Reuben D B, Wong R C, Walsh K E, Hays R D
Multicampus Program in Geriatric Medicine and Gerontology, UCLA School of Medicine 90024-1687, USA.
J Am Geriatr Soc. 1995 May;43(5):550-2. doi: 10.1111/j.1532-5415.1995.tb06105.x.
To test the feasibility of and to validate a self-report weekly postcard diary of health care utilization.
Case-series and validation study.
Community-based sample of fee-for-service and health maintenance organization (HMO) patients.
A convenience sample of 24 community-dwelling older persons who had failed a self-administered screen and were eligible for a study of outpatient comprehensive geriatric assessment consultation.
Subjects completed and mailed in a weekly postcard diary documenting medical, counseling, or rehabilitation therapy visits. If a subject did not respond within 10 days after the end of the week, a telephone call was placed to gather the information. For a subset of 10 subjects who were HMO enrollees, all records were reviewed to determine accuracy of the postcard diaries.
Of the 24 subjects enrolled, one HMO enrollee dropped out following hip surgery after 4 weeks of completing diaries. The remaining 23 subjects (96% of total entered) provided complete information for 12 weeks. Telephone follow-up to either obtain or clarify utilization information was required for 22% of subjects. For the subset of 10 HMO subjects, seven underreporting, two overreporting, and one incorrect day errors were detected-a total of 10 errors representing 9% of diaries and 1.3% of patient-days. Kappa as a measure of agreement between the two methods (self-report and chart review) was 0.82 (P < .0001). Compared with chart review, the diary report was 75.0% sensitive and 99.8% specific. Positive and negative predictive values were 91.3% and 99.2%, respectively.
These findings suggest that a postcard diary system with telephone follow-up is both a feasible and reasonably accurate method of tracking health care utilization by community-dwelling older persons, although a small percentage will be unable to adhere to this method.
测试一份关于医疗保健利用情况的自我报告式每周明信片日记的可行性并对其进行验证。
病例系列及验证研究。
基于社区的按服务收费和健康维护组织（HMO）患者样本。
24名居家老年人的便利样本，这些老年人自我管理筛查未通过，且符合门诊综合老年评估咨询研究的条件。
受试者完成并邮寄一份每周明信片日记，记录医疗、咨询或康复治疗就诊情况。如果受试者在一周结束后10天内未回复，则通过电话收集信息。对于10名HMO参保受试者的子集，审查所有记录以确定明信片日记的准确性。
在登记的24名受试者中，一名HMO参保者在完成日记4周后因髋关节手术退出。其余23名受试者（占总入组人数的96%）提供了12周的完整信息。22%的受试者需要进行电话随访以获取或澄清利用信息。对于10名HMO受试者的子集，发现7例报告不足、2例报告过度和1例日期错误——总共10个错误，占日记的9%和患者天数的1.3%。作为两种方法（自我报告和图表审查）之间一致性度量的kappa值为0.82（P < .0001）。与图表审查相比，日记报告的敏感性为75.0%，特异性为99.8%。阳性和阴性预测值分别为91.3%和99.2%。
这些发现表明，采用电话随访的明信片日记系统是跟踪居家老年人医疗保健利用情况的一种可行且相当准确的方法，尽管有一小部分人无法坚持这种方法。
