title: Agreement of Ocular Symptom Reporting Between Patient-Reported Outcomes and Medical Records.
abstract: OBJECTIVE
  Accurate documentation of patient symptoms in the electronic medical record (EMR) is important for high-quality patient care.
  
  
  OBJECTIVE
  To explore inconsistencies between patient self-report on an Eye Symptom Questionnaire (ESQ) and documentation in the EMR.
  
  
  METHODS
  This investigation was an observational study in comprehensive ophthalmology and cornea clinics at an academic institution among a convenience sample of 192 consecutive eligible patients, of whom 30 declined participation. Patients were recruited at the Kellogg Eye Center from October 1, 2015, to January 31, 2016. Patients were eligible to be included in the study if they were 18 years or older.
  
  
  METHODS
  Concordance of symptoms reported on an ESQ with data recorded in the EMR. Agreement of symptom report was analyzed using κ statistics and McNemar tests. Disagreement was defined as a negative symptom report or no mention of a symptom in the EMR for patients who reported moderate to severe symptoms on the ESQ. Logistic regression was used to investigate if patient factors, physician characteristics, or diagnoses were associated with the probability of disagreement for symptoms of blurry vision, pain or discomfort, and redness.
  
  
  RESULTS
  A total of 162 patients (324 eyes) were included. The mean (SD) age of participants was 56.6 (19.4) years, 62.3% (101 of 162) were female, and 84.9% (135 of 159) were white. At the participant level, 33.8% (54 of 160) had discordant reporting of blurry vision between the ESQ and EMR. Likewise, documentation was discordant for reporting glare (48.1% [78 of 162]), pain or discomfort (26.5% [43 of 162]), and redness (24.7% [40 of 162]), with poor to fair agreement (κ range, -0.02 to 0.42). Discordance of symptom reporting was more frequently characterized by positive reporting on the ESQ and lack of documentation in the EMR (Holm-adjusted McNemar P < .03 for 7 of 8 symptoms except for blurry vision [P = .59]). Return visits at which the patient reported blurry vision on the ESQ had increased odds of not reporting the symptom in the EMR compared with new visits (odds ratio, 5.25; 95% CI, 1.69-16.30; Holm-adjusted P = .045).
  
  
  CONCLUSIONS
  Symptom reporting was inconsistent between patient self-report on an ESQ and documentation in the EMR, with symptoms more frequently recorded on a questionnaire. These results suggest that documentation of symptoms based on EMR data may not provide a comprehensive resource for clinical practice or "big data" research.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor2currently a medical student at the University of Michigan Medical School, Ann Arbor.
authors.forename: Nita G
authors.initials: NG
authors.lastname: Valikodath
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
authors.forename: Paula Anne
authors.initials: PA
authors.lastname: Newman-Casey
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor4Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
authors.forename: David C
authors.initials: DC
authors.lastname: Musch
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor.
authors.forename: Leslie M
authors.initials: LM
authors.lastname: Niziol
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Woodward
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records; D005128:Eye Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D011785:Quality Assurance, Health Care; D012372:ROC Curve; D012650:Self Disclosure; D057566:Self Report; D011795:Surveys and Questionnaires; D014785:Vision, Ocular / Q000502:physiology*; D055815:Young Adult