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Accuracy of Parental Report and Electronic Health Record Documentation as Measures of Diet and Physical Activity Counseling

  • Ulfat Shaikh
    Correspondence
    Address correspondence to Ulfat Shaikh, MD, MPH, MS, Department of Pediatrics, University of California, Davis School of Medicine, 2516 Stockton Blvd., Room 335 Sacramento, Calif 95817.
    Affiliations
    Department of Pediatrics (Drs. Shaikh, Tancredi, Romano), Department of Internal Medicine (Dr. Romano), University of California, Davis School of Medicine, Sacramento, Calif; Graduate Group in Epidemiology (Ms. Nettiksimmons), Departments of Communication and Public Health Sciences (Dr. Bell), University of California, Davis, Davis, Calif; Center for Healthcare Policy and Research, Sacramento, Calif (Dr. Tancredi)
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  • Jasmine Nettiksimmons
    Affiliations
    Department of Pediatrics (Drs. Shaikh, Tancredi, Romano), Department of Internal Medicine (Dr. Romano), University of California, Davis School of Medicine, Sacramento, Calif; Graduate Group in Epidemiology (Ms. Nettiksimmons), Departments of Communication and Public Health Sciences (Dr. Bell), University of California, Davis, Davis, Calif; Center for Healthcare Policy and Research, Sacramento, Calif (Dr. Tancredi)
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  • Robert A. Bell
    Affiliations
    Department of Pediatrics (Drs. Shaikh, Tancredi, Romano), Department of Internal Medicine (Dr. Romano), University of California, Davis School of Medicine, Sacramento, Calif; Graduate Group in Epidemiology (Ms. Nettiksimmons), Departments of Communication and Public Health Sciences (Dr. Bell), University of California, Davis, Davis, Calif; Center for Healthcare Policy and Research, Sacramento, Calif (Dr. Tancredi)
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  • Daniel Tancredi
    Affiliations
    Department of Pediatrics (Drs. Shaikh, Tancredi, Romano), Department of Internal Medicine (Dr. Romano), University of California, Davis School of Medicine, Sacramento, Calif; Graduate Group in Epidemiology (Ms. Nettiksimmons), Departments of Communication and Public Health Sciences (Dr. Bell), University of California, Davis, Davis, Calif; Center for Healthcare Policy and Research, Sacramento, Calif (Dr. Tancredi)
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  • Patrick S. Romano
    Affiliations
    Department of Pediatrics (Drs. Shaikh, Tancredi, Romano), Department of Internal Medicine (Dr. Romano), University of California, Davis School of Medicine, Sacramento, Calif; Graduate Group in Epidemiology (Ms. Nettiksimmons), Departments of Communication and Public Health Sciences (Dr. Bell), University of California, Davis, Davis, Calif; Center for Healthcare Policy and Research, Sacramento, Calif (Dr. Tancredi)
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Published:January 03, 2012DOI:https://doi.org/10.1016/j.acap.2011.10.004

      Abstract

      Objective

      To determine whether parental reports and electronic health record documentation of physician counseling on nutrition and physical activity reflect actual counseling provided.

      Methods

      Participants were parents of 198 children 2 to 12 years of age seen in a primary care pediatric clinic at an academic medical center for well child care and their 38 physicians. Parents completed a post-visit questionnaire to report discussions on weight, nutrition, and physical activity that occurred during the visit. Electronic health records were reviewed to measure documentation of these topics during the visit. Parental reports and records were compared with actual discussions on the basis of coded audiotapes. Counseling was coded as having occurred if specific topics were mentioned during the encounter, however brief this mention was.

      Results

      A total of 48% of the children were female, they were a mean age of 5.4 years, and 28% were overweight or obese. Sensitivity of parental report was high (63%–96%), but specificity was low (43%–77%) because of parents’ tendency to overreport counseling. Sensitivity of electronic health record documentation was generally low (40%–53%) except for discussion of screen time (92%) and physical activity (88%); the specificity of these data was also poor (42% and 21%, respectively, for screen time and physical activity).

      Conclusions

      Electronic health record documentation may not be the most valid method of measuring physician counseling on weight, nutrition, and physical activity in pediatric primary care. Parental report via the use of a questionnaire administered immediately after the visit is a better alternative in quality improvement or research studies when resources do not allow for direct observation, with the caveat that parents may overreport whether counseling was provided.

      Keywords

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