Validation of self-report of XXXX and pneumococcal vaccination status in elderly outpatients.

@entity1 @entity683 @entity22066 @entity347
OBJECTIVE: To assess the validity of self-reported @entity683 and pneumococcal vaccination status. DESIGN: Cross-sectional surveys of outpatients aged 65 years or older. SETTING: A Veterans Affairs Medical Center ( @entity22066 ) and a community @entity347 ( @entity347 ). Both organizations have organized @entity683 and pneumococcal vaccination programs. SUBJECTS: @entity22066 subjects included all elderly respondents to a mailed survey of 500 randomly selected outpatients. @entity347 subjects included all respondents to a telephone survey of 300 randomly selected elderly members of the @entity347 . MEASUREMENTS: The @entity22066 survey was conducted following the 1995-1996 @entity683 season while the @entity347 survey was conducted following the 1994-1995 season. Self-report from the mailed survey for @entity22066 subjects and from the telephone survey for @entity347 subjects was compared to medical record documentation (paper and computerized combined). RESULTS: The response rate was 77% (n = 369) for the @entity22066 subjects of whom 195 (53%) were aged 65 or older. The response rate for the @entity347 subjects was 84% (n = 237). Self-report of @entity683 vaccination had a sensitivity (SENS) of 1.0 and a specificity (SPEC) of .79 with a kappa of .72 (95% CI .58-.86) among @entity22066 @entity1 . Among @entity347 @entity1 , self-report of @entity683 vaccination had a SENS of .98 and a SPEC of .71 with kappa of .75 (95% CI .69-.89). Self-report of pneumococcal vaccination status among @entity22066 @entity1 had a SENS of .97 and a SPEC of .53 with a kappa of .42 (95% CI .32-.52). Among @entity347 @entity1 , self-report of pneumococcal vaccination had a SENS of .90 and a SPEC of .64 with a kappa of .54 (95% CI .40-.68). A secondary analysis excluding subjects living outside of the @entity22066 's catchment area improved the specificity and indices of concordance of self-report of both @entity683 and pneumococcal vaccination. A secondary analysis of @entity347 data which excluded subjects who received a pneumococcal vaccination > 2 years prior to the study also improved concordance and the negative predictive value of self-report. CONCLUSIONS: Self-report of @entity683 vaccination is a highly sensitive and moderately specific measure. Self-report of pneumococcal vaccination is also a highly sensitive but less specific measure of vaccination status. Lower rates of validity for pneumococcal vaccination may reflect both less accurate recall, particularly for more distant vaccination, and less complete documentation in medical records.
