Does concordance between data sources vary by medical organization type?
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. We tested whether concordance between patient selfreport and medical record data would vary with medical organization type, controlling for patient demographic characteristics, health status, and domain of medical care.


METHODS
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. We evaluated the concordance between ambulatory medical record and patient survey data. We 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. We recommend continued efforts to improve survey data collection across different patient populations and to improve the quality of clinical data.
Tisnado
Diana M
DM
Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095-1736, USA. dtisnado@mednet.ucla.edu
Adams
John L
JL
Liu
Honghu
H
Damberg
Cheryl L
CL
Hu
Ashlee
A
Chen
Wen-Pin
WP
Kahn
Katherine L
KL
D000328:Adult; D000368:Aged; D002140:California; D003625:Data Collection / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000145:classification* / Q000706:statistics & numerical data; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009922:Oregon; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D012372:ROC Curve; D015203:Reproducibility of Results; D014861:Washington