title: Reliability of abstracting performance measures: results of the cardiac rehabilitation referral and reliability (CR3) project.
abstract: BACKGROUND
  Assessment of the reliability of performance measure (PM) abstraction is an important step in PM validation. Reliability has not been previously assessed for abstracting PMs for the referral of patients to cardiac rehabilitation (CR) and secondary prevention (SP) programs. To help validate these PMs, we carried out a multicenter assessment of their reliability.
  
  
  METHODS
  Hospitals and clinical practices from around the United States were invited to participate in the Cardiac Rehabilitation Referral Reliability (CR3) Project. Twenty-nine hospitals and 23 outpatient centers expressed interest in participating. Seven hospitals and 6 outpatient centers met participation criteria and submitted completed data. Site coordinators identified 35 patients whose charts were reviewed by 2 site abstractors twice, 1 week apart. Percent agreement and the Cohen κ statistic were used to describe intra- and interabstractor reliability for patient eligibility for CR/SP, patient exceptions for CR/SP referral, and documented referral to CR/SP.
  
  
  RESULTS
  Results were obtained from within-site data, as well as from pooled data of all inpatient and all outpatient sites. We found that intra-abstractor reliability reflected excellent repeatability (≥ 90% agreement; κ ≥ 0.75) for ratings of CR/SP eligibility, exceptions, and referral, both from pooled and site-specific analyses of inpatient and outpatient data. Similarly, the interabstractor agreement from pooled analysis ranged from good to excellent for the 3 items, although with slightly lower measures of reliability.
  
  
  CONCLUSIONS
  Abstraction of PMs for CR/SP referral has high reliability, supporting the use of these PMs in quality improvement initiatives aimed at increasing CR/SP delivery to patients with cardiovascular disease.
authors.affiliation: Cardiovascular Health Clinic, Mayo Clinic and Foundation, Rochester, Minnesota (Drs Thomas and Pack and Mr Lahr); American College of Cardiology Foundation (Mr Chiu and Ms Shahriary) and American Heart Association (Mr Chiu), Washington, District of Columbia; Colorado School of Public Health, Aurora (Dr Goff); Helen Hayes Hospital, West Haverstraw, New York (Drs King and Lichtman); GRQ, LLC, Vienna, Virginia (Ms Lui); and Columbia University, New York, New York (Dr King).
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Thomas
authors.forename: Jensen S
authors.initials: JS
authors.lastname: Chiu
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: Marjorie
authors.initials: M
authors.lastname: King
authors.forename: Brian
authors.initials: B
authors.lastname: Lahr
authors.forename: Steven W
authors.initials: SW
authors.lastname: Lichtman
authors.forename: Karen
authors.initials: K
authors.lastname: Lui
authors.forename: Quinn R
authors.initials: QR
authors.lastname: Pack
authors.forename: Melanie
authors.initials: M
authors.lastname: Shahriary
mesh_terms: D000043:Abstracting and Indexing; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072038:Cardiac Rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012017:Referral and Consultation; D015203:Reproducibility of Results; D014481:United States; D055815:Young Adult