title: Challenges of self-reported medical conditions and electronic medical records among members of a large military cohort.
abstract: BACKGROUND
  Self-reported medical history data are frequently used in epidemiological studies. Self-reported diagnoses may differ from medical record diagnoses due to poor patient-clinician communication, self-diagnosis in the absence of a satisfactory explanation for symptoms, or the "health literacy" of the patient.
  
  
  METHODS
  The US Department of Defense military health system offers a unique opportunity to evaluate electronic medical records with near complete ascertainment while on active duty. This study compared 38 self-reported medical conditions to electronic medical record data in a large population-based US military cohort. The objective of this study was to better understand challenges and strengths in self-reporting of medical conditions.
  
  
  RESULTS
  Using positive and negative agreement statistics for less-prevalent conditions, near-perfect negative agreement and moderate positive agreement were found for the 38 diagnoses.
  
  
  CONCLUSIONS
  This report highlights the challenges of using self-reported medical data and electronic medical records data, but illustrates that agreement between the two data sources increases with increased surveillance period of medical records. Self-reported medical data may be sufficient for ruling out history of a particular condition whereas prevalence studies may be best served by using an objective measure of medical conditions found in electronic healthcare records. Defining medical conditions from multiple sources in large, long-term prospective cohorts will reinforce the value of the study, particularly during the initial years when prevalence for many conditions may still be low.
authors.affiliation: Department of Defense Center for Deployment Health Research at the Naval Health Research Center, USA. besa.smith@med.navy.mil
authors.forename: Besa
authors.initials: B
authors.lastname: Smith
authors.forename: Laura K
authors.initials: LK
authors.lastname: Chu
authors.forename: Tyler C
authors.initials: TC
authors.lastname: Smith
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Amoroso
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Tomoko I
authors.initials: TI
authors.lastname: Hooper
authors.forename: Gary D
authors.initials: GD
authors.lastname: Gackstetter
authors.forename: Margaret A K
authors.initials: MA
authors.lastname: Ryan
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006302:Health Services Research / Q000379:methods; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008889:Military Personnel / Q000706:statistics & numerical data*; D015995:Prevalence; D012650:Self Disclosure; D011795:Surveys and Questionnaires; D014481:United States