@article {8551, title = {Does the Relationship of the Proxy to the Target Person Affect the Concordance between Survey Reports and Medicare Claims Measures of Health Services Use?}, journal = {Health Serv Res}, volume = {51}, year = {2016}, month = {2016 Feb}, pages = {314-27}, abstract = {

OBJECTIVES: To compare concordance of survey reports of health service use versus claims data between self respondents and spousal and nonspousal relative proxies.

DATA SOURCES: 1995-2010 data from the Survey on Assets and Health Dynamics among the Oldest Old and 1993-2010 Medicare claims for 3,229 individuals (13,488 person-years).

STUDY DESIGN: Regression models with individual fixed effects were estimated for discordance of any hospitalizations and outpatient surgery and for the numbers of under- and over-reported physician visits.

PRINCIPAL FINDINGS: Spousal proxies were similar to self respondents on discordance. Nonspousal proxies, particularly daughters/daughters-in-law and sons/sons-in-law, had less discordance, mainly due to reduced under-reporting.

CONCLUSIONS: Survey reports of health services use from nonspousal relatives are more consistent with Medicare claims than spousal proxies and self respondents.

}, keywords = {Ambulatory Surgical Procedures, Female, Hospitalization, Humans, Insurance Claim Review, Male, Medicare, Patient Acceptance of Health Care, Proxy, Self Report, Socioeconomic factors, Spouses, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12321}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26059195}, author = {George L Wehby and Michael P Jones and Fred A Ullrich and Yiyue Lou and Frederic D Wolinsky} } @article {8677, title = {A pilot study among older adults of the concordance between their self-reports to a health survey and spousal proxy reports on their behalf.}, journal = {BMC Health Serv Res}, volume = {16}, year = {2016}, month = {2016 09 09}, pages = {485}, abstract = {

BACKGROUND: Proxy respondents are frequently used in health surveys, and the proxy is most often the spouse. Longstanding concerns linger, however, about the validity of using spousal proxies, especially for older adults. The purpose of this pilot study was to evaluate the concordance between self-reports and spousal proxy reports to a standard health survey in a small convenience sample of older married couples.

METHODS: We used the Seniors Together in Aging Research (STAR) volunteer registry at the University of Iowa to identify and consent a cross-sectional, convenience sample of 28 married husband and wife couples. Private, personal interviews with each member of the married couple using a detailed health survey based on the 2012 Health and Retirement Study (HRS) instrument were conducted using computer assisted personal interviewing software. Within couples, each wife completed the health survey first for herself and then for her husband, and each husband completed the health survey first for himself and then for his wife. The health survey topics included health ratings, health conditions, mobility, instrumental activities of daily living (IADLs), health services use, and preventative services. Percent of agreement and prevalence and bias adjusted kappa statistics (PABAKs) were used to evaluate concordance.

RESULTS: PABAK coefficients indicated moderate to excellent concordance (PABAKs >0.60) for most of the IADL, health condition, hospitalization, surgery, preventative service, and mobility questions, but only slight to fair concordance (PABAKs = -0.21 to 0.60) for health ratings, and physician and dental visits.

CONCLUSIONS: These results do not allay longstanding concerns about the validity of routinely using spousal proxies in health surveys to obtain health ratings or the number of physician and dental visits among older adults. Further research is needed in a nationally representative sample of older couples in which each wife completes the health survey first for herself and then for her husband, each husband completes the health survey first for himself and then for his wife, and both spouses{\textquoteright} Medicare claims are linked to their health survey responses to determine not just the concordance between spousal reports, but the concordance of those survey responses to the medical record.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Epidemiologic Methods, Female, Health Status, Hospitalization, Humans, Iowa, Male, Medicare, Middle Aged, Patient Acceptance of Health Care, Physicians, Proxy, Spouses, United States}, issn = {1472-6963}, doi = {10.1186/s12913-016-1734-6}, author = {Frederic D Wolinsky and Ayres, Lioness and Michael P Jones and Yiyue Lou and George L Wehby and Fred A Ullrich} } @article {8522, title = {Predictors of bone mineral density testing among older women on Medicare.}, journal = {Osteoporos Int}, volume = {27}, year = {2016}, month = {2016 12}, pages = {3577-3586}, abstract = {

Although dual-energy X-ray absorptiometry (DXA) is recommended for all women >=65 and is covered by Medicare, 40~\% of women on Medicare report never having had a DXA. In a longitudinal cohort of 3492 women followed for two decades, we identified several risk factors that should be targeted to improve DXA testing rates.

INTRODUCTION: DXA is used to measure bone mineral density, screen for osteoporosis, and assess fracture risk. DXA is recommended for all women >=65~years old. Although Medicare covers DXA every 24~months for women, about 40~\% report never having had a DXA test, and little is known from prospective cohort studies about which subgroups of women have low use rates and should be targeted for interventions. Our objective was to identify predictors of DXA use in a nationally representative cohort of women on Medicare.

