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Table 4 Sources of discordance for diagnoses detected by chart review but not case finding algorithms

From: From patient care to research: a validation study examining the factors contributing to data quality in a primary care electronic medical record database

Category Specific factor COPD Depression DM HTN OA Total
n (%) n (%) n (%) n(%) n (%) n (%)
Coding       
Diagnosis not coded due to multi-problem visit - 1(3) - 1(7) 13(12) 15(9)
Use of non-specific ICD-9 code - - - - 13(10) 13(8)
Formatting (e.g. missing decimal place) - - - - 4(4) 4(2)
Terminology       
Alternate terminology used - - - 1(7) 17(16) 18(11)
Access Limitations       
Diagnosis record limited to free text fields 3(43) 15(48) 4(40) 6(43) 47(45) 75(45)
Diagnosis confirmed from inaccessible investigations or documents 2(29) - - 2(14) 14(13) 18(11)
Not detected from problem list - 1(3) - - 2(2) 3(1)
Data missing after extraction/cleaning - 6(19) 1(10) - 30(29) 37(22)
Case Definition       
Indicators excluded due to co-existing condition 2(29) 7(23) - 4(29) - 13(8)
Insufficient frequency of indicator (e.g. limited visits or labs) - - 5(50) 2(14) - 7(4)
Medications       
Medication not included in case definition 1(14) 9(29) - 7(50) - 17(10)
Validation Factors       
Uncertainty of presence of diagnosis after abstraction - - 1(10) - - 1(1)
Total Discordant Cases (Chart Review +/CPCSSN-)* 7(100) 31(100) 10(100) 14(100) 105(100) 167(100)
  1. COPD: Chronic Obstructive Pulmonary Disease; DM: Diabetes Mellitus; HTN: Hypertension; OA: Osteoarthritis.
  2. *Total is greater than row values due to multiple factors contributing to discordance.