Is telephone screening feasible? Accuracy and cost-effectiveness of identifying people medically eligible for home- and community-based services.
OBJECTIVE
To determine the accuracy of a telephone-screening system to identify persons eligible for home- and community-based long-term care.


METHODS
Data from Michigan telephone screens were compared to data from in-person assessments using the Minimum Data Set for Home Care (MDS-HC). Weighted kappa statistics measured the level of agreement between the two assessments.


RESULTS
Overall, recommendations based on the telephone screen produced a marginal match compared to recommendations based on in-person assessment. "False positives" (individuals scoring as more impaired on the telephone screen than in person) occurred in 27% of all cases, while "false negatives" (individuals scoring as less impaired on the telephone screen) only occurred among 6% of the callers. Neither individual screen questions, source of information, location of the individual, timing between screen and assessment, nor temporal changes accounted for mismatches. Telephone screens resulted in an 11% savings over the cost of providing in-person assessments to all program seekers.


CONCLUSIONS
The telephone screen has utility as a broad targeting mechanism that allows agencies to avoid costly in-person assessments for all program seekers. Evidence does not support use of the telephone screen alone to determine either medical eligibility or a specific level of care.
Fries
Brant E
BE
Institute of Gerontology, University of Michigan, Ann Arbor 48109-2007, USA. bfries@umich.edu
James
Mary
M
Hammer
Susan S
SS
Shugarman
Lisa R
LR
Morris
John N
JN
D000465:Algorithms; D003153:Community Health Services; D003695:Delivery of Health Care / Q000145:classification; D004608:Eligibility Determination; D015276:Health Care Rationing; D006699:Home Care Services; D006801:Humans; D008134:Long-Term Care; D008824:Michigan; D013219:State Government; D011795:Surveys and Questionnaires; D013689:Telephone; D014481:United States