Min Kyung Kim1, Joy Noel Baumgartner2, Jennifer Headley2, Julius Kirya3, James Kaggwa4, Joseph R Egger5. 1. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 2. Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27708, USA. 3. LifeNet International, Kampala, Uganda. 4. Makerere University - Johns Hopkins University (MI-JHU) Research Collaboration, Kampala, Uganda. 5. Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27708, USA. Electronic address: joseph.egger@duke.edu.
Abstract
OBJECTIVE: To achieve a high quality of care (QoC), accurate measurements are needed. This study evaluated the validity of QoC data from the medical records for childbirth deliveries and assessed whether medical records can be used to evaluate the efficacy of interventions to improve QoC. STUDY DESIGN AND SETTING: This study was part of a larger study of QoC training program in Uganda. Study data were collected in two phases: (1) validation data from 321 direct observations of deliveries paired with the corresponding medical records; (2) surveillance data from 1,146 medical records of deliveries. Sensitivity, specificity, and predictive values were used to measure the validity of the medical record from the validation data. Quantitative bias analysis was conducted to evaluate QoC program efficacy in the surveillance data using prevalence ratio and odds ratio. RESULTS: On average, sensitivity (84%) of the medical record was higher than the specificity (34%) across 11 QoC indicators, showing a higher validity in identifying the performed procedure. For 5 out of 11 indicators, bias-corrected odds ratios and prevalence ratios deviated significantly from uncorrected estimates. CONCLUSION: The medical records demonstrated poor validity in measuring QoC compared with direct observation. Using the medical record to assess QoC program efficacy should be interpreted carefully.
OBJECTIVE: To achieve a high quality of care (QoC), accurate measurements are needed. This study evaluated the validity of QoC data from the medical records for childbirth deliveries and assessed whether medical records can be used to evaluate the efficacy of interventions to improve QoC. STUDY DESIGN AND SETTING: This study was part of a larger study of QoC training program in Uganda. Study data were collected in two phases: (1) validation data from 321 direct observations of deliveries paired with the corresponding medical records; (2) surveillance data from 1,146 medical records of deliveries. Sensitivity, specificity, and predictive values were used to measure the validity of the medical record from the validation data. Quantitative bias analysis was conducted to evaluate QoC program efficacy in the surveillance data using prevalence ratio and odds ratio. RESULTS: On average, sensitivity (84%) of the medical record was higher than the specificity (34%) across 11 QoC indicators, showing a higher validity in identifying the performed procedure. For 5 out of 11 indicators, bias-corrected odds ratios and prevalence ratios deviated significantly from uncorrected estimates. CONCLUSION: The medical records demonstrated poor validity in measuring QoC compared with direct observation. Using the medical record to assess QoC program efficacy should be interpreted carefully.
Authors: Joy Noel Baumgartner; Jennifer Headley; Julius Kirya; Josh Guenther; James Kaggwa; Min Kyung Kim; Luke Aldridge; Stefanie Weiland; Joseph Egger Journal: Health Policy Plan Date: 2021-08-12 Impact factor: 3.344