Highlights
- •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.
Abstract
Objective
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).
Design
Longitudinal observational study.
Setting
Participants' homes.
Participants
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.
Interventions
Not applicable.
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.
Results
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.
Conclusions
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.
Keywords
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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The Uniform Data System for Medical Rehabilitation: report of patients with lower limb joint replacement discharged from rehabilitation programs in 2000-2007.Am J Phys Med Rehabil. 2010; 9: 781-794
- The Uniform Data System for Medical Rehabilitation: report of patients with hip fracture discharged from comprehensive medical programs in 2000-2007.Am J Phys Med Rehabil. 2011; 90: 177-189
- The state of the science: access to postacute care rehabilitation services.Arch Phys Med Rehabil. 2007; 88: 1513-1521
- Findings from the 1st round of the National Health and Aging Trends Study (NHATS): introduction to the special issue.J Gerontol B Psychol Sci Soc Sci. 2014; 69: S1-S7
- Validation of new measures of disability and functioning in the National Health and Aging Trends Study.J Gerontol A Biol Med Sci. 2011; 66: 1013-1021
- Total survey error.Jossey-Bass, San Francisco1979
- Measuring resource utilization: a systematic review of validated self-reported questionnaires.Medicine (Baltimore). 2016; 95e2759
- Validating household reports of health care use in the Medical Expenditure Panel Survey.Health Serv Res. 2009; 44: 1679-1700
- The accuracy of self-reported healthcare resource utilization in health economic studies.Int J Technol Assess Health Care. 2002; 18: 705-710
- Self-report was a viable method for obtaining health care utilization data in community-dwelling seniors.J Clin Epidemiol. 2005; 58: 286-290
- Comparison of self-reported and medical record health care utilization measures.J Clin Epidemiol. 1996; 49: 989-995
- Rehabilitation services use and patient-reported outcomes among older adults in the United States.Arch Phys Med Rehabil. 2017; 98: 2221-2227
- A Primer on Medicare: key facts about the Medicare program and the people it covers. Kaiser Family Foundation Report; March 2015.(Available at:)http://files.kff.org/attachment/report-a-primer-on-medicare-key-facts-about-the-medicare-program-and-the-people-it-coversDate accessed: November 24, 2017
- National Health and Aging Trends Study Development of Round 5 Survey Weights.Johns Hopkins Univ School of Public Health, Baltimore2016 (NHATS Technical Paper #14. Available at:)https://www.nhats.org/scripts/documents/NHATS_Round5_WeightsTechnicalPaper_Revised_12_12_17.pdfDate accessed: June 11, 2017
- Diagnostic tests 1: sensitivity and specificity.Br Med J. 1994; 308: 1552
- Diagnostic tests 2: predictive values.Br Med J. 1994; 303: 102
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Applied logistic regression.Wiley, New York2013
- Analysis of Medicare Advantage HMOs compared with traditional Medicare shows lower use of many services during 2003-09.Health Aff (Millwood). 2012; 31: 2609-2617
- March 2017 Report to Congress: Medicare Payment Policy. Chapter 10: Inpatient rehabilitation facility services (March 2017 report).(Available at:)http://www.medpac.gov/-documents-/reportsDate accessed: June 26, 2017
Article info
Publication history
Published online: April 10, 2018
Footnotes
Supported by the National Institutes of Health (grant no. U01-AG-032947).
Disclosures: The authors are National Health and Aging Trends Study investigators.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
