Mammography Use among Black Women: The Role of Electronic Medical Records

被引:7
|
作者
Clark, Cheryl R. [1 ,2 ,3 ]
Baril, Nashira [3 ,4 ]
Kunicki, Marycarmen [3 ,4 ]
Johnson, Natacha
Soukup, Jane
Lipsitz, Stuart
Bigby, JudyAnn [3 ,5 ]
机构
[1] Brigham & Womens Hosp, Div Gen Med & Primary Care, Ctr Community Hlth & Hlth Equity, Boston, MA 02120 USA
[2] Brigham & Womens Hosp, Brigham & Womens Faulkner Hosp Program, Boston, MA 02120 USA
[3] Boston REACH 2010 Breast & Cerv Canc Coalit, Boston, MA USA
[4] Boston Publ Hlth Commiss, Boston, MA USA
[5] Commonwealth Massachusetts, Execut Off Hlth & Human Serv, Boston, MA USA
关键词
BILLING CLAIMS DATA; INFORMATION-TECHNOLOGY; CANCER MORTALITY; ELDERLY-WOMEN; SELF-REPORT; HEALTH; CARE; POPULATION; BREAST; ACCURACY;
D O I
10.1089/jwh.2008.1153
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background and Aims: Accurately documenting mammography use is essential to assess quality of care for early breast cancer detection in underserved populations. Self-reports and medical record reports frequently result in different accounts of whether a mammogram was performed. We hypothesize that electronic medical records (EMRs) provide more accurate documentation of mammography use than paper records, as evidenced by the level of agreement between women's self-reported mammography use and mammography use documented in medical records. Methods: Black women aged 40-75 were surveyed in six primary care sites in Boston, Massachusetts (n = 411). Survey data assessed self-reported mammography prevalence within 2 years of study entry. Corresponding medical record data were collected at each site. Positive predictive value (PPV) of self-report and kappa statistics compared data agreement among sites with and without EMRs. Logistic regression estimated effects of site and patient characteristics on agreement between data sources. Results: Medical records estimated a lower prevalence of mammography use (58%) than self-report (76%). However, self-report and medical record estimates were more similar in sites with EMRs. PPV of self-report was 88% in sites with continuous access to EMRs and 61% at sites without EMRs. Kappa statistics indicated greater data agreement at sites with EMRs (0.72, 95% CI 0.56-0.88) than without EMRs (0.46, 95% CI 0.29-0.64). Adjusted for covariates, odds of data agreement were greatest in sites where EMRs were available during the entire study period (OR 4.31, 95% CI 1.67-11.13). Conclusions: Primary care sites with EMRs better document mammography use than those with paper records. Patient self-report of mammography screening is more accurate at sites with EMRs. Broader access to EMRs should be implemented to improve quality of documenting mammography use. At a minimum, quality improvement efforts should confirm the accuracy of paper records with supplemental data.
引用
收藏
页码:1153 / 1162
页数:10
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