The Procedural Validity of Retrospective Case Note Diagnosis

Mihalopoulos, Cathrine; McGorry, Patrick D.; Roberts, Susan B.; McFarlane, Colleen A.

doi:10.1046/j.1440-1614.2000.00649.x

Cited by 12 publications

(11 citation statements)

References 22 publications

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“…The present data are at variance with Mihalopoulos et al [29] . These authors reported substantially poorer agreement between diagnoses obtained by OPCRIT ratings, based upon clinical records, and diagnoses obtained by different clinical research instruments and checklists based upon research interviews compared with the concordance estimates between the different diagnoses obtained by interview data.…”

Section: Discussionsupporting

confidence: 85%

“…The discrepancy between their study and our study is most likely an effect of the different patient materials. Mihalopoulos et al [29] investigated patients with their fi rst episode of the illness, whereas the present study mainly consisted of patients treated for many years. Thus, the medical records in the present study are likely to be much more informative than the records analysed in the Australian study.…”

Section: Discussionmentioning

confidence: 99%

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Characterization of Patients with Schizophrenia and Related Psychoses: Evaluation of Different Diagnostic Procedures

et al. 2006

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Background: We aimed at estimating the value of structured interviews, medical records and clinical diagnoses for assessing lifetime diagnosis of patients with schizophrenia. In addition, the validity of the Operational Criteria Checklist (OPCRIT) system was analysed. Sampling and Methods: Swedish patients (n = 73), diagnosed with schizophrenia and related disorders by their treating physician, were scrutinized. Independent research diagnoses according to the Diagnostic and Statistical Manual, ed. 3, revised (DSM-III-R) were obtained by (1) a structured interview; (2) the OPCRIT algorithm, based on record analysis only; (3) the OPCRIT algorithm, based on record and interview analysis, or (4) a separate traditional research diagnosis based on both record and interview analysis. In addition, clinical International Classification of Diseases (ICD) diagnoses, given by the treating physician, were obtained from the case notes. Concordance rates for the different psychosis diagnoses were calculated. Results: Diagnoses based on interviews only showed poor to fair agreement with the other research diagnoses, but patients diagnosed with schizophrenia or schizophrenic psychoses (i.e. schizophrenia, schizophreniform or schizoaffective disorder) at the interview almost always also obtained a corresponding research diagnosis based on record or combined sources. Diagnoses based on records only showed a good to excellent agreement with diagnoses based on records and interviews. Clinical ICD diagnoses generally displayed poor agreement with the research diagnoses, but 94% of patients ever given a clinical ICD diagnosis of schizophrenic psychosis received a corresponding traditional research diagnosis. OPCRIT diagnoses and independently assigned research diagnoses, based on the same information, displayed excellent concordance. Conclusions: Structured interviews performed with Swedish long-term-treated psychosis patients during non-hospitalization are a poor source for the evaluation of psychosis diagnoses, but a good screening instrument for the detection of DSM-III-R schizophrenia. In the investigated population, medical records are a valuable source for diagnostic assessment of psychoses and may serve as a stand-alone procedure in this patient category. Swedish clinical ICD diagnoses have a high positive predictive power identifying DSM-III-R diagnoses of schizophrenic psychoses, indicating validity of register-based research focusing on these diagnoses. The OPCRIT system is a valid tool for assessing DSM-III-R psychosis diagnoses. It should be emphasized that the present conclusions are based on the investigated Swedish psychosis population and cannot be generalized to populations composed of other patient groups or sampled in other settings, with other traditions regarding the use and availability of medical records.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Characterization of Patients with Schizophrenia and Related Psychoses: Evaluation of Different Diagnostic Procedures

et al. 2006

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“…The mean kappa value from four studies (Azevedo et al ., ; Ekholm et al ., ; Mihalopoulos et al ., ; Vares et al ., ) was 0.72 (range 0.32–0.88, n = 392) indicating “substantial” agreement. One study reported several values for sensitivity and specificity the means of which were 0.98 and 1.00, respectively (Vares et al ., ).…”

