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November 22, 1995

Quality of Chart Review for Quality of Care-Reply

Author Affiliations

Health Care Financing Administration Kansas City, Mo

JAMA. 1995;274(20):1586. doi:10.1001/jama.1995.03530200021022

In Reply.  —Drs Localio and Landis illustrate the proper methods for measuring the accuracy of a test when there is a true, knowable result. Unfortunately, in the setting of retrospective data collection, where we cannot control how the data are recorded in the medical record, there are wide variations in how information is recorded. The information may be ambiguous or inconsistent. Therefore, a true result cannot always be known. Given that situation, one is forced to use measures of interrater agreement such as κ. As we implement the Cooperative Cardiovascular Project on a national basis, we plan to extend our measures of interrater agreement beyond simple duplicate reviews by examining the performance of abstractors on "gold standard" charts in which we have established agreement on specific variables and quality indicators by multiple, experienced abstractors.These measures of the reliability of data collection, however, are still an incomplete measure of the

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