Does Concordance Between Data Sources Vary By Medical Organization Type?
Published In: The American Journal of Managed Care, v. 13, no. 6, pt. 1, June 2007, p. 289-296
Posted on RAND.org on December 31, 2006
OBJECTIVE: Little is known about how concordance between patient self-report and medical record data varies with medical organization type. Given discrepancies in quality of care received across patient cohorts and organizations, it is important to understand the degree to which concordance metrics are robust across organization types. The authors tested whether concordance between patient self-report and medical record data would vary with medical organization type, controlling for patient demographic characteristics, health status, and domain of medical care. STUDY DESIGN: This observational study included 1270 patients sampled from 39 West Coast medical organizations with at least 1 of the following conditions: diabetes, ischemic heart disease, asthma or chronic obstructive pulmonary disease, or low back pain. METHODS: Medical records and patient self-report were used to measure 50 items grouped into 4 conceptual domains: diagnosis, clinical services delivered, counseling and referral, and medication use. The authors evaluated the concordance between ambulatory medical record and patient survey data. The authors conducted multivariate logistic regressions to test the impact of medical organization type (medical groups vs independent practice associations), controlling for patient characteristics and domain of care, on 5 concordance measures. RESULTS: Independent practice associations were associated with worse agreement, survey specificity, and medical record sensitivity, and better medical record specificity compared with medical groups. CONCLUSIONS: The medical record and patient survey do not measure quality comparably across organization types. The authors recommend continued efforts to improve survey data collection across different patient populations and to improve the quality of clinical data.