Bar charts enhance Bland–Altman plots when value ranges are limited

ObjectiveA common form of validation study compares alternative methods for collecting data. The Bland-Altman plot pairs observations across methods and plots their mean values vs. their difference. This method provides only limited information, however, when the range of observed values is small relative to the number of observations. This brief report shows how adding a simple bar chart to a Bland–Altman plot adds essential additional information.Study Design and SettingThe methodological approach is illustrated using data from a randomized controlled clinical trial of patients in a U.S. county health system.ResultsWhen the number of unique values is small, a Bland–Altman plot alone may provide inadequate information. Adding a bar chart yields new and essential information about agreement, bias, and heteroscedasticity.ConclusionStudies validating one data-collection method against another can be performed successfully even when the number of unique values is small.