International Journal for Quality in Health Care 11:187-192 (1999)
© 1999 International Society for Quality in Health Care
Evidence of self-report bias in assessing adherence to guidelines
0 Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA
1 Canadian Health Services Research Foundation, Ottawa, Canada
z Corresponding author at: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 126 Brookline Avenue, Suite 200 Boston, MA 02215, USA. E-mail: stephen_soumerai@hms.harard.edu
Objective: To assess trends in the use of self-report measures in research on adherence to practice guidelines since 1980, and to determine the impact of response bias on the validity of self-reports as measures of quality of care.
Methods: We conducted a MEDLINE search using defined search terms for the period 1980 to 1996. Included studies evaluated the adherence of (e.g. medical records), we compared self-reported and objective adherence rates (measured as per cent adherence). Evidence or response bias was defined as self-reported adherence significantly exceeding the objective measure at the 5% level.
Results: We identified 326 studies of guideline adherence. The use of self-report measures of adherence increased from 18% of studies in 1980 to 41% of studies in 1985. Of the 10 studies that used both self-report and objective measurers, eight supported the existence of response bias in all self-reported measures. In 87% of 37 comparisons, self-reported adherence rates exceeded the objective rates, resulting in a median over-estimation of adherence of 27% (absolute difference).
Conclusions: Although self-reports may provide information regarding clinicians' knowledge of guideline recommendations, they are subject to bias and should not be used as the sole measure of guideline adherence.
Key words: clinical competence, physician practice patterns, practice guidelines, process assessment, quality assurance, quality of care measurement
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