Medical record bias in documentation of obstetric and neonatal clinical quality of care indicators in Uganda.

Journal Article (Journal Article)


To achieve a high quality of care (QoC), accurate measurements are needed. This study evaluated the validity of QoC data from the medical records for childbirth deliveries and assessed whether medical records can be used to evaluate the efficacy of interventions to improve QoC.

Study design and setting

This study was part of a larger study of QoC training program in Uganda. Study data were collected in two phases: (1) validation data from 321 direct observations of deliveries paired with the corresponding medical records; (2) surveillance data from 1,146 medical records of deliveries. Sensitivity, specificity, and predictive values were used to measure the validity of the medical record from the validation data. Quantitative bias analysis was conducted to evaluate QoC program efficacy in the surveillance data using prevalence ratio and odds ratio.


On average, sensitivity (84%) of the medical record was higher than the specificity (34%) across 11 QoC indicators, showing a higher validity in identifying the performed procedure. For 5 out of 11 indicators, bias-corrected odds ratios and prevalence ratios deviated significantly from uncorrected estimates.


The medical records demonstrated poor validity in measuring QoC compared with direct observation. Using the medical record to assess QoC program efficacy should be interpreted carefully.

Full Text

Duke Authors

Cited Authors

  • Kim, MK; Baumgartner, JN; Headley, J; Kirya, J; Kaggwa, J; Egger, JR

Published Date

  • August 2021

Published In

Volume / Issue

  • 136 /

Start / End Page

  • 10 - 19

PubMed ID

  • 33667620

Electronic International Standard Serial Number (EISSN)

  • 1878-5921

International Standard Serial Number (ISSN)

  • 0895-4356

Digital Object Identifier (DOI)

  • 10.1016/j.jclinepi.2021.02.024


  • eng