Schwartz A H, Perlman B B, Paris M, Schmidt K, Thornton J C
Am J Public Health. 1980 Apr;70(4):406-8. doi: 10.2105/ajph.70.4.406.
This study was undertaken to address the issue of data reporting in the psychiatric sector of New York City Medicaid, the largest publicly financed psychiatric health care delivery system in the nation. Six outpatient psychiatric clinics in general hospitals, four with residency programs, and all 29 free standing psychiatric clinics in New York City were audited as were charts from 120 psychiatrists billing for 10 or more Medicaid patients. Overall agreement of chart and Medicaid diagnoses was 91% for psychiatrists, 79% for free-standing clinics, and 77% for hospital clinics. Agreement varied by diagnosis. Bias in the Medicaid diagnosis of Neurosis was found at the four hospitals having residency programs. Patients most likely to be misreported as having minimizing diagnoses were male, or between the ages of 18 and 29 years, or to have a prior history of psychiatric treatment. The errors in reporting in each provider sector would pose a methodological obstacle if Medicaid data were used in epidemiological research.
本研究旨在解决纽约市医疗补助计划精神科的数据报告问题，该计划是美国最大的公共资助精神卫生保健提供系统。对综合医院的六家门诊精神科诊所（其中四家设有住院医师培训项目）以及纽约市所有29家独立精神科诊所进行了审计，同时还审计了为10名或更多医疗补助计划患者计费的120名精神科医生的病历。精神科医生的病历诊断与医疗补助计划诊断的总体一致性为91%，独立诊所为79%，医院诊所为77%。一致性因诊断而异。在设有住院医师培训项目的四家医院中发现了医疗补助计划对神经症诊断的偏差。最有可能被错误报告为诊断较轻的患者为男性，年龄在18至29岁之间，或有精神科治疗史。如果在流行病学研究中使用医疗补助计划的数据，每个提供者部门的报告错误将构成方法学障碍。
