Mammography use among Black women: the role of electronic medical records.
OBJECTIVE
Accurately documenting mammography use is essential to assess quality of care for early breast cancer detection in underserved populations. Self-reports and medical record reports frequently result in different accounts of whether a mammogram was performed. We hypothesize that electronic medical records (EMRs) provide more accurate documentation of mammography use than paper records, as evidenced by the level of agreement between women's self-reported mammography use and mammography use documented in medical records.


METHODS
Black women aged 40-75 were surveyed in six primary care sites in Boston, Massachusetts (n = 411). Survey data assessed self-reported mammography prevalence within 2 years of study entry. Corresponding medical record data were collected at each site. Positive predictive value (PPV) of self-report and kappa statistics compared data agreement among sites with and without EMRs. Logistic regression estimated effects of site and patient characteristics on agreement between data sources.


RESULTS
Medical records estimated a lower prevalence of mammography use (58%) than self-report (76%). However, self-report and medical record estimates were more similar in sites with EMRs. PPV of self-report was 88% in sites with continuous access to EMRs and 61% at sites without EMRs. Kappa statistics indicated greater data agreement at sites with EMRs (0.72, 95% CI 0.56-0.88) than without EMRs (0.46, 95% CI 0.29-0.64). Adjusted for covariates, odds of data agreement were greatest in sites where EMRs were available during the entire study period (OR 4.31, 95% CI 1.67-11.13).


CONCLUSIONS
Primary care sites with EMRs better document mammography use than those with paper records. Patient self-report of mammography screening is more accurate at sites with EMRs. Broader access to EMRs should be implemented to improve quality of documenting mammography use. At a minimum, quality improvement efforts should confirm the accuracy of paper records with supplemental data.
Clark
Cheryl R
CR
Center for Community Health and Health Equity, Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA. crclark@partners.org
Baril
Nashira
N
Kunicki
Marycarmen
M
Johnson
Natacha
N
Soukup
Jane
J
Lipsitz
Stuart
S
Bigby
JudyAnn
J
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000208:ethnology*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008404:Massachusetts / Q000453:epidemiology; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010349:Patient Compliance / Q000208:ethnology*; D012044:Regression Analysis; D012650:Self Disclosure; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D016387:Women's Health / Q000208:ethnology