The Concordance of Survey Reports and Medicare Claims in a Nationally Representative Longitudinal Cohort of Older Adults

Abstract

Further research should explore whether these findings are time or cohort bound, address the potential heterogeneity of the proxy-respondent effects based on the reason for and relationship of the proxy to the target person, and evaluate the effects of a broader spectrum of performance-based cognitive abilities. In the interim, the significant predictors identified here should be included in future studies.

Cognitive Function and the Concordance Between Survey Reports and Medicare Claims in a Nationally Representative Cohort of Older Adults

“…The 2 main reasons are the general absence of objective cognitive assessments from surveys of older adults and the absence of an appropriate reference standard for comparative purposes. 8,21 Here, we used a nationally representative, prospective cohort study-the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD)-to evaluate the associations of cognitive function with the agreement between survey reports and Medicare claims. 29,30 Cognitive functioning was objectively assessed using 3 tests-a 6-item mental status test taken from the Telephone Interview for Cognitive Status (TICS-6), and 2 episodic memory tests that use the same 10 words for immediate recall and delayed recall.…”

“…[22][23][24] Comprehension reflects whether the older adult understands the question being asked, retrieval involves the recall of information relevant to the question, judgment integrates the retrieved information and fills-in any remaining knowledge gaps, response selection maps the retrieved and integrated information into a response option, and response reporting represents the recording (if self-administered) or verbalization (if interviewed) of the response option. [22][23][24] Although concerns about the potential effects of agerelated declines in cognitive function on the validity of survey reports have been raised for 5 decades, 8,21,[25][26][27][28] the problem remains empirically unresolved. The 2 main reasons are the general absence of objective cognitive assessments from surveys of older adults and the absence of an appropriate reference standard for comparative purposes.…”

“…31,32 Participants were asked whether a physician had ever told them that they had any of the 12 diseases (or conditions), or if they had used 4 health services in the last 2 years, as well as the numbers of hospital episodes and physician visits in that period. 21 Survey reports were compared with information retrieved from Medicare claims, with each comparison coded as concordant reporting, underreporting, or overreporting by participants relative to the claims. Generalized estimating equation (GEE) methods with negative binomial and logistic regression models evaluated the associations with the 3 cognitive tests, with each participant contributing up to 8 person-period observations.…”

“…[4][5][6] Moreover, the agreement between (validity of) survey reports and administrative data (eg, Medicare claims) is not well documented. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Perhaps the most important concern associated with the validity of survey reports among older adults is the potential influence of age-related decline in cognitive function. 8,[18][19][20][21] Cognitive function is important because it may affect all 5 stages in the response process-comprehension, retrieval, judgment, response selection, and response reporting.…”

“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Perhaps the most important concern associated with the validity of survey reports among older adults is the potential influence of age-related decline in cognitive function. 8,[18][19][20][21] Cognitive function is important because it may affect all 5 stages in the response process-comprehension, retrieval, judgment, response selection, and response reporting. [22][23][24] Comprehension reflects whether the older adult understands the question being asked, retrieval involves the recall of information relevant to the question, judgment integrates the retrieved information and fills-in any remaining knowledge gaps, response selection maps the retrieved and integrated information into a response option, and response reporting represents the recording (if self-administered) or verbalization (if interviewed) of the response option.…”