Accuracy of self-reports of mental health care utilization and calculated costs compared to hospital records
ABSTRACT Assessments of service utilization is often based on self-reports. Concerns regarding the accuracy of self-reports are raised especially in mental health care. The purpose of this study was to analyze the accuracy of self-reports and calculated costs of mental health services. In a prospective cohort study in Germany, self-reports regarding psychiatric inpatient and day-care use collected by telephone interviews based on the Client Socio-Demographic and Service Receipt Inventory (CSSRI) as well as calculated costs were compared to computerized hospital records. The sample consisted of patients with mental and behavioral disorders resulting from alcohol (ICD-10 F10, n=84), schizophrenia, schizophrenic and delusional disturbances (F2, n=122) and affective disorders (F3, n=124). Agreement was assessed using the concordance correlation coefficient (CCC), mean difference (95% confidence intervals (CI)) and the 95% limits of agreement. Predictors for disagreement were derived. Overall agreement of mean total costs was excellent (CCC=0.8432). Costs calculated based on self-reports were higher than costs calculated based on hospital records (15 EUR (95% CI -434 to 405)). Overall agreement of total costs for F2 patients was CCC=0.8651, for F3 CCC=0.7850 and for F10 CCC=0.6180. Depending on type of service, measure of service utilization and costs agreement ranged from excellent to poor and varied substantially between individuals. The number of admissions documented in hospital records was significantly associated with disagreement. Telephone interviews can be an accurate data collection method for calculating mean total costs in mental health care. In the future more standardization is needed.
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ABSTRACT: Population surveys and health services registers are the main source of data for the management of public health. Yet, the validity of survey data on the use of mental health services has been questioned repeatedly due to the sensitive nature of mental illness and to the risk of recall bias. The main objectives of this study were to compare data on the use of mental health services from a large scale population survey and a national health services register and to identify the factors associated with the discrepancies observed between these two sources of data. This study was based on the individual linkage of data from the cycle 1.2 of the Canadian Community Health Survey (CCHS-1.2) and from the health services register of the Régie de l'assurance maladie du Québec (RAMQ). The RAMQ is the governmental agency managing the Quebec national health insurance program. The analyses mostly focused on the 637 Quebecer respondents who were recorded as users of mental health services in the RAMQ and who were self-reported users or non users of these services in the CCHS-1.2. Roughly 75%, of those recorded as users of mental health services users in the RAMQ's register did not report using mental health services in the CCHS-1.2. The odds of disagreement between survey and administrative data were higher in seniors, individuals with a lower level of education, legal or de facto spouses and mothers of young children. They were lower in individuals with a psychiatric disorder and in frequent and more recent users of mental health services according to the RAMQ's register. These findings support the hypotheses that social desirability and recall bias are likely to affect the self-reported use of mental health services in a population survey. They stress the need to refine the investigation of mental health services in population surveys and to combine survey and administrative data, whenever possible, to obtain an optimal estimation of the population need for mental health care.BMC Public Health 10/2011; 11:837. DOI:10.1186/1471-2458-11-837 · 2.32 Impact Factor
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ABSTRACT: To assess the economic cost of chronic pain in Ireland, information was gathered from 140 people with chronic pain. Direct and indirect costs attributable to chronic pain and medical conditions of which chronic pain was a feature were recorded retrospectively for 12 months. Mean cost per chronic pain patient was estimated at €5,665 per year across all grades of pain, with mean costs increasing according to the severity of pain. A small proportion of patients account for the bulk of costs-the top 5% most expensive patients accounted for 26.4% of costs, with a mean cost per patient of €29,936, and the 10% most expensive patients were responsible for 42.8% of all costs. Total cost for individuals aged 20 and above was estimated at €5.34 billion per year, or 2.86% of Irish GDP in 2008. Those with clinically elevated depression scores had costs that were twice as high as people who scored below the depression cut-off score. Chronic pain services in Ireland are generally underresourced. Improved coordination and better management of patients via interdisciplinary pain rehabilitation program is essential and may offer a means of reducing the sizeable economic burden of chronic pain. PERSPECTIVE: The cost of chronic pain per patient was €5,665 per year extrapolated to €5.34 billion or 2.86% of GDP per year. Those with clinically significant depression had costs twice as high as those without depression. The significant burden of chronic pain highlights the need for cost effective interventions to reduce long-term disability.The journal of pain: official journal of the American Pain Society 02/2012; 13(2):139-45. DOI:10.1016/j.jpain.2011.10.004 · 4.22 Impact Factor
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ABSTRACT: During the last years, self-reported measures of mental health service use for people with mental illness have become increasingly popular. Yet, little is known about the differences between patient report and administrative records and how these may be explained. 82 of the 294 participants of the study "Outcome monitoring and outcome management in in-patient psychiatric care" were insured with a major statutory health insurance (AOK Schwaben) and gave informed consent to researchers to access their AOK administrative records. For a 6-month period prior to psychiatric hospital admission, these were compared to the costs as assessed via the German version of the "Client Sociodemographic and Service Receipt Inventory" (CSSRI-EU). Median total monthly treatment costs were 112.23 € (patient-reported) vs. 254.23 € (administrative records; paired Wilcoxon Z = - 3.75; p < 0.001). Cost differences were independent of participants' socioeconomic and clinical characteristics. Correspondence between total treatment costs was substantial for total costs (ρ = 0.48; p < 0.001) and all subtypes of costs (in- and outpatient services, medication). Despite a general tendency to underreport service use, self-report data adequately reflect the "real" health service costs as evident in the health insurance records of people with mental illness.Psychiatrische Praxis 02/2012; 39(3):122-8. DOI:10.1055/s-0031-1298869 · 1.64 Impact Factor