@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} }