Original ArticleParents were accurate proxy reporters of urgent pediatric asthma health services—a retrospective agreement analysis
Introduction
Accurate health services utilization data are important for epidemiologic studies [1], health services research [2], and economic evaluations [3], and these data are often collected via self-reported questionnaires or interviews [4], [5]. Given the increased use and importance of these data, it is imperative that the validity of self-reports be assessed. Several studies have investigated the validity of patient reports of health service utilization for ambulatory, homecare, and emergency department (ED) visits and hospitalizations by comparing patient reports to a second source of data such as medical records or administrative databases. Many of these validation studies have focused on older populations [6], [7] and adult populations with chronic diseases such as asthma and cystic fibrosis [5], [8].
Epidemiologic studies of children's use of health services are relevant and important. Researchers have historically examined hospital admission rates as a marker for disease morbidity and to explore changes in morbidity over time. Due to children's cognitive and developmental limitations, studies investigating children's use of health service often rely on parent proxy reports. Few studies have investigated the validity of parent reports for health services utilization by their children [9], [10], [11], [12]. Moreover, no studies have investigated the validity of parent reports for children with a chronic childhood disease. The objective of this study was to assess agreement between parents' reports of children's respiratory-related health services utilization (outpatient physician visits, ED visits, and inpatient admissions) and administrative health insurance claims data for children with asthma.
Section snippets
Participants
Approval was granted by the Hospital for Sick Children and Brampton Memorial Hospital Research Ethics Boards. Written informed consent was provided by parents/guardians and participants 16 years or older. Assent was provided by younger participants.
Data were extracted from a completed study of the effect of drug plans on outcomes in asthmatic children. Participants/parents were recruited from clinics, EDs, and primary and specialist physicians' practices. Residents of Ontario aged 1–18 years
Sample characteristics
The 545 respondents who consented to participate had higher average incomes (CAD$62,866 vs. CAD$54,120, P < 0.0001) and were more educated (received degree/diploma, 62.5% vs. 47.2%, P < 0.0001) compared to nonconsenters. Demographic data for the 545 children were collected from 459 parent proxies (parent group) and 86 adolescents (adolescent group). The majority (91%) of parent respondents were mothers. Also, most (59%) of the 545 children were male, and less than 10 years of age (73%), with an
Discussion
Agreement between administrative data and respondent reports was substantial for inpatient admissions (κ = 0.80), moderate for ED visits (κ = 0.60), and slight for outpatient physician visits (κ = 0.13) according to the Landis and Koch [17] criteria. Although there was a trend toward higher agreement between reports and administrative data for groups with higher income, higher education, and better PAQLQ symptom control scores, the differences in kappa values were not statistically significantly
Acknowledgments
We would like to thank Don DeBoer and Steven Shi of the Institute for Clinical Evaluative Sciences and Dr. Min Su, Dr. Peter Bikangaga, Dr. Milton Gold, and Dr. Teresa To for their contributions to this project. Thanks to Sara Quirk for technical assistance.
This research was funded by an operating grant from the Canadian Institutes of Health Research (Grant #77437).
References (31)
- et al.
Cost-effectiveness of a home-based environmental intervention for inner-city children with asthma
J Allergy Clin Immunol
(2005) - et al.
Comparison of self-reported and medical health care utilization measures
J Clin Epidemiol
(1996) - et al.
Pharmacy Medication Monitoring Program Advisory Board. Health services utilization reporting in respiratory patients
J Clin Epidemiol
(1998) - et al.
Self-reports of health care utilization compared to provider reports
J Clin Epidemiol
(2001) - et al.
The collection of service utilisation data: a research note on validity
Soc Sci Med
(1979) - et al.
Indoor environmental exposures among children with asthma seen in an urban emergency department
Pediatrics
(2006) - et al.
Use of healthcare, patient satisfaction, and burden of care in Guillain-Barre syndrome
J Rehabil Med
(2006) - et al.
Accuracy of self-reported health services use and patterns of care among urban older adults
Med Care
(1999) - et al.
Agreement between self-reported and routinely collected health-care utilization data among seniors
Health Serv Res
(2002) - et al.
Evaluation of the ambulatory and home care record: agreement between self-reports and administrative data
Int J Technol Assess Health Care
(2006)
Validity of maternal report of acute health care use for children younger than 3 years
Arch Pediatr Adolesc Med
How well they remember: the accuracy of parent reports
Arch Pediatr Adolesc Med
Methodological challenges in assessing children's mental health services utilization
Ment Health Serv Res
Agreement between CASA parent reports and provider records of children's ADHD services
J Behav Health Serv Res
Measuring quality of life in children with asthma
Qual Life Res
Cited by (23)
The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States
2014, Journal of PainCitation Excerpt :Parents completed an online version of the CSRI to collect retrospective data on economic costs incurred for their child's pain condition over the preceding 12 months. Parents were chosen as proxy reporters of their adolescents' health care utilization, as parents have been shown to be reliable informants for this purpose.32 Parents reported on the type and quantity of health services used.
Agreement between internet-based self- and proxy-reported health care resource utilization and administrative health care claims
2012, Value in HealthCitation Excerpt :Bhandari and Wagner [2] reported a weighted average of 60% agreement at 3 months recall, 36% agreement at 6 months recall, and 20% agreement at 12 months recall. Finally, the type of HCRU reported can also affect the level of agreement, with self-report accuracy increasing with more rare or memorable visits, including inpatient hospitalizations or visits to a specialist [16,17]. Numerous studies have evaluated the validity of self-report data relative to medical records and administrative claims data.
Factors associated with disparities in emergency department use among Latino children with asthma
2012, Annals of Allergy, Asthma and ImmunologyEvaluation of quality of life among the caregivers of asthmatic children: The new IFABI-R questionnaire
2011, Allergologia et ImmunopathologiaRelationship of asthma management, socioeconomic status, and medication insurance characteristics to exacerbation frequency in children with asthma
2011, Annals of Allergy, Asthma and ImmunologyCan an evidence-based guideline reminder card improve asthma management in the emergency department?
2010, Respiratory Medicine