Measuring multimorbidity in older adults: comparing different data sources.

BACKGROUND: Multimorbidity is a global health issue, particularly for older adults in the primary care setting. An adequate portrayal of its epidemiology is essential to properly identify and understand the health care needs of this population. This study aimed to compare the differences in the prevalence of selected chronic conditions and multimorbidity, including its associated characteristics, using health survey/self-reported (SR) information only, administrative (Adm) data only and the combined (either) sources. METHODS: This was a secondary analysis of survey data from the first cycle of the Longitudinal Survey on Senior's Health and Health Services Use linked to health-Adm data. The analytical sample consisted of 1625 community-dwelling older adults (≥65 years) recruited in the waiting rooms of primary health clinics in a selected administrative region of the province of Quebec. Seventeen chronic conditions were assessed according to two different data sources. We examined the differences in the observed prevalence of chronic conditions and multimorbidity and the agreement between data sources. RESULTS: The prevalence of each of the 17 chronic conditions ranged from 1.2 to 68.7% depending on the data source. The agreement between different data sources was highly variable, with kappa coefficients (κ) ranging from 0.05 to 0.73. Multimorbidity was very high in this population, with an estimated prevalence of up to 95.9%. In addition, we found that the association between sociodemographic and behavioural factors and the presence of multimorbidity varied according to the different data sources and thresholds. CONCLUSIONS: This is the first study to simultaneously investigate chronic conditions and multimorbidity prevalence among primary care older adults using combined SR and health-Adm data. Our results call attention to (1) the possibility of underestimating cases when using a single data source and (2) the potential benefits of integrating information from different data sources to increase case identification. This is an important aspect of characterizing the health care needs of this fast-growing population.

Which information source is best? Concordance between patient report, clinician report and medical records of patient co-morbidity and adjuvant therapy health information.

RATIONALE, AIM AND OBJECTIVES: Previous studies investigating agreement between data sources for co-morbidity and adjuvant therapy information have suggested agreement varies depending on how the information is collected. The aim of this study was to compare agreement among three data sources: patient report, clinician report and medical record. METHOD: Data were collected as part of a nurse-delivered telephone intervention (the CONNECT programme). Patient report was collected using a self-administered questionnaire. Clinician report was collected from the patient's treating surgeon. Medical record information was extracted by a member of the research team. The proportion of specific agreement [positive (PA) and negative agreement (NA)] and Kappa statistics were calculated. RESULTS: The study sample comprised 756 surgical patients with colorectal cancer. For the majority of co-morbidities the lowest level of agreement was found between the patient and clinician (PA 0.29-0.64, Kappa values ranged from 0.22 to 0.58). The highest agreement and Kappa values for co-morbidities were generally found between the patient report and medical record (PA 0.36-0.80 and NA 0.92-0.99; Kappa 0.34-0.77). There was good agreement between patient and clinician reports for receipt adjuvant therapy {Kappa 0.78 [confidence interval (CI) 0.72-0.84] and 0.84 [CI 0.80-0.88], respectively; PA 0.87 and 0.92, respectively}. No consistent pattern in the predictors of non-agreement was found. CONCLUSION: Given there was higher agreement between patient report and medical record review, the use of patient self-report questionnaires to ascertain co-morbid conditions remains a valid method for health services research.