title: How Reliable are Patient-Reported Rehospitalizations? Implications for the Design of Future Practical Clinical Studies.
abstract: BACKGROUND
  Longitudinal clinical investigations often rely on patient reports to screen for postdischarge adverse outcomes events, yet few studies have examined the accuracy of such patient reports.
  
  
  RESULTS
  Patients with acute myocardial infarction (MI) in the TRANSLATE-ACS study were asked during structured interviews at 6 weeks, 6 months, and 12 months postdischarge to report any rehospitalizations. The accuracy of patient-reported rehospitalizations within 1 year of postdischarge was determined using claims-based medical bill validation as the reference standard. The cumulative incidence of rehospitalizations was compared when identified by patient report versus medical bills. Patients were categorized by the accuracy in reporting events (accurate, under-, or over- reporters) and characteristics were compared between groups. Among 10 643 MI patients, 4565 (43%) reported 7734 rehospitalizations. The sensitivity and positive predictive value of patient-reported rehospitalizations were low at 67% and 59%, respectively. A higher cumulative incidence of rehospitalization was observed when identified by patient report versus medical bills (43% vs 37%; P<0.001). Overall, 18% of patients over-reported and 10% under-reported the number of hospitalizations. Compared with accurate reporters, under-reporters were more likely to be older, female, African American, unemployed, or a non-high-school graduate, and had greater prevalence of clinical comorbidities such as diabetes and past cardiovascular disease.
  
  
  CONCLUSIONS
  The accuracy of patient-reported rehospitalizations was low with patients both under- and over-reporting events. Longitudinal clinical research studies need additional mechanisms beyond patient report to accurately identify rehospitalization events.
  
  
  BACKGROUND
  URL: https://clinicaltrials.gov. Unique identifier: NCT01088503.
authors.affiliation: Duke Clinical Research Institute, Durham, NC (A.K., E.D.P., D.K., K.J.A., L.D.R., D.B.M., T.Y.W.).
authors.forename: Arun
authors.initials: A
authors.lastname: Krishnamoorthy
authors.affiliation: Duke Clinical Research Institute, Durham, NC (A.K., E.D.P., D.K., K.J.A., L.D.R., D.B.M., T.Y.W.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke Clinical Research Institute, Durham, NC (A.K., E.D.P., D.K., K.J.A., L.D.R., D.B.M., T.Y.W.).
authors.forename: J David
authors.initials: JD
authors.lastname: Knight
authors.affiliation: Duke Clinical Research Institute, Durham, NC (A.K., E.D.P., D.K., K.J.A., L.D.R., D.B.M., T.Y.W.).
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: Eli Lilly & Company, Indianapolis, IN (M.B.E., M.E.Z., P.L.M.C.).
authors.forename: Mark B
authors.initials: MB
authors.lastname: Effron
authors.affiliation: Eli Lilly & Company, Indianapolis, IN (M.B.E., M.E.Z., P.L.M.C.).
authors.forename: Marjorie E
authors.initials: ME
authors.lastname: Zettler
authors.affiliation: Duke Clinical Research Institute, Durham, NC (A.K., E.D.P., D.K., K.J.A., L.D.R., D.B.M., T.Y.W.).
authors.forename: Linda
authors.initials: L
authors.lastname: Davidson-Ray
authors.affiliation: Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.).
authors.forename: Brian A
authors.initials: BA
authors.lastname: Baker
authors.affiliation: Eli Lilly & Company, Indianapolis, IN (M.B.E., M.E.Z., P.L.M.C.).
authors.forename: Patrick L
authors.initials: PL
authors.lastname: McCollam
authors.affiliation: Duke Clinical Research Institute, Durham, NC (A.K., E.D.P., D.K., K.J.A., L.D.R., D.B.M., T.Y.W.).
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.affiliation: Duke Clinical Research Institute, Durham, NC (A.K., E.D.P., D.K., K.J.A., L.D.R., D.B.M., T.Y.W.).
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
mesh_terms: D000368:Aged; D005260:Female; D017048:Health Care Costs; D017722:Hospital Charges; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D010359:Patient Readmission; D015203:Reproducibility of Results; D012107:Research Design; D012307:Risk Factors; D057566:Self Report; D013997:Time Factors; D014481:United States
keywords: myocardial infarction; patient outcome assessment; validation studies
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