Related Experiment Video
Updated: Aug 14, 2026
Safety Precautions and Operating Procedures in an (A)BSL-4 Laboratory: 4. Medical Imaging Procedures
Published on: October 3, 2016
The appropriateness of using a medical procedure. Is information in the medical record valid?
Insights
Medical records accurately capture the reasons for performing coronary angiography, validating their use in assessing procedure appropriateness. This finding is crucial for understanding variations in healthcare practices.
Area of Science:
- Cardiology
- Health Services Research
- Medical Informatics
Background:
- Geographic variations in medical procedure use are often linked to clinical appropriateness.
- The reliability of medical records for assessing procedure appropriateness is not well-established.
- Coronary angiography is a common cardiovascular procedure with potential for varied utilization.
Purpose of the Study:
- To determine if medical records provide valid data on the reasons for performing coronary angiography.
- To assess the agreement between medical record indications and physician-reported indications for coronary angiography.
- To evaluate the suitability of medical records for judging the appropriateness of coronary angiography.
Main Methods:
- A national physician panel developed 300 detailed clinical indications for coronary angiography.
- Reasons for performing the procedure from medical records were compared with physician interview data.
- Data were collected from 35 billing entities in two Los Angeles Professional Standards Review Organization areas, covering 81% of Medicare angiographies.
- Sixty-six medical records were reviewed, and physician interviews were conducted by blinded data collectors.
Main Results:
- Ninety-one percent agreement was achieved between the indications documented in medical records and those reported by physicians.
- Physician interviews and medical record reviews demonstrated high concordance regarding the reasons for coronary angiography.
- The study successfully compared physician-reported reasons with medical record data.
Conclusions:
- Medical records are a valid and suitable source for obtaining information on why coronary angiography is performed.
- The findings support the use of medical records in evaluating the appropriateness of coronary angiography utilization.
- This validates a key data source for future health services research on procedure appropriateness and utilization patterns.
Abstract:
Understanding the clinical appropriateness of a procedure's use may be critical in explaining geographic variations in its use. Little is known, however, about whether data on appropriateness can be obtained from a medical record. A national panel of physicians formulated a list of 300 mutually exclusive, detailed clinical indications for performing coronary angiography. Using this list, we compared the reasons physicians perform coronary angiography as revealed in medical records with those given in interviews with the physicians who actually did the procedure. Thirty-five of 47 eligible billing entities (74%) from two Los Angeles Professional Standards Review Organization areas participated. These physicians practiced in 14 hospitals and accounted for 81% of all angiographies performed on Medicare patients in the two areas. Sixty-six records (approximately two per physician) were reviewed; physician interviews were conducted by two trained data collectors who were blinded to each other's results. Ninety-one percent agreement was reached on the specific indication for performing coronary angiography when information from the record review and interview was compared. We conclude that medical records yield valid information on why coronary angiography is performed and that they are a suitable source to use in judging the appropriateness of that use.
More Related Videos
07:50A Metadata Extraction Approach for Clinical Case Reports to Enable Advanced Understanding of Biomedical Concepts
Published on: September 20, 2018
06:55Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
Related Concept Videos
01:24Data Reporting and Recording
01:20Introduction to Documentation and Reporting
Nursing documentation records essential information and details regarding a patient's care and treatment in written or electronic form. It is a critical aspect of nursing practice that involves documenting assessments, interventions, outcomes, and other relevant details about a patient's health status.
Documentation maps the patient's health journey by creating a comprehensive and precise...
01:11Purpose of Health Records I
Here's a breakdown of how health records serve these purposes:
01:19Purpose of Health Records II
01:26Guidelines for Nursing Documentation II
Timely documentation is crucial to ensure continuity of care for patients. Any delays in recording or reporting medical information can result in medical errors and even adverse patient outcomes. From medication administration to diagnostic test results, every detail must be accurately and promptly documented to provide the best possible care for patients.
01:23Ethical Standards II
Nurses are entrusted with upholding various ethical principles and standards. Nurses forge solid therapeutic relationships using trust, empathy, autonomy, confidentiality, and professional competence.
Confidentiality is crucial, embodying respect for individual privacy and...