title: Estimating chlamydia screening coverage: a comparison of self-report and health care effectiveness data and information set measures.
abstract: BACKGROUND
  Population-based surveys (self-report) and health insurance administrative data (Healthcare Effectiveness Data and Information Set [HEDIS]) are used to estimate chlamydia screening coverage in the United States. Estimates from these methods differ, but few studies have compared these 2 indices in the same population.
  
  
  METHODS
  In 2010, we surveyed a random sample of women aged 18 to 25 years enrolled in a Washington State-managed care organization. Respondents were asked if they were sexually active in last year and if they tested for chlamydia in that time. We linked survey responses to administrative records of chlamydia testing and reproductive/testing services used, which comprise the HEDIS definition of the screened population and the sexually active population, respectively. We compared self-report and HEDIS using 3 outcomes: (1) sexual activity (gold standard = self-report), (2) any chlamydia screening (no gold standard), and (3) within-plan chlamydia screening (gold standard = HEDIS).
  
  
  RESULTS
  Of 954 eligible respondents, 377 (40%) completed the survey and consented to administrative record linkage. Chlamydia screening estimates for HEDIS and self-report were 47% and 53%, respectively. The sensitivity and specificity of HEDIS to define sexually active women were 84.8% (95% confidence interval [CI], 79.6%-89.1%) and 63.5% (95% CI, 52.4%-73.7%), respectively. Forty percent of women had a chlamydia test in their administrative record, but 53% self-reported being tested for chlamydia (κ = 0.35); 19% reported out-of-plan chlamydia testing. The sensitivity of self-reported within-plan chlamydia testing was 71.3% (95% CI, 61.0%-80.1%); the specificity was 80.6% (95% CI, 72.6%-87.2%).
  
  
  CONCLUSIONS
  The Healthcare Effectiveness Data and Information Set does not accurately identify sexually active women and may underestimate chlamydia testing coverage. Self-reported testing may not be an accurate measure of true chlamydial testing coverage.
authors.affiliation: From the *Department of Epidemiology, University of Washington, Seattle, WA; †Group Health Research Institute, Seattle, WA; ‡Departments of Global Health and §Medicine, University of Washington, Seattle, WA; and ¶Public Health-Seattle and King County HIV/STD Program, Seattle, WA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Khosropour
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Broad
authors.forename: Delia
authors.initials: D
authors.lastname: Scholes
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Saint-Johnson
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Manhart
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Golden
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008403:Mass Screening; D008962:Models, Theoretical; D015203:Reproducibility of Results; D034121:Reproductive Health Services; D057566:Self Report; D018571:Sentinel Surveillance; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014861:Washington / Q000453:epidemiology