@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 {7825, title = {Patterns of older Americans{\textquoteright} health care utilization over time.}, journal = {Am J Public Health}, volume = {103}, year = {2013}, month = {2013 Jul}, pages = {1314-24}, publisher = {103}, abstract = {

OBJECTIVES: We analyzed correlates of older Americans{\textquoteright} continuous and transitional health care utilization over 4 years.

METHODS: We analyzed data for civilian, noninstitutionalized US individuals older than 50 years from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of persistent and intermittent use of physician, inpatient hospital, home health, and outpatient surgery over the 2004-2008 survey periods.

RESULTS: Individuals with worse or worsening health were more likely to persistently use medical care and transition into care and not transition out of care over time. Financial variables were less often significant and, when significant, were often in an unexpected direction.

CONCLUSIONS: Older individuals{\textquoteright} health and changes in health are more strongly correlated with persistence of and changes in care-seeking behavior over time than are financial status and changes in financial status. The more pronounced sensitivity to health status and changes in health are important considerations in insurance and retirement policy reforms.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Delivery of Health Care, Female, Health Services, Health Status, Health Surveys, Home Care Services, Hospitalization, Humans, Income, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Middle Aged, Office Visits, Patient Acceptance of Health Care, Time Factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2012.301124}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and Patricia A St Clair and John V Pepper} } @article {7433, title = {Surgery as a teachable moment for smoking cessation.}, journal = {Anesthesiology}, volume = {112}, year = {2010}, month = {2010 Jan}, pages = {102-7}, publisher = {112}, abstract = {

BACKGROUND: A "teachable moment" is an event that motivates spontaneous behavior change. Some evidence suggests that major surgery for a smoking-related illness can serve as a teachable moment for smoking cessation. This study tested the hypotheses that surgery increases the likelihood of smoking cessation and that cessation is more likely after major surgical procedures compared with outpatient surgery.

METHODS: Secondary analyses were performed of longitudinal biennial survey data (1992-2004) from the nationally representative Health and Retirement Study of U.S. adults older than 50 yr, determining the relationship between the incidence of smoking cessation and the occurrence of surgery.

RESULTS: Five thousand four hundred ninety-eight individuals reported current smoking at enrollment, and 2,444 of them (44.5\%) quit smoking during the period of examination. The incidence of quitting in smokers undergoing major surgery was 20.6/100 person-years of follow-up and 10.2/100 person-years in those undergoing outpatient surgery. In a multivariate negative binomial regression model, the incidence rate ratio of quitting associated with major surgery was 2.02 (95\% CI: 1.67-2.44) and that of those associated with outpatient surgery was 1.28 (95\% CI: 1.09-1.50). Estimates derived from national surgical utilization data show that approximately 8\% of all quit events in the United States annually can be attributed to the surgical procedures analyzed.

CONCLUSIONS: Undergoing surgery is associated with an increased likelihood of smoking cessation in the older U.S. population. Cessation is more likely in association with major procedures compared with outpatient surgery. These data support the concept that surgery is a teachable moment for smoking cessation.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Analysis of Variance, Cohort Studies, Female, Follow-Up Studies, General Surgery, Humans, Longitudinal Studies, Male, Middle Aged, Patient Education as Topic, Regression Analysis, Smoking cessation, Treatment Outcome, United States}, issn = {1528-1175}, doi = {10.1097/ALN.0b013e3181c61cf9}, author = {Yu Shi and David O. Warner} } @article {6881, title = {Health care utilization among older adults with arthritis.}, journal = {Arthritis Rheum}, volume = {49}, year = {2003}, month = {2003 Apr 15}, pages = {164-71}, publisher = {49}, abstract = {

OBJECTIVE: To evaluate the effect of arthritis on subsequent 2-year use of health care services and out-of-pocket costs among older adults and determine if comorbidities or economic resources mitigate that effect.

METHODS: Data were analyzed from 6230 participants interviewed in 1993 and 1995 in the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults. Baseline arthritis status was ascertained from the report of an arthritis-related physician{\textquoteright}s visit or a joint replacement not associated with a hip fracture. The effect of baseline arthritis on the odds of subsequent 2-year health care utilization and high out-of-pocket expenses were estimated from multiple logistic regression controlling for demographic factors, comorbidity, and economic resources.

RESULTS: Older adults with arthritis are significantly more likely to have a physician visit (odds ratio [OR] 3.0), hospital admission (OR 1.6), outpatient surgery (OR 1.3), receive home health care (OR 1.6), and have out-of-pocket cost >5000 US dollars (OR 1.6) compared with contemporaries having similar demographics (age, sex, racial/ethnic group, marital status), comorbid conditions, and economic resources (education, income, wealth, health insurance), but not reporting arthritis.

CONCLUSIONS: Older adults with symptomatic arthritis reported greater medical utilization and cost compared with people not reporting arthritis. These disparities persisted after accounting for differences in demographics, comorbidities, and economic factors. These findings document greater economic burdens on a personal and societal level among people with arthritis. As individuals, older adults with arthritis spend more out-of-pocket dollars for health care than their contemporaries without arthritis. On a societal level, these findings of greater health care utilization among people with arthritis point to increasing future demands on the US health care system due to demographic increases in the numbers of older adults with arthritis and support policies aimed at improving arthritis prevention and treatment as well as reducing the economic disparities between those with and without arthritis.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Arthritis, Comorbidity, Cost of Illness, Female, Health Services, Home Care Services, Hospitals, Humans, Insurance, Health, Longitudinal Studies, Male, Nursing homes, Physicians{\textquoteright} Offices, Social Class}, issn = {0004-3591}, doi = {10.1002/art.11003}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} }