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Original Investigation
January 26, 2017

Agreement of Ocular Symptom Reporting Between Patient-Reported Outcomes and Medical Records

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
  • 2currently a medical student at the University of Michigan Medical School, Ann Arbor
  • 3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 4Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
JAMA Ophthalmol. Published online January 26, 2017. doi:10.1001/jamaophthalmol.2016.5551
Key Points

Question  Are eye symptoms reported differently in the electronic medical record (EMR) vs patient report on an Eye Symptom Questionnaire (ESQ)?

Findings  Large inconsistencies were noted in this observational study of 162 patients, with participants having discordant symptom reporting between the ESQ and EMR, including blurry vision, glare, pain or discomfort, and redness.

Meaning  These data suggest that symptom reporting varies between methods, with patients tending to report more symptoms on self-reported questionnaires.


Importance  Accurate documentation of patient symptoms in the electronic medical record (EMR) is important for high-quality patient care.

Objective  To explore inconsistencies between patient self-report on an Eye Symptom Questionnaire (ESQ) and documentation in the EMR.

Design, Setting, and Participants  This investigation was an observational study in comprehensive ophthalmology and cornea clinics at an academic institution among a convenience sample of 192 consecutive eligible patients, of whom 30 declined participation. Patients were recruited at the Kellogg Eye Center from October 1, 2015, to January 31, 2016. Patients were eligible to be included in the study if they were 18 years or older.

Main Outcomes and Measures  Concordance of symptoms reported on an ESQ with data recorded in the EMR. Agreement of symptom report was analyzed using κ statistics and McNemar tests. Disagreement was defined as a negative symptom report or no mention of a symptom in the EMR for patients who reported moderate to severe symptoms on the ESQ. Logistic regression was used to investigate if patient factors, physician characteristics, or diagnoses were associated with the probability of disagreement for symptoms of blurry vision, pain or discomfort, and redness.

Results  A total of 162 patients (324 eyes) were included. The mean (SD) age of participants was 56.6 (19.4) years, 62.3% (101 of 162) were female, and 84.9% (135 of 159) were white. At the participant level, 33.8% (54 of 160) had discordant reporting of blurry vision between the ESQ and EMR. Likewise, documentation was discordant for reporting glare (48.1% [78 of 162]), pain or discomfort (26.5% [43 of 162]), and redness (24.7% [40 of 162]), with poor to fair agreement (κ range, −0.02 to 0.42). Discordance of symptom reporting was more frequently characterized by positive reporting on the ESQ and lack of documentation in the EMR (Holm-adjusted McNemar P < .03 for 7 of 8 symptoms except for blurry vision [P = .59]). Return visits at which the patient reported blurry vision on the ESQ had increased odds of not reporting the symptom in the EMR compared with new visits (odds ratio, 5.25; 95% CI, 1.69-16.30; Holm-adjusted P = .045).

Conclusions and Relevance  Symptom reporting was inconsistent between patient self-report on an ESQ and documentation in the EMR, with symptoms more frequently recorded on a questionnaire. These results suggest that documentation of symptoms based on EMR data may not provide a comprehensive resource for clinical practice or “big data” research.