Accuracy of self-reported health services use and patterns of care among urban older adults

BACKGROUND. Understanding older adults' volume and patterns of health servi ce use is fundamental to efforts to improve the quality and efficiency of s ervices, OBJECTIVE. TO analyze the accuracy of older adults' self report of health s ervices use and to determine the proportion of: care obtained outside a def ined urban academic health care system. RESEARCH DESIGN. Telephone survey of self-reports validated against data ro utinely archived in an electronic medical record system. SUBJECTS. Stratified random sample of 422 patients (greater than or equal t o 60 years) who had contact with the health care system at least once in th e previous 3 months. MEASURES. Self reports of hospitalizations, emergency room visits, physicia ns visits, extended care visits, and home care visits over the past 12 mont hs, health status, physical activity, and sociodemographics factors. RESULTS. The sample population was more likely to report health services us e and functional disability than was a community-based sample of older adul ts; 67% of the sample were women, 53.9% were African American, 71% were age 65 and over, 38.7% lived alone, and 24.6% reported poor financial resource s, Based on data from the electronic medical record, 27.9% of the sample we re hospitalized at least once in the prior 12 months, 54.6% had at least on e emergency room visit, and the mean number of ambulatory visits was 8.1. C omparing self-report data to the electronic record data, 24.1% of older adu lts with a hospitalization in the prior 22 months failed to report the epis ode; 28.1% of those with an emergency room visit failed to report the episo de as did 5.2% of those with an ambulatory care visit. The accuracy of the self reports ol: volume of these services were also substantially under rep orted. We were unable to identify any patient characteristics that were hig hly correlated with inaccuracy, We estimate that approximately 9.5% of heal th care costs are accrued outside this urban health care system. CONCLUSIONS. These older adults substantially under-report health services use, including hospital episodes over a 12-month period, Reliance on self-r eported use data over the prior year to model patterns of health care use a mong older adults is not supported by these data.