Patient Perception Versus Medical Record Entry of Health-Related Conditions Among Patients With Heart Failure

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• 作者：Adnan S. Malik MD^a ; Grigorios Giamouzis MD ; PhD^b ; Vasiliki V. Georgiopoulou MD^a ; Lucy V. Fike MPH^a ; Andreas P. Kalogeropoulos MD^a ; Catherine R. Norton MD^a ; Dan Sorescu MD^a ; Sidra Azim MD^a ; Sonjoy R. Laskar MD^a ; Andrew L. Smith MD^a ; Sandra B. Dunbar RN ; DSN^c ; Javed Butler MD ; MPH^a ; ^{javed.butler@emory.edu}
• 刊名：The American Journal of Cardiology
• 出版年：2011
• 出版时间：15 February 2011
• 年：2011
• 卷：107
• 期：4
• 页码：569-572
• 全文大小：256 K

文摘

A shared understanding of medical conditions between patients and their health care providers may improve self-care and outcomes. In this study, the concordance between responses to a medical history self-report (MHSR) form and the corresponding provider documentation in electronic health records (EHRs) of 19 select co-morbidities and habits in 230 patients with heart failure were evaluated. Overall concordance was assessed using the κ statistic, and crude, positive, and negative agreement were determined for each condition. Concordance between MHSR and EHR varied widely for cardiovascular conditions (κ = 0.37 to 0.96), noncardiovascular conditions (κ = 0.06 to 1.00), and habits (κ = 0.26 to 0.69). Less than 80 % crude agreement was seen for history of arrhythmias (72 % ), dyslipidemia (74 % ), and hypertension (79 % ) among cardiovascular conditions and lung disease (70 % ) and peripheral arterial disease (78 % ) for noncardiovascular conditions. Perfect agreement was observed for only 1 of the 19 conditions (human immunodeficiency virus status). Negative agreement >80 % was more frequent than >80 % positive agreement for a condition (15 of 19 [79 % ] vs 8 of 19 [42 % ], respectively, p = 0.02). Only 20 % of patients had concordant MSHRs and EHRs for all 7 cardiovascular conditions; in 40 % of patients, concordance was observed for ≤5 conditions. For noncardiovascular conditions, only 28 % of MSHR-EHR pairs agreed for all 9 conditions; 37 % agreed for ≤7 conditions. Cumulatively, 39 % of the pairs matched for ≤15 of 19 conditions. In conclusion, there is significant variation in the perceptions of patients with heart failure compared to providers' records of co-morbidities and habits. The root causes of this variation and its impact on outcomes need further study.