验证医疗保险 CAHPS 调查中慢性疾病报告的有效性。
Validating Reports of Chronic Conditions in the Medicare CAHPS Survey.
机构信息
Department of Health Care Policy, Harvard Medical School, Boston.
Harvard PhD Program in Health Policy, Harvard University, Cambridge.
出版信息
Med Care. 2019 Oct;57(10):830-835. doi: 10.1097/MLR.0000000000001187.
BACKGROUND
The Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey includes items about chronic conditions, health history, and self-rated health. Questions remain about the concordance between patient reports and administrative sources on questions related to health history.
OBJECTIVE
To validate CAHPS measures of chronic conditions against claims-based measures from the Medicare Chronic Conditions Warehouse (CCW).
METHODS
We linked CAHPS responses from 301,050 fee-for-service Medicare beneficiaries in 2010-2012 with summaries of their claims in the CCW and identified nearest equivalent measures of conditions across sources. We calculated sensitivities and specificities for conditions and estimated regression models to assess the effects of patient characteristics on the sensitivity.
RESULTS
The sensitivity of CAHPS measures differed across conditions, ranging from 0.513 for history of stroke to 0.773 for history of cancer. Sensitivity was generally lower for older beneficiaries, those reporting good self-rated health, and those with fair or poor mental health. Specificity was 0.904 or greater for all conditions, up to 0.961 for stroke.
CONCLUSIONS
Despite difference in timeframes and definitions of conditions, the measured sensitivities demonstrated reasonable validity. Variation in sensitivity is consistent with covariates that either directly measure health severity within a diagnosis or can be construed as a proxy for severity of illness.
背景
医疗保险消费者评估医疗保健提供者和系统（CAHPS）调查包括关于慢性病、健康史和自我评估健康的项目。关于健康史相关问题，患者报告和管理源之间的一致性仍存在疑问。
目的
根据医疗保险慢性病仓库（CCW）的索赔数据，验证 CAHPS 慢性病测量方法的准确性。
方法
我们将 2010-2012 年 301,050 名自费医疗保险受益人的 CAHPS 回复与 CCW 中的索赔摘要相关联，并在各来源中确定了条件的最接近等效措施。我们计算了疾病的敏感性和特异性，并估计了回归模型，以评估患者特征对敏感性的影响。
结果
CAHPS 测量方法的敏感性因疾病而异，从中风病史的 0.513 到癌症病史的 0.773。对于年龄较大的受益人群、自我评估健康状况良好的人群以及心理健康状况一般或较差的人群，敏感性通常较低。所有疾病的特异性均为 0.904 或更高，中风的特异性高达 0.961。
结论
尽管疾病的时间框架和定义存在差异，但测量的敏感性具有合理的有效性。敏感性的差异与直接在诊断中测量健康严重程度的协变量或可被视为疾病严重程度的替代指标一致。
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