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Cardiologists' charting varied by risk factor, and was often discordant with patient report
Shannon Gravely-Witte1, Donna E Stewart, Neville Suskin
1University Health Network Women's Health Program, 200 Elizabeth St., Toronto, Ontario, Canada. sgravely@yorku.ca
Insights
Cardiologist documentation of cardiac risk factors like hypertension and diabetes is high, but less so for dyslipidemia and smoking. Patient reports often differ from chart records, questioning chart accuracy for quality assessment.
Area of Science:
- Cardiology
- Public Health
- Health Informatics
Background:
- Incomplete documentation of cardiac risk factors impacts patient care and outcomes.
- Assessing the accuracy of medical records against patient self-reports is crucial for quality improvement.
Purpose of the Study:
- To evaluate the completeness of cardiac risk factor documentation in cardiology practice.
- To determine the agreement between physician records and patient self-reported cardiac risk factors.
Main Methods:
- Systematic extraction of cardiac risk factor data from 68 Ontario cardiologists' patient charts (789 patients).
- Comparison of documented risk factors with patient survey responses to assess concordance.
Main Results:
- High documentation rates for hypertension (90.4%) and diabetes (87.2%).
- Lower documentation for dyslipidemia (80.5%) and smoking behavior (78.6%).
- Moderate to substantial agreement between chart data and patient reports for diabetes, obesity, and smoking; lower agreement for hypertension and family history.
Conclusions:
- While key risk factors like hypertension and diabetes are well-documented, crucial modifiable factors such as dyslipidemia and smoking require improved attention.
- Physician chart documentation may not be a reliable sole criterion for assessing the quality of cardiac risk factor reporting.
Objective:
To assess the completeness of cardiac risk factor documentation by cardiologists, and agreement with patient report.
Study Design And Setting:
A total of 68 Ontario cardiologists and 789 of their ambulatory cardiology patients were randomly selected. Cardiac risk factor data were systematically extracted from medical charts, and a survey was mailed to participants to assess risk factor concordance.
Results:
With regard to completeness of risk factor documentation, 90.4% of charts contained a report of hypertension, 87.2% of diabetes, 80.5% of dyslipidemia, 78.6% of smoking behavior, 73.0% of other comorbidities, 48.7% of family history of heart disease, and 45.9% of body mass index or obesity. Using Cohen's k, there was a concordance of 87.7% between physician charts and patient self-report of diabetes, 69.5% for obesity, 56.8% for smoking status, 49% for hypertension, and 48.4% for family history.
Conclusion:
Two of four major cardiac risk factors (hypertension and diabetes) were recorded in 90% of patient records; however, arguably the most important reversible risk factors for cardiac disease (dyslipidemia and smoking) were only reported 80% of the time. The results suggest that physician chart report may not be the criterion standard for quality assessment in cardiac risk factor reporting.
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