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Feasibility and Accuracy of a Postcard Diary System for Tracking Healthcare Utilization of Community‐Dwelling Older Persons
Author(s) -
Reuben David B.,
Wong Richard C.,
Walsh Kathleen E.,
Hays Ron D.
Publication year - 1995
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1995.tb06105.x
Subject(s) - medicine , medical record , telephone interview , health maintenance , gerontology , health care , chart , tracking (education) , kappa , physical therapy , rehabilitation , family medicine , surgery , psychology , social science , linguistics , philosophy , statistics , pedagogy , mathematics , sociology , economics , economic growth
OBJECTIVE: To test the feasibility of and to validate a self‐report weekly postcard diary of health care utilization. DESIGN: Case‐series and validation study. SETTING: Community‐based sample of fee‐for‐service and health maintenance organization (HMO) patients. PARTICIPANTS: A convenience sample of 24 community‐dwelling older persons who had failed a self‐administered screen and were eligible for a study of outpatient comprehensive geriatric assessment consultation. MEASUREMENTS: Subjects completed and mailed in a weekly postcard diary documenting medical, counseling, or rehabilitation therapy visits. If a subject did not respond within 10 days after the end of the week, a telephone call was placed to gather the information. For a subset of 10 subjects who were HMO enrollees, all records were reviewed to determine accuracy of the postcard diaries. RESULTS: Of the 24 subjects enrolled, one HMO enrollee dropped out following hip surgery after 4 weeks of completing diaries. The remaining 23 subjects (96% of total entered) provided complete information for 12 weeks. Telephone follow‐up to either obtain or clarify utilization information was required for 22% of subjects. For the subset of 10 HMO subjects, seven underreporting, two overreporting, and one incorrect day errors were detected–a total of 10 errors representing 9% of diaries and 1.3% of patient‐days. Kappa as a measure of agreement between the two methods (self‐report and chart review) was 0.82 ( P < .0001). Compared with chart review, the diary report was 75.0% sensitive and 99.8% specific. Positive and negative predictive values were 91.3% and 99.2%, respectively. CONCLUSION: These findings suggest that a postcard diary system with telephone follow‐up is both a feasible and reasonably accurate method of tracking health care utilization by community‐dwelling older persons, although a small percentage will be unable to adhere to this method.