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2. Measuring Differences Between Patients' and Physicians' Health Perceptions: The Patient--Physician Discordance Scale

Author

Sewitch, Maida J., Abrahamowicz, Michal, Dobkin, Patricia L., and Tamblyn, Robyn

Subjects
Chronic diseases -- Care and treatment, Inflammatory bowel diseases -- Care and treatment, Physician and patient -- Analysis, Psychology and mental health
Abstract

Byline: Maida J. Sewitch (1), Michal Abrahamowicz (2,3,4), Patricia L. Dobkin (2), Robyn Tamblyn (2) Keywords: patient--physician discordance; chronic disease; scale development; inflammatory bowel disease Abstract: We report on the development and validation of an instrument to assess discordance between physicians and their patients on evaluations of health-related information: the Patient--Physician Discordance Scale (PPDS). The 10-item questionnaire is designed to be employed across chronic diseases and can be used in clinical practice and research. It measures the extent of patient--physician discordance on five aspects of the patient'ls health status and five aspects of the office visit. A prospective study with 200 outpatients with inflammatory bowel disease and their treating physicians revealed that the 10-item discordance scores had good construct validity and satisfactory convergent validity. Overall discordance and the three subscales, discordance on symptoms and treatment, well-being, and communication and satisfaction, identified by factor analysis, had acceptable internal consistency. Patient and physician ratings demonstrated moderate-to-high concurrent validity. Study limitations and directions for future research with PPDS are discussed. Author Affiliation: (1) Groupe de recherche interdisciplinaire en sante, Faculte de medecine, Universite de Montreal, C.P. 6128, Succ. Centre-Ville, Montreal, Quebec, Canada, H3C 3J7 (2) Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec, Canada (3) Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada (4) Canadian Institutes of Health Research, Ottawa, Ontario, Canada Article History: Registration Date: 05/10/2004

Published
2003

3. Accuracy of administrative claims data for polypectomy

Author

Wyse, Jonathan M., Joseph, Lawrence, Barkun, Alan N., and Sewitch, Maida J.

Subjects
Diagnosis, Evaluation, Patient outcomes, Cancer screening -- Evaluation, Colonoscopy -- Evaluation, Colorectal cancer -- Diagnosis, Medical care quality -- Evaluation, Polypectomy -- Patient outcomes, Cancer -- Diagnosis, Medical care -- Quality management
Abstract

Population-based screening programs for colorectal cancer rely heavily on the performance of colonoscopy as either the initial examination or as the follow-up to a positive screening by virtual colonography, double-contrast [...], Background: The frequency of polypectomy is an important indicator of quality assurance for population-based colorectal cancer screening programs. Although administrative databases of physician claims provide population-level data on the performance of polypectomy, the accuracy of the procedure codes has not been examined. We determined the level of agreement between physician claims for polypectomy and documentation of the procedure in endoscopy reports. Methods: We conducted a retrospective cohort study involving patients aged 50-80 years who underwent colonoscopy at seven study sites in Montreal, Que., between January and March 2007. We obtained data on physician claims for polypectomy from the Regie de l'Assurance Maladie du Quebec (RAMQ) database. We evaluated the accuracy of the RAMQ data against information in the endoscopy reports. Results: We collected data on 689 patients who underwent colonoscopy during the study period. The sensitivity of physician claims for polypectomy in the administrative database was 84.7% (95% confidence interval [CI] 78.6%-89.4%), the specificity was 99.0% (95% CI 97.5%-99.6%), concordance was 95.1% (95% CI 93.1%-96.5%), and the kappa value was 0.87 (95% CI 0.83-0.91). Interpretation: Despite providing a reasonably accurate estimate of the frequency of polypectomy, physician claims underestimated the number of procedures performed by more than 15%. Such differences could affect conclusions regarding quality assurance if used to evaluate population-based screening programs for colorectal cancer. Even when a high level of accuracy is anticipated, validating physician claims data from administrative databases is recommended.

Published
2011
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