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Evaluation of the ambulatory and home care record: Agreement between self-reports and administrative data

Published online by Cambridge University Press:  28 March 2006

Denise N. Guerriere
University of Toronto
Wendy J. Ungar
University of Toronto and The Hospital for Sick Children
Mary Corey
University of Toronto and The Hospital for Sick Children
Ruth Croxford
Sunnybrook and Women's College Health Sciences Centre
Jennifer E. Tranmer
University of Toronto
Elizabeth Tullis
University of Toronto and St. Michael's Hospital
Peter C. Coyte
University of Toronto


Objectives: Although measuring the utilization of ambulatory and home-based healthcare resources is an essential component of economic analyses, very little methodological attention has been devoted to the development and evaluation of resource costing tools. This study evaluated a newly developed tool, the Ambulatory and Home Care Record (AHCR), which comprehensively evaluates costs incurred by the health system and care recipients and their unpaid caregivers.

Methods: The level of agreement between self-reports from 110 cystic fibrosis care recipients and administrative data was assessed for four categories of health services: home-based visits with healthcare professionals, ambulatory visits with healthcare professionals, laboratory and diagnostic tests, and prescription medications.

Results: Agreement between care recipients' reports on the AHCR and administrative data ranged from moderate (kappa=0.41; 95 percent confidence interval, 0.16–0.61) for physician specialist visits to perfect (kappa=1.0) for physiotherapy visits.

Conclusions: By evaluating and standardizing a resource and costing tool, such as the AHCR, economic evaluations may be improved and comparisons of the resource implications for different services and for diverse populations are possible.

