Comparison of self-reported and medical record health care utilization measures. Patient-reported use of health service resources compared with information from health providers. Resource use data by patient report or hospital records: Do they agree? Measuring hospital use without claims: a comparison of patient and provider reports. Accuracy of patients' recall of pap and cholesterol screening. A comparison of patient interview data with pharmacy and medical records for patients with acquired immunodeficiency syndrome or human immunodeficiency virus infection. Accuracy of self-reported health services use and patterns of care among urban older adults. Pill Count, Self-Report, and Pharmacy Claims Data to Measure Medication Adherence in the Elderly Cost Measurement in Economic Evaluations of Health Care: Whom to Ask? Validation of self-reported chronic conditions and health services in a managed care population. The accuracy of self-reported healthcare resource utilization in health economic studies. Comparison of self-report versus agency records of service utilization in a community sample of individuals with alcohol use disorders.
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 r and omly selected cohort of 500 community-dwelling men aged 40 to 79 years in Olmsted County , Minnesota . Men had previously completed a self-administered question naire 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 review ed , 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 research ers and health planners using self-reported measures of utilization The objectives of the present study were to examine the accuracy of older people 's reports of health services re source use after discharge from acute care compared with information from healthcare providers . Paired data were obtained from health providers and a consecutive sample of hospitalised patients ( aged 60 years or over ) enrolled in a r and omised controlled trial of hospital-at-home versus usual acute care .  Retrospective reports of the use ( yes/no ) and number of patient hospital admissions , and community nursing , physiotherapy , health visiting and general practitioner ( GP ) services were obtained between baseline , and 4- and 12-week follow-ups , although the recall period varied for different re sources . The comparability of paired reports was examined by using crude and chance-corrected agreement , and by testing for systematic differences in the distribution of paired responses . Out of 219 patients enrolled in the trial , 190 and 185 patients provided data at 4 ( 87 % ) and 12 weeks ( 84 % ) , respectively . Crude agreement was over 72 % ( range = 42 - 93 % ) , and chance-corrected agreement was moderate or good ( kappa coefficients from 0.23 to 0.71 ) for 11 out of 12 comparisons . Systematic differences in the pattern of paired responses were observed for seven comparisons . Patients more often reported receiving a routine GP home visit ( by 12 weeks ) , whilst health providers reported statistically significantly ( P < 0.05 ) more patients admitted to hospital ( 12 weeks ) and more admissions per person , requesting a GP home visit ( 12 weeks ) or surgery consultation , and having district nursing ( 4 and 12 weeks ) and physiotherapy ( 4 weeks only ) . The data indicate that patients tend to underestimate re sources used compared with health providers over relatively short time frames Background Economic evaluations alongside clinical trials are becoming increasingly common . Cost data are often collected through the use of postal question naires ; however , the accuracy of this method is uncertain . We compared postal question naires with hospital records for collecting data on physiotherapy service use . Methods As part of a r and omised trial of orthopaedic medicine compared with orthopaedic surgery we collected physiotherapy use data on a group of patients from retrospective postal question naires and from hospital records .  Results 315 patients were referred for physiotherapy .  Hospital data on attendances was available for 30 % ( n = 96 ) , compared with 48 % ( n = 150 ) of patients completing question naire data ( 95 % Cl for difference = 10 % to 24 % ) ; 19 % ( n = 59 ) had data available from both sources . The two methods produced an intraclass correlation coefficient of 0.54 ( 95 % Cl 0.31 to 0.70 ) . However , the two methods produced significantly different estimates of re source use with patient self report recalling a mean of 1.3 extra visits ( 95 % Cl 0.4 to 2.2 ) compared with hospital records . Conclusions Using question naires in this study produced data on a greater number of patients compared with examination of hospital records . However , the two data sources did differ in the quantity of physiotherapy used and this should be taken into account in any analysis OBJECTIVE We compared the validity of  hospital admission and length of stay reports from patients , outpatient providers , and hospitals , and we examined possible sources of error . DATA SOURCES Data were collected from people enrolled in a r and omized trial of treatment for severe mental illness and substance use disorders , from community mental health centers ( CMHCs ) , and from hospitals . Reports for each of the 74 study participants covered two-year time periods beginning and ending at various times between 1989 and 1993 . STUDY DESIGN We compared reports from the various sources and constructed a hybrid with data from all three sources . Using parametric and non-parametric statistics , we compared patient , CMHC , and hospital reports with each other and with the hybrid source . In subsequent regression analyses we explored correlates of reporting accuracy . PRINCIPAL FINDINGS Single- source reports underestimated hospital use , but when patient and CMHC reports were combined , results were very similar to those obtained by the more laborious hybrid method . Patient reports became less accurate as the time between discharge and reporting increased ; people with bipolar disorders reported admissions with greater accuracy than did people with schizophrenia . CMHC reporting accuracy decreased as the distance to the admitting hospital increased and were less accurate for people with more severe psychiatric symptoms . CONCLUSIONS Reports from single sources are likely to underestimate hospital use for different reasons . Combining carefully collected data from patients and outpatient providers produces estimates of hospital