Self-reported utilization of health care services: improving measurement and accuracy.
ABSTRACT Self-report is often used to estimate health care utilization. However, the accuracy of such data is of paramount concern. The authors conducted a systematic review of 42 studies that evaluated the accuracy of self-report utilization data, where utilization was defined as a visit to a clinical provider or entity. They also present a broad conceptual model that identifies major issues to consider when collecting, analyzing, and reporting such data. The results show that self-report data are of variable accuracy. Factors that affect accuracy include (1) sample population and cognitive abilities, (2) recall time frame, (3) type of utilization, (4) utilization frequency, (5) questionnaire design, (6) mode of data collection, and (7) memory aids and probes.
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ABSTRACT: Self-reported data on health care use is a key input in a range of studies. However, the length of recall period in self-reported health care questions varies between surveys, and this variation may affect the results of the studies. This study uses a large survey experiment to examine the role of the length of recall periods for the quality of self-reported hospitalization data by comparing registered with self-reported hospitalizations of respondents exposed to recall periods of one, three, six, or twelve months. Our findings have conflicting implications for survey design, as the preferred length of recall period depends on the objective of the analysis. For an aggregated measure of hospitalization, longer recall periods are preferred. For analysis oriented more to the micro-level, shorter recall periods may be considered since the association between individual characteristics (e.g., education) and recall error increases with the length of the recall period.Journal of Health Economics 02/2014; 35C:34-46. DOI:10.1016/j.jhealeco.2014.01.007 · 2.25 Impact Factor
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ABSTRACT: Posttraumatic stress disorder (PTSD) is a significant predictor of both poorer physical health and increased health care utilization, whereas adequate social support is associated with better physical health and less health care utilization. However, research has not previously examined the simultaneous effects of PTSD and social support on health and health care utilization. This study examined both the independent and interactive effects of PTSD and a particular type of social support (postactive-duty social support from military friends) on self-reported physical health and number of Veterans Health Administration (VHA) visits in the last year. These relationships were examined in a representative, national sample of 3,524 women veterans who completed telephone interviews as part of the National Survey of Women Veterans in 2008-2009. Regression analyses were conducted using these cross-sectional data to examine main effects of PTSD and military social support on physical health and VHA utilization and their interaction. Screening positive for PTSD was associated with poorer health (B = -3.19, SE = 1.47) and increased VHA utilization (B = 0.98, SE = 0.16), whereas greater military social support was associated with better health (B = 0.97, SE = 0.44) and less frequent VHA utilization (B = -0.15, SE = 0.05). Neither moderation model was significant, such that military social support behaved in a similar way regardless of PTSD status.Journal of Traumatic Stress 12/2013; 26(6). DOI:10.1002/jts.21859 · 2.72 Impact Factor
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ABSTRACT: Health literacy has emerged as an important factor related to health in older persons. The reason for the link between health literacy and health outcomes is not clear. Possible explanations include common relations among income, education, access to health care, health-promotion behaviors, frequency of reading, and perceptual impairments. In this study we investigate the relation of health literacy to self-reported health status and explore the impact of these explanatory variables on this relation in persons aged 40 years and older who participated in the 2003 U.S. National Assessment of Adult Literacy (NAAL). Using regression models, we evaluated the impact of potential explanatory variables on the relation of health literacy to self-reported health status. Regression models confirmed previously-observed relations of health literacy, age, income, and education to health. The inclusion of income and education significantly decreased the relation of health literacy to health. While other variables, such as health maintenance and preventive health behaviors, were significantly related to health, they did not change the relation of health literacy to health. Even after taking multiple explanatory variables into account, the relation between health literacy and health status remained significant, suggesting that they alone do not completely account for the observed relation. Some other factor or combination of factors may account for the relation of health literacy to health.Educational Gerontology 11/2012; 38(11):776-787. DOI:10.1080/03601277.2011.645441 · 0.39 Impact Factor