Is self or caregiver report comparable to Medicare claims indicators of healthcare utilization after stroke?

Orla Sheehan, Janet Prvu-Bettger, Jin Huang, William E. Haley, J. David Rhodes, Suzanne E Judd, Meredith L. Kilgore, David L Roth

Research output: Contribution to journalArticle

Abstract

Background: Claims data from Medicare or other payers might not generalize to other populations regarding service use after stroke especially among younger patients. However, high agreement between self-report and Medicare claims data would support the use of self-reported healthcare utilization data in these populations. Methods: A population-based sample of 147 stroke participants with traditional fee-for service Medicare and their family caregivers was examined. Concordance with Medicare claims was examined for stroke participant self-report for Emergency Room visits, hospitalizations, and physician visits for a six-month period after stroke, and for both stroke participant and caregiver reports of receipt of Physical Therapy (PT), Speech and Language Pathology (SLP), or Home Health Agency (HHA) visits. Results: Agreement was good for Emergency Room visits (kappa 0.75), hospitalization (kappa 0.70), and physician visits (Prevalence Adjusted Bias Adjusted Kappa [PABAK] 0.69) but more moderate for physical therapy, speech and language therapy, and home health agency visits (kappa 0.56–0.63). Caregiver agreement with Medicare claims was similar to stroke participant agreement. African Americans were less likely to self-report therapy compared to whites (OR 0.32 PT, 0.38 SLP, 0.29 HHA, p < 0.03). Younger stroke participants reported lower levels of Emergency Room visits than claims (OR 0.81, p = 0.001). Conclusion: Healthcare utilization after stroke can be reliably assessed from Medicare claims, Stroke participant, or Caregiver report for salient events such as hospitalizations and Emergency Room visits. Self-report and caregiver report appear to be less reliable for identifying use of therapy or home health services. Caution should be used when interpreting disparities based on self-report data alone in these areas.

Original languageEnglish (US)
JournalTopics in Stroke Rehabilitation
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Medicare
Caregivers
Stroke
Delivery of Health Care
Self Report
Home Care Agencies
Hospital Emergency Service
Speech-Language Pathology
Hospitalization
Language Therapy
Population
Physicians
Speech Therapy
Therapeutics
Fee-for-Service Plans
African Americans
Health Services

Keywords

  • caregiver-report
  • Healthcare utilization
  • Medicare claims
  • self report
  • stroke

ASJC Scopus subject areas

  • Rehabilitation
  • Community and Home Care
  • Clinical Neurology

Cite this

Is self or caregiver report comparable to Medicare claims indicators of healthcare utilization after stroke? / Sheehan, Orla; Prvu-Bettger, Janet; Huang, Jin; Haley, William E.; David Rhodes, J.; E Judd, Suzanne; Kilgore, Meredith L.; Roth, David L.

In: Topics in Stroke Rehabilitation, 01.01.2018.

Research output: Contribution to journalArticle

Sheehan, Orla ; Prvu-Bettger, Janet ; Huang, Jin ; Haley, William E. ; David Rhodes, J. ; E Judd, Suzanne ; Kilgore, Meredith L. ; Roth, David L. / Is self or caregiver report comparable to Medicare claims indicators of healthcare utilization after stroke?. In: Topics in Stroke Rehabilitation. 2018.
@article{2f78f6bb2c594a96bfece6eae4e34a0e,
title = "Is self or caregiver report comparable to Medicare claims indicators of healthcare utilization after stroke?",
abstract = "Background: Claims data from Medicare or other payers might not generalize to other populations regarding service use after stroke especially among younger patients. However, high agreement between self-report and Medicare claims data would support the use of self-reported healthcare utilization data in these populations. Methods: A population-based sample of 147 stroke participants with traditional fee-for service Medicare and their family caregivers was examined. Concordance with Medicare claims was examined for stroke participant self-report for Emergency Room visits, hospitalizations, and physician visits for a six-month period after stroke, and for both stroke participant and caregiver reports of receipt of Physical Therapy (PT), Speech and Language Pathology (SLP), or Home Health Agency (HHA) visits. Results: Agreement was good for Emergency Room visits (kappa 0.75), hospitalization (kappa 0.70), and physician visits (Prevalence Adjusted Bias Adjusted Kappa [PABAK] 0.69) but more moderate for physical therapy, speech and language therapy, and home health agency visits (kappa 0.56–0.63). Caregiver agreement with Medicare claims was similar to stroke participant agreement. African Americans were less likely to self-report therapy compared to whites (OR 0.32 PT, 0.38 SLP, 0.29 HHA, p < 0.03). Younger stroke participants reported lower levels of Emergency Room visits than claims (OR 0.81, p = 0.001). Conclusion: Healthcare utilization after stroke can be reliably assessed from Medicare claims, Stroke participant, or Caregiver report for salient events such as hospitalizations and Emergency Room visits. Self-report and caregiver report appear to be less reliable for identifying use of therapy or home health services. Caution should be used when interpreting disparities based on self-report data alone in these areas.",
keywords = "caregiver-report, Healthcare utilization, Medicare claims, self report, stroke",
author = "Orla Sheehan and Janet Prvu-Bettger and Jin Huang and Haley, {William E.} and {David Rhodes}, J. and {E Judd}, Suzanne and Kilgore, {Meredith L.} and Roth, {David L}",
year = "2018",
month = "1",
day = "1",
doi = "10.1080/10749357.2018.1493251",
language = "English (US)",
journal = "Topics in Stroke Rehabilitation",
issn = "1074-9357",
publisher = "Thomas Land Publishers Inc.",

}

TY - JOUR

T1 - Is self or caregiver report comparable to Medicare claims indicators of healthcare utilization after stroke?

AU - Sheehan, Orla

AU - Prvu-Bettger, Janet

AU - Huang, Jin

AU - Haley, William E.

AU - David Rhodes, J.

AU - E Judd, Suzanne

AU - Kilgore, Meredith L.

AU - Roth, David L

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Claims data from Medicare or other payers might not generalize to other populations regarding service use after stroke especially among younger patients. However, high agreement between self-report and Medicare claims data would support the use of self-reported healthcare utilization data in these populations. Methods: A population-based sample of 147 stroke participants with traditional fee-for service Medicare and their family caregivers was examined. Concordance with Medicare claims was examined for stroke participant self-report for Emergency Room visits, hospitalizations, and physician visits for a six-month period after stroke, and for both stroke participant and caregiver reports of receipt of Physical Therapy (PT), Speech and Language Pathology (SLP), or Home Health Agency (HHA) visits. Results: Agreement was good for Emergency Room visits (kappa 0.75), hospitalization (kappa 0.70), and physician visits (Prevalence Adjusted Bias Adjusted Kappa [PABAK] 0.69) but more moderate for physical therapy, speech and language therapy, and home health agency visits (kappa 0.56–0.63). Caregiver agreement with Medicare claims was similar to stroke participant agreement. African Americans were less likely to self-report therapy compared to whites (OR 0.32 PT, 0.38 SLP, 0.29 HHA, p < 0.03). Younger stroke participants reported lower levels of Emergency Room visits than claims (OR 0.81, p = 0.001). Conclusion: Healthcare utilization after stroke can be reliably assessed from Medicare claims, Stroke participant, or Caregiver report for salient events such as hospitalizations and Emergency Room visits. Self-report and caregiver report appear to be less reliable for identifying use of therapy or home health services. Caution should be used when interpreting disparities based on self-report data alone in these areas.

AB - Background: Claims data from Medicare or other payers might not generalize to other populations regarding service use after stroke especially among younger patients. However, high agreement between self-report and Medicare claims data would support the use of self-reported healthcare utilization data in these populations. Methods: A population-based sample of 147 stroke participants with traditional fee-for service Medicare and their family caregivers was examined. Concordance with Medicare claims was examined for stroke participant self-report for Emergency Room visits, hospitalizations, and physician visits for a six-month period after stroke, and for both stroke participant and caregiver reports of receipt of Physical Therapy (PT), Speech and Language Pathology (SLP), or Home Health Agency (HHA) visits. Results: Agreement was good for Emergency Room visits (kappa 0.75), hospitalization (kappa 0.70), and physician visits (Prevalence Adjusted Bias Adjusted Kappa [PABAK] 0.69) but more moderate for physical therapy, speech and language therapy, and home health agency visits (kappa 0.56–0.63). Caregiver agreement with Medicare claims was similar to stroke participant agreement. African Americans were less likely to self-report therapy compared to whites (OR 0.32 PT, 0.38 SLP, 0.29 HHA, p < 0.03). Younger stroke participants reported lower levels of Emergency Room visits than claims (OR 0.81, p = 0.001). Conclusion: Healthcare utilization after stroke can be reliably assessed from Medicare claims, Stroke participant, or Caregiver report for salient events such as hospitalizations and Emergency Room visits. Self-report and caregiver report appear to be less reliable for identifying use of therapy or home health services. Caution should be used when interpreting disparities based on self-report data alone in these areas.

KW - caregiver-report

KW - Healthcare utilization

KW - Medicare claims

KW - self report

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=85050655031&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050655031&partnerID=8YFLogxK

U2 - 10.1080/10749357.2018.1493251

DO - 10.1080/10749357.2018.1493251

M3 - Article

JO - Topics in Stroke Rehabilitation

JF - Topics in Stroke Rehabilitation

SN - 1074-9357

ER -