Roberts R O, Bergstralh E J, Schmidt L, Jacobsen S J
Section of Clinical Epidemiology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
J Clin Epidemiol. 1996 Sep;49(9):989-95. doi: 10.1016/0895-4356(96)00143-6.
Self-reported utilization of health care services is important in epidemiological studies and in health care planning, policy, and research, and the accuracy of such information is essential. This study assessed the validity of self-reported utilization of health care services in a randomly selected cohort of 500 community-dwelling men aged 40 to 79 years in Olmsted County, Minnesota. Men had previously completed a self-administered questionnaire that elicited information on utilization of health care services; questions included total inpatient hospital nights in the previous year, total ambulatory physician visits in the previous year, and physician visits in the previous 2 weeks. The complete community medical records of the men were reviewed, and the accuracy of self-reported information was evaluated by assessing the difference between self-reported utilization and actual medical record utilization as ascertained from the medical records, and the distribution of these differences. Exact agreement was 93% for inpatient hospital nights, 91% for ambulatory physician visits in 2 weeks, and 30% for ambulatory physician visits in the previous year. There was an increase in the variability of the difference between self-reported and medical record utilization with an increasing number of inpatient nights or ambulatory physician visits, and a significant bias toward underreporting with an increasing number of ambulatory physician visits in the previous year. These findings suggest that self-reported inpatient nights in the previous year and ambulatory physician visits in 2 weeks are reasonably accurate, but self-reported ambulatory physician visits in the previous year may be less accurate and likely to be biased toward underreporting at higher numbers of visits. This information should be taken into account by researchers and health planners using self-reported measures of utilization.
在流行病学研究以及医疗保健规划、政策制定和研究中，自我报告的医疗保健服务利用率很重要，且此类信息的准确性至关重要。本研究评估了明尼苏达州奥尔姆斯特德县随机选取的500名年龄在40至79岁的社区居住男性队列中自我报告的医疗保健服务利用率的有效性。这些男性此前已完成一份自我管理问卷，该问卷收集了有关医疗保健服务利用率的信息；问题包括上一年的住院总天数、上一年的门诊医生就诊总次数以及前两周的医生就诊次数。研究人员查阅了这些男性完整的社区医疗记录，并通过评估自我报告的利用率与从医疗记录中确定的实际医疗记录利用率之间的差异以及这些差异的分布情况，来评估自我报告信息的准确性。住院天数的完全一致率为93%，两周内门诊医生就诊次数的完全一致率为91%，上一年门诊医生就诊次数的完全一致率为30%。随着住院天数或门诊医生就诊次数的增加，自我报告与医疗记录利用率之间差异的变异性增大，且上一年门诊医生就诊次数增加时，存在明显的漏报倾向。这些发现表明，上一年自我报告的住院天数和两周内门诊医生就诊次数相当准确，但上一年自我报告的门诊医生就诊次数可能不太准确，且就诊次数较多时可能存在漏报倾向。使用自我报告的利用率指标的研究人员和卫生规划人员应考虑到这些信息。
