- •In older adults in the United States, survey-based measures accurately capture rehabilitation service use over the past year.
- •Underreporting errors were higher for black enrollees, the very old, and those with lower education levels.
- •Agreement between survey responses and claims decreases with months since use and increases with the duration of use up to 3 to 4 weeks.
To explore the accuracy of rehabilitation service use reports by older adults as well as variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home).
Longitudinal observational study.
Community-dwelling adults ages 65 and older (N=4228) in the 2015 National Health and Aging Trends Study who were enrolled in Medicare Parts A and B for 12 months before their interview.
Main Outcome Measures
Respondents were asked whether they received rehabilitation services in the past year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service.
Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the past year. Self-reported measures had high sensitivity (77%) and positive predictive value (80%) and even higher specificity and negative predictive value (approaching 95%). However, in adjusted models, sensitivity was lower for black enrollees, the very old, and those with lower education levels.
Survey-based measures of rehabilitation accurately captured use over the past year, but differential reporting should be considered when characterizing rehabilitation use in certain subgroups of older Americans.
List of abbreviations:CI (confidence interval), HCPCS (Healthcare Common Procedure Coding System), NHATS (National Health and Aging Trends Study), NPV (negative predictive value), OR (odds ratio), PPV (positive predictive value)
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Published online: April 10, 2018
Supported by the National Institutes of Health (grant no. U01-AG-032947).
Disclosures: The authors are National Health and Aging Trends Study investigators.
© 2018 by the American Congress of Rehabilitation Medicine