use that are substantially the same as those developed through methods that are more laborious and costly Am J Public Health 2000 90:1431–5 A cross-sectional , door-to-door community survey was used to gather self-report data on Pap smear and cholesterol screening from 195 rural Australian individuals r and omly selected from population statistics . Trained interviewers used a st and ard reporting form to collect information on screening results , knowledge of recommended screening frequency , and demographics . The two regional pathology laboratories were queried about consenting patients . Adequate screening was defined as any smear within 2 years . Of 146 women eligible for validation of Pap smears , the sensitivity of a self-report of inadequate screening was 45 % , the specificity was 98 % , the negative predictive value was 72 % , and the positive predictive value was 93 % . For example , 93 % of women who said they had not had a Pap smear in at least 2 years in fact had not , while only 72 % of those who cl aim ed to have had a smear within 2 years actually had . Among 91 women reporting Pap results , more than half of those with abnormalities were missed by self-report . The accuracy of recall was not associated with knowledge or demographic factors . Comment : Although its use of a rural , Australian population limits the ability to generalize the conclusions of the report for the population in the United States , the results of this study are consistent with those of previous ones : women tend to overestimate the frequency of their Pap smears and to minimize their recall of abnormalities .  Self-report should not be used in studies of the adequacy of Pap smear screening , and it should not be relied on to determine who is eligible for screening at 3-year intervals by virtue of three prior normal smears . ( LSM To assess the reliability of information reported by patients with AIDS or HIV infection , 123 homosexual men were recruited in Victoria , Australia , in 1992 - 1993 and interviewed to collect data retrospectively and prospect ively on HIV-related illness and treatment . These data were compared with information in medical and pharmacy records . There was no evidence of bias in the patient report of date of diagnosis of HIV infection or date or result of most recent CD4 count , although there was considerable imprecision . Past and current prescription of AZT were recalled accurately by patients compared with medical records ( kappa = 0.89 and 0.86 , respectively ) , but previous HIV-related illnesses and enrollment in clinical studies or trials were generally recalled poorly ( kappa < 0.4 in some cases ) . Data collected prospect ively on prescription of drugs and use of health care services were reasonably accurately reported by patients . This analysis supports the need for routine assessment of the validity of patient-reported exposure and outcome data in epidemiological studies in order to minimize the possible biases that can result from inaccurate information BACKGROUND Underst and ing older adults ' volume and patterns of health service use is fundamental to efforts to improve the quality and efficiency of services . OBJECTIVE To analyze the accuracy of older adults ' self report of health services use and to determine the proportion of care obtained outside a defined urban academic health care system . RESEARCH DESIGN Telephone survey of self-reports vali date d against data routinely archived in an electronic medical record system . SUBJECTS Stratified r and om sample of 422 patients ( > or = 60 years ) who had contact with the health care system at least once in the previous 3 months . MEASURES Self reports of hospitalizations , emergency room visits , physicians visits , extended care visits , and home care visits over the past 12 months , health status , physical activity , and sociodemographics factors . RESULTS The sample population was more likely to report health services use and functional disability than was a community-based sample of older adults ; 67 % of the sample were women , 53.9 % were African American , 71 % were age 65 and over , 38.7 % lived alone , and 24.6 % reported poor financial re sources . Based on data from the electronic medical record , 27.9 % of the sample were hospitalized at least once in the prior 12 months , 54.6 % had at least one emergency room visit , and the mean number of ambulatory visits was 8.1 . Comparing self-report data to the electronic record data , 24.1 % of older adults with a hospitalization in the prior 12 months failed to report the episode ; 28.1 % of those with an emergency room visit failed to report the episode as did 5.2 % of those with an ambulatory care visit . The accuracy of the self reports of volume of these services were also substantially under reported . We were unable to identify any patient characteristics that were highly correlated with inaccuracy . We estimate that approximately 9.5 % of health care costs are accrued outside this urban health care system . CONCLUSIONS These older adults substantially under-report health services use , including hospital episodes over a 12-month period . Reliance on self-reported use data over the prior year to model patterns of health care use among older adults is not supported by these data OBJECTIVE : To compare medication adherence calculated from four different data sources including a pill count and self-report obtained during a home medication history , as well as calculations based on refill frequency derived from a provincial prescription cl aims data base ( manual and electronic ) . DESIGN : Baseline medication adherence was collected as part of a prospect i ve , r and omized , controlled study . Mean medication adherence results obtained from the four data sources were compared using repeated- measures ANOVA followed by a Tukey 's multiple range test . SETTING : A pharmacy consultation service located at an interdisciplinary wellness center for noninstitutionalized elderly . PATIENTS : 65 years or older , noninstitutionalized , taking one or more prescribed or nonprescribed medications . Clients would either present to the wellness center or be referred by the Provincial Home Care program . RESULTS : When calculated from self-report or manual or electronic prescription cl aims data , mean percent adherence by drug was high and not statistically different ( 95.8 % ± 17.1 % , 107.6 % ± 40.3 % , and 94.6 % ± 24.0 % , respectively ) , whereas the