METHODS: We used baseline and biennial follow-up survey data (1993-2012) for 3492 women >=70~years old from the nationally representative closed cohort known as the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The survey data for these women were then linked to their Medicare claims (1991-2012), yielding 17,345 person years of observation. DXA tests were identified from the Medicare claims, and Cox proportional hazard regression models were used with both fixed and time-dependent predictors from the survey interviews including demographic characteristics, socioeconomic factors, health status, health habits, and the living environment.

RESULTS: DXA use was positively associated with being Hispanic American, better cognition, higher income, having arthritis, using other preventative services, and living in Florida or other southern states. DXA use was negatively associated with age, being African-American, being overweight or obese, having mobility limitations, and smoking.

CONCLUSIONS: Interventions to increase DXA use should target the characteristics that were observed here to be negatively associated with such screening.

}, keywords = {Absorptiometry, Photon, Aged, Bone density, Delivery of Health Care, Female, Humans, Medicare, Osteoporosis, Prospective Studies, United States}, issn = {1433-2965}, doi = {10.1007/s00198-016-3688-2}, url = {http://link.springer.com/10.1007/s00198-016-3688-2}, author = {Yiyue Lou and Edmonds, S. W. and Michael P Jones and Fred A Ullrich and George L Wehby and Cram, P. and Frederic D Wolinsky} } @article {10276, title = {Cognitive function and the concordance between survey reports and Medicare claims in a nationally representative cohort of older adults.}, journal = {Med Care}, volume = {53}, year = {2015}, month = {2015 May}, pages = {455-62}, abstract = {

BACKGROUND: While age-related cognitive decline may affect all stages in the response process--comprehension, retrieval, judgment, response selection, and response reporting--the associations between objective cognitive tests and the agreement between self-reports and Medicare claims has not been assessed. We evaluate those associations using the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD).

METHODS: Eight waves of reinterviews (1995-2010) were linked to Medicare claims for 3661 self-respondents yielding 12,313 person-period observations. Cognitive function was measured by 2 episodic memory tests (immediate and delayed recall of 10 words) and 1 mental status test (backward counting, dates, and names). Survey reports on 12 diseases and 4 health services were mapped to Medicare claims to derive counts of concordant reports, underreports, and overreports, as were the numbers of hospital episodes and physician visits. GEE negative binomial and logistic regression models were used.

RESULTS: Better mental status was associated with more concordant reporting and less underreporting on disease history and the number of hospital episodes. Better mental status and delayed word recall were associated with more concordant reporting and less underreporting on health services use. Better delayed recall was significantly associated with less underreporting on the number of physician visits. These associations were not appreciably altered by adjustment for demographic characteristics, socioeconomic status, self-rated health, or secular trends.

CONCLUSION: We recommend that future surveys of older adults include an objective measure of mental status (rather than memory), especially when those survey reports cannot be verified by access to Medicare claims or chart review.

}, keywords = {Aged, Aging, Cognition Disorders, Data collection, Female, Humans, Insurance Claim Review, Male, Medicare, Mental Health, Psychiatric Status Rating Scales, Self Report, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000338}, url = {https://www.ncbi.nlm.nih.gov/pubmed/25793268}, author = {Frederic D Wolinsky and Michael P Jones and Fred A Ullrich and Yiyue Lou and George L Wehby} } @article {9444, title = {The Concordance of Survey Reports and Medicare Claims in a Nationally Representative Longitudinal Cohort of Older Adults}, journal = {Medical Care}, volume = {52}, year = {2014}, pages = {462-468}, abstract = {Background: Concordance between survey reports and claims data is not well established. We compared them for disease histories, preventative, and other health services use in a large, nationally representative sample of older Medicare beneficiaries with special attention given to evaluating age, aging, memory, and respondent status effects. Methods: Baseline (1993) and biennial follow-up data (through 2010) from the Survey on Assets and Health Dynamics among the Oldest-Old were linked to Medicare claims from 1991 to 2010, for 4910 participants yielding 19,556 person-periods. Concordance was measured by simple, weighted, and prevalence and bias-adjusted κ, and Lin{\textquoteright}s concordance statistics. Generalized estimating equation negative binomial models were used to predict the summary counts of concordant reports, survey underreports, and survey overreports. Results: Concordance was highly variable overall, unacceptably low for arthritis and physician visits, and less than substantial for angina, heart disease, hypertension, and outpatient surgery. Generalized estimating equation negative binomial models revealed reductions in reporting accuracy (more underreporting and overreporting) associated with both age (interindividual) and aging (intraindividual) effects, countervailing memory effects on concordance due to less underreporting but more overreporting, and countervailing proxy-respondent effects on concordance due to less underreporting but more overreporting. Conclusions: Further research should explore whether these findings are time or cohort bound, address the potential heterogeneity of the proxy-respondent effects based on the reason for and relationship of the proxy to the target person, and evaluate the effects of a broader spectrum of performance-based cognitive abilities. In the interim, the significant predictors identified here should be included in future studies.}, keywords = {Medicare linkage, Medicare/Medicaid/Health Insurance, Meta-analyses, Survey Methodology}, issn = {0025-7079}, doi = {10.1097/MLR.0000000000000120}, url = {http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage\&an=00005650-201405000-00014}, author = {Frederic D Wolinsky and Michael P Jones and Fred A Ullrich and Yiyue Lou and George L Wehby} }