title: Measuring Preventive Care Delivery: Comparing Rates Across Three Data Sources.
abstract: Preventive care delivery is an important quality outcome, and electronic data reports are being used increasingly to track these services. It is highly informative when electronic data sources are compared to information manually extracted from medical charts to assess validity and completeness.
  
  
  
  This cross-sectional study used a random sample of Medicaid-insured patients seen at 43 community health centers in 2011 to calculate standard measures of correspondence between manual chart review and two automated sources (electronic health records [EHRs] and Medicaid claims), comparing documentation of orders for and receipt of ten preventive services (n=150 patients/service). Data were analyzed in 2015.
  
  
  
  Using manual chart review as the gold standard, automated EHR extraction showed near-perfect to perfect agreement (κ=0.96-1.0) for services received within the primary care setting (e.g., BMI, blood pressure). Receipt of breast and colorectal cancer screenings, services commonly referred out, showed moderate (κ=0.42) to substantial (κ=0.62) agreement, respectively. Automated EHR extraction showed near-perfect agreement (κ=0.83-0.97) for documentation of ordered services. Medicaid claims showed near-perfect agreement (κ=0.87) for hyperlipidemia and diabetes screening, and substantial agreement (κ=0.67-0.80) for receipt of breast, cervical, and colorectal cancer screenings, and influenza vaccination. Claims showed moderate agreement (κ=0.59) for chlamydia screening receipt. Medicaid claims did not capture ordered or unbilled services.
  
  
  
  Findings suggest that automated EHR and claims data provide valid sources for measuring receipt of most preventive services; however, ordered and unbilled services were primarily captured via EHR data and completed referrals were more often documented in claims data.
authors: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon. Electronic address: bailstef@ohsu.edu.
authors: Steffani R
authors: SR
authors: Bailey
authors: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
authors: John D
authors: JD
authors: Heintzman
authors: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health & Science University, Portland, Oregon.
authors: Miguel
authors: M
authors: Marino
authors: OCHIN, Inc., Portland, Oregon.
authors: Megan J
authors: MJ
authors: Hoopes
authors: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon.
authors: Brigit A
authors: BA
authors: Hatch
authors: OCHIN, Inc., Portland, Oregon; Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
authors: Rachel
authors: R
authors: Gold
authors: OCHIN, Inc., Portland, Oregon.
authors: Stuart C
authors: SC
authors: Cowburn
authors: OCHIN, Inc., Portland, Oregon.
authors: Christine A
authors: CA
authors: Nelson
authors: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
authors: Heather E
authors: HE
authors: Angier
authors: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon.
authors: Jennifer E
authors: JE
authors: DeVoe
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D001330:Electronic Data Processing; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D011315:Preventive Medicine / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult