self-reported utilization of health care services improving.pptVIP

Self-Reported Utilization of Health Care Services: Improving Measurement and Accuracy Aman Bhandari Todd H. Wagner Collecting Health Care Utilization Costly and time consuming No gold standard method Administrative data are incomplete / inaccurate Limited benefits Out-of-plan or out-of-pocket utilization Capitated health plans Using Self Report Primary data collection Complement to administrative data Substitute for administrative data (more attractive given HIPAA) Secondary data analyses NHIS MEPS AHEAD/HRS Study Motivation Widespread use of self-reported utilization Use in VA CSP trials Under what conditions is it accurate? Can you improve accuracy? Study Goals Review literature Health services Psychology “Develop” a cognitive model for understanding self-report Create “standards,” if possible Literature Review Databases BIOSIS from 1969-2003 The Cochrane Library Current Contents from 1993-2003 Medline from 1966-2003 PsycINFO from 1872-2003 Web of Science from 1945-2003 Search Criteria Keywords included: “interviews,” “questionnaires,” “recall,” “self assessment,” “self-report,” or “survey design.” and “utilization” or “health care utilization” Reviewed abstracts to identify articles Reviewed bibliographies for additional citations Inclusion Criteria Articles or book chapters Self report compared to archival data computerized medical record financial record medical chart abstraction or other administrative record Exclusion Criteria Non-English articles Diagnostic tests Medication use Preventive care Articles Reviewed What is Self Report? Cognitive process of recalling information Ample opportunity for distortion and error (Khilstrom et. al 2000) Implied assumption: self-report not valid when people lack the cognitive capabilities How do you define and measure capabilities Conceptual Model Fixed Attributes Process influenced by illnesses or disabilities (e.g., dementia or mental retardation) Older age is consistently correlated with poorer rec