Health service utilization in IBD: comparison of self-report and administrative data

Teresa Longobardi, John R Walker, Lesley A Graff, Charles N Bernstein, Teresa Longobardi, John R Walker, Lesley A Graff, Charles N Bernstein

Abstract

Background: The reliability of self-report regarding health care utilization in inflammatory bowel disease (IBD) is unknown. If proven reliable, it could help justify self-report as a means of determining health care utilization and associated costs.

Methods: The Manitoba IBD Cohort Study is a population-based longitudinal study of participants diagnosed within 7 years of enrollment. Health care utilization was assessed through standardized interview. Participants (n = 352) reported the total number of nights hospitalized, frequency of physician contacts in the prior 12 months and whether the medical contacts were for IBD-related reasons or not. Reports of recent antibiotic use were also recorded. Actual utilization was drawn from the administrative database of Manitoba Health, the single comprehensive provincial health insurer.

Results: According to the administrative data, 15% of respondents had an overnight hospitalization, while 10% had an IBD-related hospitalization. Self-report concordance was highly sensitive (92%; 82%) and specific (96%; 97%, respectively). 97% of participants had contact with a physician in the previous year, and 69% had IBD-related visits. Physician visits were significantly under-reported and there was a trend to over-report the number of nights in hospital.

Conclusions: Self-report data can be helpful in evaluating health service utilization, provided that the researcher is aware of the systematic sources of bias. Outpatient visits are well identified by self-report. The discordance for the type of outpatient visit may be either a weakness of self-report or a flaw in diagnosis coding of the administrative data. If administrative data are not available, self-report information may be a cost-effective alternative, particularly for hospitalizations.

