Publications

Can Older Adults Accurately Report their Use of Physical Rehabilitation Services?

Objectives

To explore accuracy of rehabilitation service use reports by older adults and variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home).

Design

We calculate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of survey-based measures from an observational panel study, the National Health and Aging Trends Study (NHATS), relative to measures developed from linked Medicare claims.

Participants

Community-dwelling sample of Medicare fee-for-service beneficiaries in 2015 NHATS who were enrolled in Medicare Parts A and B for 12 months prior to their interview (N=4,228).

Main Outcome Measures

Respondents were asked whether they received rehabilitation services in the last year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service.

Results

Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the last year. Self-reported measures had high sensitivity (77%) and PPV (80%) and even higher specificity and NPV (approaching 95%). However, in adjusted models sensitivity was lower for Black enrollees, the very old, and those with lower education levels.

Conclusions

Survey-based measures of rehabilitation accurately captured use over the past year but differential reporting should be considered when characterizing rehabilitation use in certain subgroups of older Americans.