title: Population Colorectal Cancer Screening Estimates: Comparing Self-Report to Electronic Health Record Data in California.
abstract: INTRODUCTION: Population-based surveys are used to assess colorectal cancer (CRC) screening rates, but may be subject to self-report biases. Clinical data from electronic health records (EHR) are another data source for assessing screening rates and self-report bias; however, use of EHR data for population research is relatively new. We sought to compare CRC screening rates from a self-report survey, the 2007 California Health Interview Survey (CHIS), to EHR data from Palo Alto Medical Foundation (PAMF), a multi-specialty healthcare organization serving three counties in California.  METHODS: Ever- and up-to-date CRC screening rates were compared between CHIS respondents (N=18,748) and PAMF patients (N=26,283). Both samples were limited to English proficient subjects aged 51-75 with health insurance and a physician visit in the past two years. PAMF rates were age-sex standardized to the CHIS population. Analyses were stratified by racial/ethnic group.  RESULTS: EHR data included PAMF internally completed tests (84%), and patient-reported externally completed tests which were either confirmed (7%) or unconfirmed (9%) by a physician. When excluding unconfirmed tests, PAMF screening rates were 6-14 percentage points lower than CHIS rates, for both ever- and up-to-date CRC screening among Non-Hispanic White, Black, Hispanic/Latino, Chinese, Filipino and Japanese subjects. When including unconfirmed tests, differences in screening rates between the two data sets were minimal.  CONCLUSION: Comparability of CRC screening rates from survey data and clinic-based EHR data depends on whether or not unconfirmed patient-reported tests in EHR are included. This indicates a need for validated methods of calculating CRC screening rates in EHR data.
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA.
authors.forename: Latha P
authors.initials: LP
authors.lastname: Palaniappan
authors.forename: Annette E
authors.initials: AE
authors.lastname: Maxwell
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Crespi
authors.forename: Eric C
authors.initials: EC
authors.lastname: Wong
authors.forename: Jessica
authors.initials: J
authors.lastname: Shin
authors.forename: Elsie J
authors.initials: EJ
authors.lastname: Wang