MEASURING HOSPITAL USE WITHOUT CLAIMS - A COMPARISON OF PATIENT AND PROVIDER REPORTS

Objective. We compared the validity of hospital admission and length o f stay reports from patients, outpatient providers, and hospitals, and we examined possible sources of error. Data Sources. Data were collec ted from people enrolled in a randomized trial of treatment for severe mental illness and substance use disorders, from community mental hea lth centers (CMHCs), and from hospitals. Reports for each of the 74 st udy participants covered two-year time periods beginning and ending at various times between 1989 and 1993. Study Design. We compared report s from the various sources and constructed a hybrid with data from all three sources. Using parametric and non-parametric statistics, we com pared patient, CMHC, and hospital reports with each other and with the hybrid source. In subsequent regression analyses we explored correlat es of reporting accuracy. Principal Findings. Single-source reports un derestimated hospital use, but when patient and CMHC reports were comb ined, results were very similar to those obtained by the more laboriou s hybrid method. Patient reports became less accurate as the time betw een discharge and reporting increased; people with bipolar disorders r eported admissions with greater accuracy than did people with schizoph renia. CMHC reporting accuracy decreased as the distance to the admitt ing hospital increased and were less accurate for people with more sev ere psychiatric symptoms. Conclusions. Reports from single sources are likely to underestimate hospital use for different reasons. Combining carefully collected data from patients and outpatient providers produ ces estimates of hospital use that are substantially the same as those developed through methods that are more laborious and costly.