Self-report versus electronic medical record recorded healthcare utilisation in older community-dwelling adults: Comparison of two prospective cohort studies

Abstract

Introduction: Self-reported measures of healthcare utilisation are often used in longitudinal cohort studies involving older community-dwelling people. The aim of this study is to compare healthcare utilisation rates using patient self-report and manual extraction from the general practice (GP) electronic medical record (EMR).

Methods: Study population: Two prospective cohort studies (n = 806 and n = 1,377, aged ≥70 years) conducted in the Republic of Ireland were compared. Study outcomes: GP, outpatient department (OPD) and emergency department (ED) visits over a one-year period. Statistical analysis: Descriptive statistics of the two cohorts are presented. A negative binomial regression was performed and results are presented as incidence rate ratios (IRR) with 95% confidence intervals (CI). For the outcome of any ED visit, linear regression was performed, yielding risk ratios (RR) with 95% CI.

Results: The annual rates of GP, OPD and ED visits were 6.30 (SD 4.63), 2.11 (SD 2.46) and 0.26 (SD 0.62) respectively in GP EMR cohort, compared to 5.65 (SD 8.06), 2.09 (SD 5.83) and 0.32 (SD 0.84) in the self-report cohort. In univariate regression analysis comparing healthcare utilisation, the self-report cohort reported a lower frequency of GP visits (unadjusted IRR 0.90 (95% CI 0.84, 0.96), p = 0.02)), a greater frequency of ED visits (1.20 (0.98, 1.49), p = 0.083)), and no difference in OPD visits (unadjusted IRR 0.99 (95% CI 0.86, 1.13), p = 0.845)). In multivariate analysis, adjusted for relevant confounders, there was no difference in GP visits (adjusted IRR 0.99 (95% CI 0.92, 1.06), p = 0.684)) or OPD visits (adjusted IRR 1.09 (0.95, 1.25), p = 0.23)) between the two cohorts. However, the self-report cohort reported 37% more ED visits (adjusted IRR 1.37 (1.10, 1.71), p = 0.005)) and were more likely to report any ED visit (adjusted RR 1.23 (95% CI 1.02, 1.48), p = 0.028)).

Conclusions: This study demonstrates that reported rates of GP and OPD visits were similar but there were differences in reported ED visits, with significantly higher self-reported visits. This may be due to ED visits not being notified to the GP and contextual issues such as transfer of healthcare utilisation data between sectors may vary in different healthcare systems.

Fig 1

Flow of participants through the CPCR cohort A (GP electronic medical record (EMR) review, 2010–2012) and TILDA cohort B (self-reported healthcare utilisation, 2009–2012).