References

    1. Crohn's and Colitis Foundation of Canada. The Burden of IBD in Canada. Toronto: The Foundation; 2008. Available at: Accessed June 14, 2009.
    1. Kappelman MD, Rifas-Shiman SL, Leinman K, Kappelman MD, Rifas-Shiman SL, Kleinman K, Ollendorf D, Bousvaros A, Grand RJ, Finkelstein JA. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol. 2007;5:1424–9. doi: 10.1016/j.cgh.2007.07.012.
    1. Hendriksen C, Kreiner S, Binder V. Long term prognosis in ulcerative colitis - based on results from a regional patient group from the county of Copenhagen. Gut. 1985;26:158–63. doi: 10.1136/gut.26.2.158.
    1. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn's disease. Br J Surg. 2000;87:1697–701. doi: 10.1046/j.1365-2168.2000.01589.x.
    1. Longobardi T, Bernstein CN. Health care resource utilization in inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006;4:731–43. doi: 10.1016/j.cgh.2006.02.013.
    1. Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev. 2006;63:217–35. doi: 10.1177/1077558705285298.
    1. Evans C, Crawford B. Patient self-reports in pharmacoeconomic studies. Their use and impact on study validity. Pharmacoeconomics. 1999;15:241–56. doi: 10.2165/00019053-199915030-00004.
    1. Wolinsky FD, Miller TR, An H, Geweke JF, Wallace RB, Wright KB, Chrischilles EA, Liu L, Pavlik CB, Cook EA, Ohsfeldt RL, Richardson KK, Rosenthal GE. Hospital episodes and physician visits: the concordance between self-reports and medicare claims. Med Care. 2007;45:300–7. doi: 10.1097/01.mlr.0000254576.26353.09.
    1. Information on Manitoba available at: Accessed June 10, 2009.
    1. Accessed March 22, 2011.
    1. Roos LL, Mustard CA, Nicol JP. Registries and administrative data: organization and accuracy. Med Care. 1993;31:201–12. doi: 10.1097/00005650-199303000-00002.
    1. Roos LL, Gupta S, Soodeen RA, Jebamani L. Data quality in an information-rich environment: Canada as an example. Can J Aging. 2005;24(Suppl 1):153–70.
    1. Kozyrskyj AL, Mustard CA. Validation of an electronic, population-based prescription database. Ann Pharmacother. 1998;32:1152–7. doi: 10.1345/aph.18117.
    1. Roos LL, Nicol JP. A research registry: uses, development, and accuracy. J Clin Epidemiol. 1999;52:39–47. doi: 10.1016/S0895-4356(98)00126-7.
    1. Bernstein CN, Blanchard JF, Rawsthorne P, Wajda A. Epidemiology of Crohn's Disease and Ulcerative Colitis in a central Canadian province: A population-based study. Am J Epidemiol. 1999;149(10):916–24.
    1. Graff LA, Walker JR, Lix L, Rawsthorne P, Rogala L, Miller N, Jakul L, McPhail C, Ediger J, Bernstein CN. The relationship of inflammatory bowel disease type and activity to psychological functioning and quality of life. Clin Gastroenterol Hepatol. 2006;4:1491–1501. doi: 10.1016/j.cgh.2006.09.027.
    1. Clara I, Lix LM, Walker JR, Graff LA, Miller N, Rogala L, Rawsthorne P, Bernstein CN. The Manitoba IBD Index: evidence for a new and simple indicator of IBD activity. Am J Gastroenterol. 2009;104:1754–63. doi: 10.1038/ajg.2009.197.
    1. Gravel R, Beland Y. The Canadian Community Health Survey: mental health and wellbeing. Can J Psychiatry. 2005;50:573–9.
    1. Lin LI-K. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45:255–68. doi: 10.2307/2532051.
    1. Lin LI-K. A note on the concordance correlation coefficient. Biometrics. 2000;56:324–5.
    1. Sansone RA, Sansone LA, Wiederman MW. Increased health care utilization as a function of participation in trauma research. Am J Psychiatry. 1997;154:1025–7.
    1. Ritter PL, Stewart AL, Kaymaz H, Sobel DS, Block DA, Lorig KR. Self-reports of health care utilization compared to provider records. J Clin Epidemiol. 2001;54:136–41. doi: 10.1016/S0895-4356(00)00261-4.
    1. Roberts RO, Bergstralh EJ, Schmidt L, Jacobsen SJ. Comparison of self-reported and medical record health care utilization measures. J Clin Epidemiol. 1996;49:989–95. doi: 10.1016/0895-4356(96)00143-6.
    1. Wolinsky FD, Miller TR, An H, Geweke JF, Wallace RB, Wright KB, Chrischilles EA, Liu L, Pavlik CB, Cook EA, Ohsfeldt RL, Richardson KK, Rosenthal GE. Hospital episodes and physician visits: The concordance between self-reports and medical claims. Med Care. 2007;45(4):300–7. doi: 10.1097/01.mlr.0000254576.26353.09.
    1. Belli RF. The structure of autobiographical memory and the event history calendar: potential improvements in the quality of retrospective reports in surveys. Memory. 1998;6:383–406. doi: 10.1080/741942610.
    1. Belli RF, Smith LM, Andreski PM, Agrawal S. Methodological comparisons between CATI event history calendar and standardized conventional questionnaire instruments. Public Opinion Quarterly. 2007;71:603–22. doi: 10.1093/poq/nfm045.
    1. Dubois MF, Raîche M, Hébert R, Gueye NR. Assisted self-report of health-services use showed excellent reliability in a longitudinal study of older adults. J Clin Epidemiol. 2007;60(10):1040–5. doi: 10.1016/j.jclinepi.2006.12.011.
    1. Blumenthal D, Tavenner M. The "meaningful use" regulation for electronic health records. N Engl J Med. 2010;363(6):501–4. doi: 10.1056/NEJMp1006114.
    1. Pagliari C, Detmer D, Singleton P. Potential of electronic health records. BMJ. 2007;335(7615):330–3. doi: 10.1136/.

Source: PubMed

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