Concordance of self- and program-reported rates of cardiac rehabilitation referral, enrollment and participation

BACKGROUND: Despite potential bias, researchers often rely on patient self-reported data of health care use. However, the validity and accuracy of self-reported data on cardiac rehabilitation (CR) use are unknown.OBJECTIVE: To assess the concordance between patient self-report and site-verified CR referral, enrollment and participation.METHODS: A consecutive sample of 661 coronary artery disease inpatients (mean [+/- SD] age 61.27 +/- 1.31 years; 157 women [23.8 %]) treated at three acute care sites was recruited (75 % response rate) as part of a larger study comparing automatic with usual referral methods. CR referral, enrollment (attendance at intake assessment) and participation (percentage of program attended) were discerned in a mailed survey nine months following discharge (n=506; 84.3 % retention). A total of 24 CR sites were contacted for verification.RESULTS: A total of 276 participants (54.5 %) self-reported CR referral, and CR sites verified receipt of 262 referrals (51.8 %) (Cohen's kappa 0.899). A total of 232 participants (45.8 %) self-reported CR enrollment, with site-verification for 208 participants (41.1 %) (Cohen's kappa 0.846). Self-reported data indicated that participants attended a mean of 81.78 +/- 25.84 % of prescribed CR sessions, with CR sites reporting that participants completed 80.75 +/- 31.27 % of the program (r=0.662; P < 0.001). Equivalency testing revealed that the self-reported and site-verified rates of program participation were equivalent (z < 1.96).CONCLUSIONS: The almost perfect agreement between the self-reported and site-verified use of CR services suggests that self-administered items are highly valid in this population.