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Validating Reports of Chronic Conditions in the Medicare CAHPS Survey

Matthew W Brault1,2, Bruce E Landon1,3, Alan M Zaslavsky1

  • 1Department of Health Care Policy, Harvard Medical School, Boston.

Medical Care
|August 28, 2019
PubMed

Insights

The Medicare CAHPS survey

Area of Science:

  • Health Services Research
  • Medical Informatics
  • Patient-Reported Outcomes

Background:

  • The Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey collects data on patient-reported health history and chronic conditions.
  • Concerns exist regarding the agreement between patient self-reports and administrative data for health history information.

Purpose of the Study:

  • To validate CAHPS measures of chronic conditions by comparing them with claims-based data from the Medicare Chronic Conditions Warehouse (CCW).

Main Methods:

  • Linked CAHPS survey responses (2010-2012) from 301,050 fee-for-service Medicare beneficiaries with their claims data in the CCW.
  • Identified equivalent condition measures across both data sources.
  • Calculated sensitivity and specificity for CAHPS condition measures and used regression models to analyze patient characteristic effects on sensitivity.

Main Results:

  • CAHPS measures showed varying sensitivity for different conditions, ranging from 0.513 for stroke to 0.773 for cancer.
  • Sensitivity was lower in older beneficiaries, those reporting good self-rated health, and those with fair/poor mental health.
  • Specificity was high across all conditions (≥0.904), reaching 0.961 for stroke.

Conclusions:

  • Despite differences in data definitions and timeframes, CAHPS measures demonstrated reasonable validity for chronic conditions.
  • Observed variations in sensitivity are likely related to patient characteristics influencing health severity or proxy indicators of illness severity.
Abstract

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