RESEARCH - Discordance between self-report of physician diagnosis and administrative database diagnsis of arthritis and its predictors

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Journal of Rheumatology

Sep 2009

Discordance Between Self-report of Physician Diagnosis and

Administrative Database Diagnosis of Arthritis and Its Predictors

From the Rheumatology Section, Medicine Service, Veterans Affairs (VA)

Medical Center, and the Division of Rheumatology, Department of

Medicine, University of Minnesota, Minneapolis, Minnesota, USA.

J.A. Singh, MD, MPH, Rheumatology Section, Medicine Service, VA

Medical Center, and Division of Rheumatology, Department of Medicine,

University of Minnesota.

Abstract

Objective. To study predictors of discordance between self-reported

physician diagnosis and administrative database diagnosis of

arthritis.

Methods. A cohort of all veterans who utilized Veterans Integrated

Service Network (VISN)-13 medical facilities were mailed a

questionnaire that included patient self-report of physician diagnosis

of arthritis and questions regarding demographics, functional

limitation, and SF-36V (a validated version of the Medical Outcomes

Study Short-Form 36). Kappa coefficient was used to assess the extent

of agreement between self-report of physician diagnosis and

administrative database definitions that incorporated International

Classification of Diseases (ICD) codes and use of medications for

arthritis. We identified predictors of overall discordance between

self-report and administrative database diagnosis using multivariable

logistic regression analyses.

Results. Among 70,334 eligible veterans surveyed, 19,749 subjects had

an ICD diagnosis of arthritis in the administrative database in the

year prior to the survey; 34,440 answered the arthritis question and

18,464 self-reported a physician diagnosis of arthritis. Kappa

coefficient showed slight to fair agreement of 0.19–0.32 between

self-report and administrative database definitions of arthritis. We

found significantly higher overall discordance among veterans with

more comorbidities, greater age, worse functional status, lower use of

outpatient and inpatient services, lower education level, and among

single medical-site users.

Conclusion. Low level of agreement between self-report and database

diagnosis of arthritis and its significant association with patient

demographic, clinical, and functional characteristics highlights the

limitation of use of these strategies for identification of patients

with arthritis in epidemiological studies.

http://jrheum.org/content/36/9/2000.abstract

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