Accuracy of Self-Reported Health Services Use and Patterns of Care Among Urban Older Adults

BACKGROUND: Understanding older adults' volume and patterns of health service use is fundamental to efforts to improve the quality and efficiency of services. OBJECTIVE: To analyze the accuracy of older adults' self report of health services use and to determine the proportion of care obtained outside a defined urban academic health care system. RESEARCH DESIGN: Telephone survey of self-reports validated against data routinely archived in an electronic medical record system. SUBJECTS: Stratified random sample of 422 patients (> or = 60 years) who had contact with the health care system at least once in the previous 3 months. MEASURES: Self reports of hospitalizations, emergency room visits, physicians visits, extended care visits, and home care visits over the past 12 months, health status, physical activity, and sociodemographics factors. RESULTS: The sample population was more likely to report health services use and functional disability than was a community-based sample of older adults; 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 resources. Based on data from the electronic medical record, 27.9% of the sample were hospitalized at least once in the prior 12 months, 54.6% had at least one emergency room visit, and the mean number of ambulatory visits was 8.1. Comparing self-report data to the electronic record data, 24.1% of older adults with a hospitalization in the prior 12 months failed to report the episode; 28.1% of those with an emergency room visit failed to report the episode as did 5.2% of those with an ambulatory care visit. The accuracy of the self reports of volume of these services were also substantially under reported. We were unable to identify any patient characteristics that were highly correlated with inaccuracy. We estimate that approximately 9.5% of health 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-reported use data over the prior year to model patterns of health care use among older adults is not supported by these data.