Section: Resultsmentioning

confidence: 99%

“…The mean kappa across seven studies (Craddock et al ., ; Ekholm et al ., ; Isohanni et al ., ; Lazartigues et al ., ; Makikyro et al ., ; Mihalopoulos et al ., ; Vares et al ., ) was 0.60 (range 0.27–0.89, n = 605), indicating agreement at the top‐end of the “moderate” banding. The most commonly used classificatory system in these studies was DSM.…”

Section: Resultsmentioning

confidence: 99%

A review of the reliability and validity of OPCRIT in relation to its use for the routine clinical assessment of mental health patients

Brittain

Ståhl

Rucker

et al. 2013

Int J Methods Psych Res

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The OPCRIT program is a symptom checklist with accompanying algorithms producing operationally defined diagnoses. We undertook a review of studies which had used OPCRIT and had reported statistics concerning its reliability and validity, producing summary measures from 44 studies. The first main measure of interest was inter-rater reliability where mean kappa values indicated that agreement between raters was "substantial" with a marginal improvement at the diagnostic (0.76) versus individual item (0.69) level. The second main measure of interest was convergent validity - the agreement between OPCRIT and clinical diagnoses. Most studies reported these figures as concordance rates suggesting mean agreement, unadjusted for chance, of 69%. Very few studies used the chance-adjusted kappa statistic but where this was used agreement was "fair" (0.39). Agreement between OPCRIT and other research diagnoses was "moderate" (0.60). We also considered differences between the way OPCRIT has traditionally been used in research settings and the naturalistic manner in which it will be employed in the hospital ward. This review provides a summary of the reliability and validity of OPCRIT, which will be considered during the preparation for its use in the routine characterization of mental health patients in clinical settings.

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“…Although the OPCRIT is considered a reliable and well-validated tool, its design was primarily for extracting diagnostic information from case notes. Its use in retrospective data collection and as a mechanism for scaling symptom severity is open to challenge 15 and one cannot exclude the inadvertent biases introduced during the rating process. Two of the authors (S.N.S.…”

Section: Discussionmentioning

confidence: 99%

Unheard voices: outcomes of tertiary care for treatment-refractory psychosis

et al. 2014

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Aims and method In up to a quarter of patients, schizophrenia is resistant to standard treatments. We undertook a naturalistic study of 153 patients treated in the tertiary referral in-patient unit of the National Psychosis Service based at the Maudsley Hospital in London. A retrospective analysis of symptoms on admission and discharge was undertaken using the OPCRIT tool, along with preliminary economic modelling of potential costs related to changes in accommodation.Results In-patient treatment demonstrated statistically significant improvements in all symptom categories in patients already identified as having schizophrenia refractory to standard secondary care. The preliminary cost analysis showed net savings to referring authorities due to changes from pre- to post-discharge accommodation.Clinical implications Despite the enormous clinical, personal and societal burden of refractory psychotic illnesses, there is insufficient information on the outcomes of specialised tertiary-level care. Our pilot data support its utility in all domains measured.

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The Procedural Validity of Retrospective Case Note Diagnosis

Abstract: The procedural validity of diagnoses assigned via the application of checklists of operational criteria to case notes and clinical abstracts alone is unacceptably poor. Such sources need to be buttressed by other data, particularly direct patient interview and informant material.

Cited by 12 publications

References 22 publications

Characterization of Patients with Schizophrenia and Related Psychoses: Evaluation of Different Diagnostic Procedures

Characterization of Patients with Schizophrenia and Related Psychoses: Evaluation of Different Diagnostic Procedures

A review of the reliability and validity of OPCRIT in relation to its use for the routine clinical assessment of mental health patients

Unheard voices: outcomes of tertiary care for treatment-refractory psychosis

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