Population Colorectal Cancer Screening Estimates: Comparing Self-Report to Electronic Health Record Data in California. International journal of cancer prevention Palaniappan, L. P., Maxwell, A. E., Crespi, C. M., Wong, E. C., Shin, J., Wang, E. J. 2011; 4 (1)


INTRODUCTION: Population-based surveys are used to assess colorectal cancer (CRC) screening rates, but may be subject to self-report biases. Clinical data from electronic health records (EHR) are another data source for assessing screening rates and self-report bias; however, use of EHR data for population research is relatively new. We sought to compare CRC screening rates from a self-report survey, the 2007 California Health Interview Survey (CHIS), to EHR data from Palo Alto Medical Foundation (PAMF), a multi-specialty healthcare organization serving three counties in California. METHODS: Ever- and up-to-date CRC screening rates were compared between CHIS respondents (N=18,748) and PAMF patients (N=26,283). Both samples were limited to English proficient subjects aged 51-75 with health insurance and a physician visit in the past two years. PAMF rates were age-sex standardized to the CHIS population. Analyses were stratified by racial/ethnic group. RESULTS: EHR data included PAMF internally completed tests (84%), and patient-reported externally completed tests which were either confirmed (7%) or unconfirmed (9%) by a physician. When excluding unconfirmed tests, PAMF screening rates were 6-14 percentage points lower than CHIS rates, for both ever- and up-to-date CRC screening among Non-Hispanic White, Black, Hispanic/Latino, Chinese, Filipino and Japanese subjects. When including unconfirmed tests, differences in screening rates between the two data sets were minimal. CONCLUSION: Comparability of CRC screening rates from survey data and clinic-based EHR data depends on whether or not unconfirmed patient-reported tests in EHR are included. This indicates a need for validated methods of calculating CRC screening rates in EHR data.

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