Abstract
OBJECTIVE: To examine the relationship between resident physicians’ perceptions of their preventive cardiology practices and a chart audit assessment of their documented services.
DESIGN: A criterion standard comparison of two methods used to assess resident physicians’ practices: self-report and chart audit.
SETTING: Physician ambulatory care in a residency program.
PATIENTS AND OTHER PARTICIPANTS: Coronary artery disease (CAD) risk factor assessment was evaluated by self-report for 72 resident physicians and by chart audit of randomly selected records of 544 of their patients who did not have CAD or a debilitating chronic disease during a one-year period.
INTERVENTION: Measurements of the residents’ perceived CAD risk factor assessment practice by self-report, and chart audit assessments of their recorded care.
MAIN OUTCOME: The relationship between self-reported and chart audit assessments of CAD risk factors.
RESULTS: Chart audit assessment of CAD risk factor management was highly significantly (p<0.01) lower than self-reported behaviors for evaluation of cigarette smoking, diet, physical activity, stress, plasma cholesterol, blood pressure, and body weight/obesity.
CONCLUSIONS: Three different interpretations of these findings are apparent. 1) Physician self-report is a poor tool for the measurement of clinical behavior, and therefore research of physician behavior should not rely solely on self-reported data; 2) physicians’ chart recording of their clinical practice is insufficient to reflect actual care; or 3) neither is an accurate measure of actual practice.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Wells KB, Ware JE Jr, Lewis CE. Physicians’ attitudes in counseling patients about smoking. Med Care. 1984;22:360–5.
Baker F. Data sources for health care quality evaluation. Eval Health Care Prof. 1983;6:263–81.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74.
Epstein AM, McNeil BJ. Relationship of beliefs and behavior in test ordering. Am J Med. 1986;80:865–70.
Pellegrine ED, Hart RJ, Henderson SR, Loeb SE, Edwards G. Relevance and utility of courses in medical ethics—a survey of physicians’ perceptions. JAMA. 1985;253:49–53.
Kosch SG, Dallman JJ. Essential areas for behavioral science training: a needs assessment approach. J Med Educ. 1983;58:619–26.
Nichols AW. Management of elevated serum cholesterol in a university-based family practice. J Fam Pract. 1988;26:281–5.
Romm FJ, Fletcher SW, Hulka BS. The periodic health examination: comparison of recommendations and internists’ performance. South Med J. 1981;74:265–71.
Cohen MV, Byrne M-J, Levine B, Gutowski T, Adelson R. Low rate of treatment of hypercholesterolemia by cardiologists in patients with suspected and proven coronary artery disease. Circulation. 1991;83:1294–304.
Mandel IG, Franks P, Dickinson JC. Screening guidelines in a family medicine program: a five-year experience. J Fam Pract. 1982;14:901–7.
Lichtman SW, Pisarka K, Berman ER, et al. Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. N Engl J Med. 1992;327:1893–8.
Scott CS, Leaf DA, Neighbor WE, Schaad DC, Brock DM, Van Citters RL. Preventive cardiology education and practice in residency training: residents’ attitudes, perceptions, and practices. Am J Prev Med. 1990;6(suppl 1):60–9.
Neighbor WE, Scott CS, Schaad DC, Macdonald SC, Van Citters R. Assessment and counseling of coronary risk factors by family practice residents. J Fam Pract. 1991;32:273–81.
Sherman SE, Hershman WY. Exercise counseling: how do general internists do? J Gen Intern Med. 1993;8:243–8.
Lewis CE. Disease prevention and health promotion practices of primary care physicians in the United States. Am J Prev Med. 1991;114:54–8.
Frame PS. Periodic health screening in a rural private practice. J Fam Pract. 1979;9:57–64.
Mardel IG, Franks P, Dickinson JC. Screening guidelines in a family medical program: a five-year experience. J Fam Pract. 1982;14:901–7.
Room FJ, Fletcher SW, Hulka BS. The periodic health examination: comparison of recommendations and internists’ performance. South Med J. 1981;74:265–71.
O’Neil AC, Petersen LA, Cook EF, Bates DW, Lee TH, Brennan TA. Physician reports compared with medical record review to identify adverse medical events. Ann Intern Med. 1993;119:370–6.
Cummings SR, Stein MJ, Hansen B, Richard RJ, Gerbert B, Coates TJ. Smoking counseling and preventive medicine. A survey of internists in private practice and a health maintenance organization. Arch Intern Med. 1989;149:345–9.
Anda RF, Remington PL, Seinko DG, Davis RM. Are physicians advising smokers to quit? The patient’s perspective. JAMA. 1987;257:1916–9.
Kehoe R, Wu S-Y, Leske MC, Chylack LT. Comparing self-reported and physician-reported medical history. Am J Epidemiol. 1994;139:813–8.
Healthy People 2,000: national health promotion and disease objectives. Washington, DC: Department of Health and Human Services. 1990.
Lloyd SS, Rissing JP. Physician coding errors in patient records. JAMA. 1985;254:1330–6.
Romm FJ, Putnam SM. The validity of the medical record. Med Care. 1981;19:310–7.
Bentsen BG. The accuracy of recording patient problems in family practice. J Med Educ. 1976;51:311–6.
Gehlbach SH. Comparing methods of data collection in an academic ambulatory practice. J Med Educ. 1976;54:730–2.
Zuckerman AE, Strafield B, Hochreiter C, Kovasnay B. Validating the content of pediatric outpatient medical care by means of tape-recording doctor—patient encounters. Pediatrics. 1975;56:407–11.
Author information
Authors and Affiliations
Additional information
Supported by Grant No. HL 30564 from the National Heart, Lung and Blood Institute.
Rights and permissions
About this article
Cite this article
Leaf, D.A., Neighbor, W.E., Schaad, D. et al. A comparison of self-report and chart audit in studying resident physician assessment of cardiac risk factors. J Gen Intern Med 10, 194–198 (1995). https://doi.org/10.1007/BF02600254
Issue Date:
DOI: https://doi.org/10.1007/BF02600254