Agreement between self-reports and medical records was only fair in a cross-sectional study of performance of annual eye examinations among adults with diabetes in managed care

Med Care. 2007 Sep;45(9):876-83. doi: 10.1097/MLR.0b013e3180ca95fa.


Background: Despite consensus about the importance of measuring quality of diabetes care and the widespread use of self-reports and medical records to assess quality, little is known about the degree of agreement between these data sources.

Objectives: To evaluate agreement between self-reported and medical record data on annual eye examinations and to identify factors associated with agreement.

Research design and subjects: Data from interviews and medical records were available for 8409 adults with diabetes who participated in the baseline round of the Translating Research Into Action for Diabetes (TRIAD) Study.

Measures: Agreement between self-reports and medical records was evaluated as concordance and Cohen's kappa coefficient.

Results: Self-reports indicated a higher performance of annual dilated eye examinations than did medical records (75.9% vs. 38.8%). Concordance between the data sources was 57.9%. Agreement was only fair (kappa coefficient = 0.25; 95% confidence interval, 0.23-0.26). Nearly two-thirds (64.6%) of discordance was due to lack of evidence in the medical record to support self-reported performance of the procedure. After adjustment, agreement was most strongly related to health plan (chi = 977.9, df = 9; P < 0.0001), and remained significantly better for 3 of the 10 health plans (P < 0.00001) and for persons younger than 45 years of age (P = 0.00002).

Conclusions: The low level of agreement between self-report and medical records suggests that many providers of diabetes care do not have easily available accurate information on the eye examination status of their patients.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetic Retinopathy / diagnosis
  • Diabetic Retinopathy / epidemiology*
  • Diagnostic Tests, Routine*
  • Female
  • Humans
  • Linear Models
  • Male
  • Managed Care Programs / standards
  • Managed Care Programs / statistics & numerical data*
  • Medical Records / statistics & numerical data*
  • Middle Aged
  • Outcome Assessment, Health Care
  • Quality Indicators, Health Care*
  • Reproducibility of Results
  • Risk Assessment
  • Self Disclosure*
  • Surveys and Questionnaires
  • United States / epidemiology