The reliability and validity of doctor-recorded morbidity data in active data collection systems

Abstract

Objective - To test the reliability and validity of morbidity data recorded by general practitioners (family physicians) on structured recording forms in active data collection systems. Design - The consulting general practitioner recorded the problems managed at 347 video-taped doctor-patient contacts. Two observers independently viewed the video-tapes and completed a recording form for each. Problems were centrally coded, using the International Classification of Primary Care (ICPC). Setting - Primary health care. Main outcome measures - Overall distribution of the morbidity; positive agreement regarding the morbidity managed at matched contacts at three levels of specificity (chapter; chapter-component; specific rubric); agreement taking negative agreement into account using Cohen's Kappa. Results - Overall distribution of morbidity did not differ between observers. Positive mean agreement was 78.8% at chapter level, 69.6% at chapter-component, and 55.9% at rubric level. Kappa statistics showed agreement better than chance in all chapters, but failed to reach significance at rubric level in three chapters. Conclusion - Morbidity data actively collected by GPs provide a reliable overview of morbidity managed in general practice. At a specific contact the morbidity recorded is reliable and valid at chapter level, and in most cases, at chapter-component level. At rubric level variance between practitioners in labelling the problem calls into question the validity and reliability of the data.