© 2006 Cambridge University Press

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Aday LA. 1996. Designing and conducting health surveys: A comprehensive guide. 2nd ed. Indianapolis, IN: Jossey-Bass Publishers;
Aday LA, Wegner DH, Andersen RM, et al. 1989 Home care for ventilator-assisted children. Health Aff (Millwood). 8: 137147.Google Scholar
Bartholomew L, Parcel G, Seilheimer D, et al. 1991 Development of a health education program to promote the self-management of cystic fibrosis. Health Educ Q. 18: 42294243.Google Scholar
Browne G, Arpin K, Corey P, et al. 1990 Individual correlates of health service utilization and the cost of poor adjustment to chronic illness. Med Care. 28: 4358.Google Scholar
Browne GB, Roberts J, Weir R, et al. 1995. The cost of poor adjustment to chronic illness: Lessons from three studies. Working Paper Series: Health and Social Care 2, System-Linked Research Unit;
Coast J, Richards SH, Peters TJ, et al. 1998 Hospital at home or acute hospital care: A cost minimisation analysis. BMJ. 316: 18021806.Google Scholar
Davis P, Drumm M, Konstan M. 1996 Cystic Fibrosis. Am J Respir Crit Care Med. 154: 12291256.Google Scholar
Donner A, Eliasziw M. 1992 A goodness-of-fit approach to inference procedures for the kappa statistic: Confidence interval construction, significance-testing and sample size estimation. Stat Med. 11: 15111519.Google Scholar
Donner A, Eliasziw M. 1987 Sample size requirements for reliability studies. Stat Med. 6: 441448.Google Scholar
Dougherty GE, Soderstrom L, Schiffrin A. 1998 An economic evaluation of home care for children with newly diagnosed diabetes. Med Care. 36: 586598.Google Scholar
Drummond MF, O'Brien B, Stoddard GL, et al. 1997. Methods for the economic evaluation of health care programmes. Toronto: Oxford University Press;
Feinstein AR, Cicchetti DV. 1990 High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol. 43: 543549.Google Scholar
Fitzsimmons SC. 1993 The changing epidemiology of cystic fibrosis. J Pediatr. 122: 19.Google Scholar
Fleiss JL. 1981: The measurement of interrater agreement. In: Fleiss JL, ed. Statistical methods for rates and proportions. 2nd ed. New York: John Wiley and Sons; 212236.
2000. Foundation CCF. Report of the Canadian Patient Data Registry;
Gold M, Siegel J, Russell L, et al. 1996. Cost-effectiveness in health and medicine. New York: Oxford University Press;
Guzman J, Peloso P, Bombardier C. 1999 Capturing health care utilization after occupational low-back pain: Development of an interviewer-administered questionnaire. J Clin Epidemiol. 52: 419427.Google Scholar
Hazlett DE. 1989 A study of pediatric home ventilator management: Medical, psychosocial, and financial aspects. J Pediatr Nurs. 4: 284294.Google Scholar
Landis JR, Koch GG. 1977 The measurement of observer agreement for categorical data. Biometrics. 33: 159174.Google Scholar
Landry J, Smyer M, Tubman J, et al. 1988 Validation of two methods of data collection of self-reported medicine use among the elderly. Gerontologist. 28: 672676.Google Scholar
Law MG, Hurley SF, Carlin JB, et al. 1996 A comparison of patient interview data with pharmacy and medical records for patients with acquired immunodeficiency syndrome or human immunodeficiency virus infection. J Clin Epidemiol. 49: 9971002.Google Scholar
Leister KA, Edwards WA, Christensen DB, et al. 1981 A comparison of patient drug regimens as viewed by the physician, pharmacist and patient. Med Care. 19: 658664.Google Scholar
Leonard B, Brust JD, Sapienza JJ. 1992 Financial and time costs to parents of severely disabled children. Public Health Rep. 107: 302312.Google Scholar
McAleese KA, Knapp MA, Rhodes TT. 1993 Financial and emotional cost of bronchopulmonary dysplasia. Clin Pediatr (Phila). 32: 393400.Google Scholar
McCance K, Huether S. 1991. Pathophysiology: The biological basis for disease in adults and children. Toronto: C.V. Mosby Company;
Norrish A, North D, Kirkman P, et al. 1994 Validity of self-reported hospital admission in a prospective study. Am J Epidemiol. 140: 938942.Google Scholar
Paganini-Hill A, Ross RK. 1982 Reliability of recall of drug usage and other health-related information. Am J Epidemiol. 116: 114122.Google Scholar
Ramsey B. 1996 Management of pulmonary disease in patients with cystic fibrosis. N Engl J Med. 355: 179188.Google Scholar
Roberts R, Bergstralh E, Schmidt L, et al. 1996 Comparison of self-reported and medical record health care utilization measures. J Clin Epidemiol. 49: 989995.Google Scholar
Shepperd S, Harwood D, Gray A, et al. 1998 Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: Cost minimisation analysis. BMJ. 316: 17911796.Google Scholar
Stevens B, Stockwell M, Browne G, et al. 1995 Evaluation of a home-based traction program for children with congenital dislocated hips and Legg Perthes disease. Can J Nurs Res. 27: 133150.Google Scholar
Stommel M, Given C, Given B. 1992 The cost of cancer home care to families. Cancer. 71: 18671874.Google Scholar
Sullivan SD, Ramsey SD, Lee TA. 2000 The economic burden of COPD. Chest. 117 (Suppl): 5S9S.Google Scholar
Szucs TD, Anderhub H, Rutishauser M. 1999 The economic burden of asthma: Direct and indirect costs in Switzerland. Eur Respir J. 13: 281286.Google Scholar
Terreri M, Ferraz M, Goldenberg J, et al. 2001 Resource utilization and cost of rheumatic fever. J Rheumatol. 28: 13941397.Google Scholar
Ungar WJ, Coyte PC, The Pharmacy Medication Monitoring Program Advisory Board. 1998 Health services utilization reporting in respiratory patients. J Clin Epidemiol. 51: 13351342.Google Scholar
Wiktorowicz M, Goeree R, Papaioannou A, et al. 2001 Economic implications of hip fracture: Health service use, institutional care and cost in Canada. Osteoporos Int. 12: 271278.Google Scholar
Wolf E, Penchas S, Werczberger A, et al. 1997 Home care therapy for respirator-dependant patients. Isr J Med Sci. 29: 617623.Google Scholar
Yates B. 1997. Analyzing costs, procedures, processes and outcomes in human services. California: Sage Publications;