Journal List > J Rheum Dis > v.23(6) > 1064290

Ahn, Cho, Kim, Choi, Lee, Bae, and Sung: Agreement of Major Diagnosis and Comorbidity between Self-reported Questionnaire and Medical Record Review in Patients with Rheumatic Disease

Abstract

Objective

Self-report questionnaires are frequently used to obtain information in epidemiological research. However, information reported by patients are sometimes inconsistent with medical records. This study compared self-reported major rheumatologic diagnoses and comorbid conditions with those from a medical record review.

Methods

A cross-sectional survey was conducted at two tertiary academic hospitals. All patients who visited the rheumatology department from September 2, 2009 to September 13, 2009 were enrolled in this survey. Structured patient questionnaires and medical record reviews were performed in each hospital. We evaluated agreement with kappa statistics (κ) between these two data sources for major rheumatologic diagnosis and Charlson Comorbidity Index (CCI) score. Multiple logistic regression models were used to investigate factors associated with disagreement.

Results

A total of 369 patients were interviewed at clinic exit. Of them, 302 patients (81.8%) were female, and the average age was 52.1 years. The agreement for major rheumatologic diagnosis between the questionnaire and patient chart was good (κ=0.763). The agreement rate for all rheumatic diseases was 81.8%; rheumatoid arthritis with 94.9%, systemic lupus erythematosus with 96.3%, and ankylosing spondylopathy with 100%. Higher educational level and longer attendance at our clinic were associated with agreement between major rheumatologic diagnoses. The agreement rate for CCI score between the data sources was 76.1%.

Conclusion

In patients with rheumatologic diseases, the agreement for major diagnoses between self-reports and the medical record review was good, although it varied with the specific disease and patient characteristics. Comparing major rheumatologic diagnoses, the agreement rate for CCI was low.

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Figure 1.
Comparison of frequency of comorbid conditions between self-reports and medical records. DM: diabetes mellitus, PABAK: prevalence-adjusted and bias-adjusted kappa.
jrd-23-348f1.tif
Table 1.
Demographic and clinical characteristics of enrolled patients (n=369)
Characteristic Data
Age (yr) 52.1±14.9
Female 302 (81.8)
Follow-up duration (mo) 54.5±65.0
Residence area  
 Urban 292 (79.2)
 Rural 75 (20.3)
 Not replied 2 (0.5)
Education level  
 Less than high school 105 (28.5)
 High school 127 (34.4)
 University 131 (35.5)
 Not replied 6 (1.6)
Income (US dollar/mo)  
 ≤2,000 132 (35.8)
 2,001∼4,000 116 (31.4)
 >4,000 104 (28.2)
 Not replied 17 (4.6)
Major diagnosis based on medical records  
 Osteoarthritis 84 (22.8)
 Rheumatoid arthritis 136 (36.9)
 Systemic lupus erythematosus 54 (14.6)
 Ankylosing spondylitis 12 (3.3)
 Gout 13 (3.5)
 Behçet's disease 15 (4.1)
 Myositis 3 (0.8)
 Adult-onset still's disease 2 (0.5)
 Scleroderma 7 (1.9)
 Fibromyalgia 12 (3.3)
 Osteoporosis 1 (0.3)
 Sjögren's syndrome 2 (0.5)
 Vasculitis 4 (1.1)
 Psoriatic arthritis 2 (0.5)
 Raynaud disease 1 (0.3)
 Mixed connective tissue disease 3 (0.8)
 Others 18 (4.9)
 Charlson comorbidity index 0.35±0.81 (0∼6)

Values are presented as mean±standard deviation (range) or number (%).

Table 2.
Agreement of major rheumatologic diagnosis between self-reports and medical records
Diagnosis Major diagnosis based on medical record
OA RA SLE AS Gout Behçet's disease Myositis AOSD Systemic sclerosis FMS Osteoporosis Sjögren's syndrome Vasculitis PsA Raynaud syndrome MCTD Others Total
Major diagnosis based on self-report
 OA 58 4 0 0 0 1 0 0 0 5 1 0 0 0 0 0 4 73
 RA 23 129 1 0 2 1 0 0 1 2 0 1 0 0 0 0 4 164
 SLE 0 0 52 0 0 0 0 0 1 0 0 0 1 0 0 1 1 56
 AS 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 1 13
 Gout 0 1 0 0 11 1 0 0 0 0 0 0 0 0 0 0 0 13
 Behçet's disease 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 12
 Myositis 2 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 1 6
 AOSD 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 2
 Systemic sclerosis 0 0 1 0 0 0 0 0 5 0 0 0 0 0 0 0 0 6
 FMS 0 1 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 5
 Osteoporosis 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 2
 Sjögren's syndrome 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1
 Vasculitis 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 1 4
 PsA 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 2
 Raynaud syndrome 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 2
 MCTD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1
 Others 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 7
 Total 84 136 54 12 13 15 3 2 7 12 1 2 4 2 1 3 18 369
 Concordance rate (%) 69.0 94.9 96.3 100 84.6 80.0 100 100 71.4 33.3 0 50.0 75.0 100 100 33.3 50.0 81.8

Values are presented as number. OA: osteoarthritis, RA: rheumatoid arthritis, SLE: systemic lupus erythematosus, AS: ankylosing spondylitis, AOSD: adult-onset still's disease, FMS: fibromyalgia, PsA: psoriatic arthritis, MCTD: mixed connective tissue disorder.

Table 3.
Factors influencing disagreement of major rheumatologic diagnosis or CCI
Variable Adjusted OR (95% CI)
Disagreement of major rheumatologic diagnosis Disagreement of CCI
Age 1.00 (0.98∼1.02) 1.01 (0.99∼1.03)
Female 0.66 (0.33∼1.34) 2.39 (0.96∼5.94)
Income (million won/mo)    
 >400 1 1
 201∼400 1.21 (0.59∼2.51) 0.60 (0.25∼1.43)
 ≤200 0.63 (0.30∼1.34) 1.36 (0.64∼2.86)
Education    
 Graduated university/college 1 1
 Graduated high school 2.72 (1.14∼6.50) 0.87 (0.34∼2.22)
 Did not graduate high school 3.68 (1.78∼7.64) 1.38 (0.66∼2.87)
Follow-up duration 0.89 (0.83∼0.96) 1.02 (0.97∼1.08)
Residence area    
 Urban 1 1
 Rural 0.71 (0.40∼1.26) 1.18 (0.64∼2.17)
Patient reported number of comorbidities    
 0 1 1
 1 0.83 (0.37∼1.85) 11.77 (5.77∼23.99)
 ≥2 2.99 (1.01∼8.89) 60.64 (12.62∼291.48)

CCI: Charlson Comorbidity Index, OR: odds ratio, CI: confidence interval.

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