pill count adherence was significantly lower at 74.0 % ± 41.5 % ( p < 0.0001 ) . CONCLUSIONS : An unexpected finding was that the pill count technique used in this study of elderly clients using chronic , repeat medications appeared to underestimate medication adherence . Numerous other limitations of pill count , self-report , and a province-wide prescription cl aims data base in estimating medication adherence are presented . When using medication adherence as a process measure , the research er and practitioner should be aware of the limitations unique to the data source they choose , and interpret data cautiously Purpose s : The purpose s of this study were 1 ) to investigate the feasibility of using providers ’ administrative systems for the assessment of healthcare utilization in economic evaluations performed alongside multicenter studies , 2 ) to assess the convergent validity of patients ’ and providers ’ reports of care , and 3 ) to investigate whether differences between providers ’ and patients ’ reports are related to age , gender , health , recall period , and volumes of care . Methods : Data were obtained as part of a cost-utility analysis alongside a multicenter clinical trial in patients with rectal cancer . For a sample of 179 patients from 49 hospitals , data on hospitalizations , outpatient visits , medications , and care products during the first year after treatment were obtained from the patients by question naire or diary . For all patients , hospitals were contacted for information on hospitalizations and outpatient visits . For a sub sample of 94 patients , 86 pharmacists and 10 suppliers of stoma care products were contacted for information on medications and care products . Results : Response by providers of care was high , ranging from 84 % to 100 % . With respect to hospital days and outpatient visits , we found no significant differences between patients ’ and providers ’ reports . For medications and care products , agreement was lower , with providers reporting up to 2 times more product types and costs than patients . Providers failed to report 20 % to 25 % of all products , whereas patients failed to report 50 % to 60 % of all products . Conclusions : Patients ’ reports seem as valid as providers ’ reports for hospital days and outpatient visits . For medications and care products , we recommend the use of reports from providers of care , whenever feasible , because they much less underestimate volumes and costs than patients BACKGROUND Self-reported data are commonly used to estimate the prevalence of health conditions and the use of preventive health services in the population , but the validity of such data is often question ed . METHODS The Behavioral Risk Factor Survey ( BRFS ) was admin istered by telephone to a stratified , r and om sample of health maintenanc e organization ( HMO ) subscribers in Colorado in 1993 , and self-reports w ere compared with HMO medical records for 599 adults aged > 21 .  Sensitivity and specificity were calculated for three chronic conditions and use of six preventive services . RESULTS Sensitivity was highest for hypertension ( 83 % ) , moderate for diabetes ( 73 % ) , and lowest for hypercholesterolemia ( 59 % ) ; specificity was > 80 % for all three conditions . Sensitivity ranged from 86 % to 99 % for  influenza immunization , clinical breast examination , blood cholesterol screening , mammography , Pap test , and blood pressure screening ; specificity was < 75 % for all preventive services . CONCLUSIONS Self-reports are reasonably accurate for certain chronic conditions and for routine screening exams and can provide a useful estimate for broad measures of population prevalence OBJECTIVE Individuals ' re collection s of the number and type of health service encounters are frequently required for health economic studies . We sought to establish whether the accuracy of self-reported healthcare re source utilization is a function of the duration of the recall period and the saliency of the health service encounter . METHODS  Patient re collection s of a range of community services ( general practitioner visits , community midwifery visits ) and hospital services ( accident and emergency attendances , hospital outpatient attendances , inpatient admissions ) over 4-month and 8-month time periods were obtained from women participating in a r and omized controlled trial . Comparisons were made with healthcare re source utilization data extracted from medical records . Where significant differences were identified between the self-reported and medically recorded data , a multivariate linear regression model was constructed to identify the factors associated with underreporting and overreporting of healthcare re source utilization . RESULTS The study revealed a tendency to underreport community service utilization , which appears to be exacerbated when the recall period is extended . A number of sociodemographic and clinical factors significantly associated with this tendency to underreport community service utilization were identified . The self-reporting of hospital service utilization over varying periods of recall was found to be more accurate . CONCLUSION It is important that economic analysts establish optimal methods for estimating re source utilization quantities within health economic analytical design s. In particular , greater emphasis should be placed on extracting information on community service utilization from medical records or routine health service information systems Health services research has become an important area for evaluating the cost effectiveness of interventions . When used in treatment outcome research , the accuracy of self-report data is essential . The reliability and validity of self-report service utilization among alcohol and drug addicted individuals is question able and largely unexplored . This study assessed the  accuracy  of  self-report utilization of services compared to service record abstract ion in a sample of treatment seeking individuals with alcohol use disorders . The results of the comparative analysis found that the level of agreement for some services , particularly medical , psychiatric and substance abuse inpatient admissions , and social service involvement was good . There was less agreement in emergency room visits and arrests . Factors related to discrepancies between self-report and records were explored
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