived as accurate, it may not include population-specific information and may exclude care provided outside a specific health care facility. Sole reliance on medical record information may lead to underutilization of health care services and inadequate assessment of population health status. In this study, we analyzed agreement, without assuming a gold standard, between self-reported and recorded chronic conditions in an American Indian/Alaska Native cohort. Self-reported health history was collected from 3821 adult participants of the Alaska EARTH study during 2004-2006. Participant medical records were electronically accessed and reviewed. Self-reported chronic conditions were underreported in relation to the medical record and both information sources reported the absence more reliably than the presence of conditions (across conditions, median positive predictive value = 64%, median negative predictive value = 94%). Agreement was affected by age, gender, and education. Differences between participant- and provider-based prevalence of chronic conditions demonstrate why health care administrators and policy makers should not rely exclusively on medical record-based administrative data for a comprehensive evaluation of population health.
健康信息的金标准是健康记录。住院和门诊诊断为卫生系统提供数据，用于预测医疗成本和规划项目变更。尽管健康记录信息可能可靠且被认为准确，但它可能不包括特定人群的信息，也可能排除特定医疗机构之外提供的护理。单纯依赖病历信息可能导致医疗服务利用不足和对人群健康状况的评估不充分。在本研究中，我们在不假定金标准的情况下，分析了美国印第安/阿拉斯加原住民队列中自我报告和记录的慢性病之间的一致性。2004年至2006年期间，从阿拉斯加EARTH研究的3821名成年参与者中收集了自我报告的健康史。通过电子方式获取并审查了参与者的病历。与病历相比，自我报告的慢性病报告不足，而且两种信息来源报告疾病不存在的可靠性高于存在（在各种疾病中，阳性预测值中位数 = 64%，阴性预测值中位数 = 94%）。一致性受年龄、性别和教育程度的影响。基于参与者和提供者的慢性病患病率差异表明，医疗保健管理人员和政策制定者为何不应仅依赖基于病历的行政数据来全面评估人群健康。
