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    How Reliable are Patient-Reported Rehospitalizations? Implications for the Design of Future Practical Clinical Studies.

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    Date
    2016-01-25
    Authors
    Anstrom, Kevin J
    Baker, BA
    Davidson-Ray, L
    Effron, MB
    Knight, JD
    Krishnamoorthy, A
    Mark, Daniel B
    McCollam, PL
    Peterson, Eric David
    Wang, TY
    Zettler, ME
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    Abstract
    BACKGROUND: Longitudinal clinical investigations often rely on patient reports to screen for postdischarge adverse outcomes events, yet few studies have examined the accuracy of such patient reports. METHODS AND RESULTS: Patients with acute myocardial infarction (MI) in the TRANSLATE-ACS study were asked during structured interviews at 6 weeks, 6 months, and 12 months postdischarge to report any rehospitalizations. The accuracy of patient-reported rehospitalizations within 1 year of postdischarge was determined using claims-based medical bill validation as the reference standard. The cumulative incidence of rehospitalizations was compared when identified by patient report versus medical bills. Patients were categorized by the accuracy in reporting events (accurate, under-, or over- reporters) and characteristics were compared between groups. Among 10 643 MI patients, 4565 (43%) reported 7734 rehospitalizations. The sensitivity and positive predictive value of patient-reported rehospitalizations were low at 67% and 59%, respectively. A higher cumulative incidence of rehospitalization was observed when identified by patient report versus medical bills (43% vs 37%; P<0.001). Overall, 18% of patients over-reported and 10% under-reported the number of hospitalizations. Compared with accurate reporters, under-reporters were more likely to be older, female, African American, unemployed, or a non-high-school graduate, and had greater prevalence of clinical comorbidities such as diabetes and past cardiovascular disease. CONCLUSIONS: The accuracy of patient-reported rehospitalizations was low with patients both under- and over-reporting events. Longitudinal clinical research studies need additional mechanisms beyond patient report to accurately identify rehospitalization events. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT01088503.
    Type
    Journal article
    Subject
    myocardial infarction
    patient outcome assessment
    validation studies
    Aged
    Female
    Health Care Costs
    Hospital Charges
    Humans
    Male
    Middle Aged
    Myocardial Infarction
    Patient Discharge
    Patient Outcome Assessment
    Patient Readmission
    Reproducibility of Results
    Research Design
    Risk Factors
    Self Report
    Time Factors
    United States
    Permalink
    https://hdl.handle.net/10161/15005
    Published Version (Please cite this version)
    10.1161/JAHA.115.002695
    Publication Info
    Anstrom, Kevin J; Baker, BA; Davidson-Ray, L; Effron, MB; Knight, JD; Krishnamoorthy, A; ... Zettler, ME (2016). How Reliable are Patient-Reported Rehospitalizations? Implications for the Design of Future Practical Clinical Studies. J Am Heart Assoc, 5(1). 10.1161/JAHA.115.002695. Retrieved from https://hdl.handle.net/10161/15005.
    This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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    Scholars@Duke

    Anstrom

    Kevin J. Anstrom

    Professor of Biostatistics and Bioinformatics
    My research interests include clinical trials, cost-benefit analysis, health economics, semiparametric estimation, and medical informatics.
    Peterson

    Eric David Peterson

    Fred Cobb, M.D. Distinguished Professor of Medicine
    Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical Research Institute (DCRI), Durham, NC, USA. Dr Peterson is the Principal Investigator of the National Institute of Health, Lung and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial  He is also the Principal I
    Alphabetical list of authors with Scholars@Duke profiles.
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    Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy

    Rights for Collection: Scholarly Articles

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