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Comparative Study
. 2011 Feb 15;107(4):569-72.
doi: 10.1016/j.amjcard.2010.10.017. Epub 2010 Dec 22.

Patient perception versus medical record entry of health-related conditions among patients with heart failure

Adnan S Malik  1 , Grigorios Giamouzis, Vasiliki V Georgiopoulou, Lucy V Fike, Andreas P Kalogeropoulos, Catherine R Norton, Dan Sorescu, Sidra Azim, Sonjoy R Laskar, Andrew L Smith, Sandra B Dunbar, Javed Butler
Affiliations
Comparative Study

Patient perception versus medical record entry of health-related conditions among patients with heart failure

Adnan S Malik et al. Am J Cardiol. .

Abstract

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.

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Figures

Figure 1
Figure 1
Summary measures of patient versus EHR concordance for co-morbidities. Suboptimal proportional concordance was noted for cardiovascular and noncardiovascular co-morbidities and for the behavioral habits assessed.
See this image and copyright information in PMC

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