Document Type

Thesis

Date of Degree

Fall 2014

Degree Name

MS (Master of Science)

Degree In

Epidemiology

First Advisor

Charles F. Lynch

Second Advisor

Barcey T. Levy

Abstract

Patient self-report of colorectal cancer (CRC) screening remains a critical source of information in determining adherence to recommended guidelines. Accurate assessment is important for clinical decision-making, quality assurance and research. Population subgroup differences can affect self-report accuracy. Studies relying on patient self-report benefit from assessing validity and attempting to quantify measurement error and bias. This study assessed self-reported CRC screening data accuracy - estimating overall and test-specific adherence using four common validity measures (sensitivity, specificity, concordance, and report-to-records ratio [R2R]) - and evaluated associations between predictor variables and accuracy that might explain variation in estimates.

1,399 patients aged 51-80 years from 16 family medicine offices in the Iowa Research Network (IRENE), a practice-based research network (PBRN), completed an investigator-developed questionnaire and had medical records (MRs) available. Comparison of self-report of up-to-date screening with test documentation in the MR was used to estimate validity; multivariable analysis assessed predictors of concordance, or agreement between self-report and test documentation in the MR, for colonoscopy (CSPY). Predictor variables included patient characteristics (age, gender, education, income, insurance status, family

history of CRC and IRENE office), healthcare utilization practices (recency of last visit to office and duration of patient status in office) and patient rural-urban residence classified according to a four-category Rural-Urban Commuting Area (RUCA) coding scheme.

Sixty percent of patients reported they were up-to-date with CRC screening by any test, while 48% had screening documented in the MR (sensitivity 0.95, specificity 0.73, concordance 0.83 and R2R 1.24). Nearly all documentation was for CSPY (sensitivity 0.94, specificity 0.76, concordance 0.84 and R2R 1.21). Education, insurance source, CRC family history and patient duration in office, when adjusted for all other variables in the final model, were significant (p < 0.05) predictors of concordance. Age modified a significant association with concordance for patient rural-urban residence (p = 0.03) and for recency of last visit (p = 0.04).

Self-reported CRC screening validity was generally acceptable, but overreporting was prevalent across all tests. MR documentation of CRC screening was almost exclusively based on CSPY. Concordance between self-reported CSPY and the MR was good but varied with patient characteristics, healthcare utilization practices and rural-urban residence.

Public Abstract

Patient self-report of colorectal cancer (CRC) screening remains a critical source of information in determining adherence to recommended guidelines. Accurate assessment is important for clinical decision-making, quality assurance and research. Population subgroup differences can affect self-report accuracy. Studies relying on patient self-report benefit from assessing validity and attempting to quantify measurement error and bias. This study assessed self-reported CRC screening data accuracy, estimating overall and test-specific adherence, and evaluated associations between predictor variables and accuracy that might explain variation in estimates.

1,399 patients aged 51-80 years from 16 family medicine offices completed an investigator-developed questionnaire and had medical records (MRs) available. Comparison of self-report of up-to-date screening with test documentation in the MR was used to estimate validity; multivariable analysis assessed predictors of concordance, or agreement between self-report and test documentation in the MR.

Sixty percent of patients reported they were up-to-date with CRC screening by any test, while 48% had screening documented in the MR. Nearly all documentation was for colonoscopy. Education, insurance source, CRC family history and patient duration in office, adjusted for all other variables in the final model, were significant predictors of concordance. Age modified a significant association with concordance for patient rural-urban residence and for recency of last visit.

Self-reported CRC screening validity was generally acceptable, but overreporting was prevalent across all tests. MR documentation of CRC screening was almost exclusively based on colonoscopy. Concordance between self-reported colonoscopy and the MR was good but varied with patient characteristics, healthcare utilization practices and rural-urban residence.

Keywords

publicabstract

Pages

xi, 89 pages

Bibliography

Includes bibliographical references (pages 85-89).

Copyright

Copyright 2014 Carol Moss

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