How Reliable are Patient-Reported Rehospitalizations? Implications for the Design of Future Practical Clinical Studies.
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 articleSubject
myocardial infarctionpatient 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
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https://hdl.handle.net/10161/15005Published Version (Please cite this version)
10.1161/JAHA.115.002695Publication 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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Show full item recordScholars@Duke
Kevin J. Anstrom
Professor of Biostatistics and Bioinformatics
My research interests include clinical trials, cost-benefit analysis, health economics,
semiparametric estimation, and medical informatics.
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
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