title: Is telephone screening feasible? Accuracy and cost-effectiveness of identifying people medically eligible for home- and community-based services.
abstract: 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.
authors.affiliation: Institute of Gerontology, University of Michigan, Ann Arbor 48109-2007, USA. bfries@umich.edu
authors.forename: Brant E
authors.initials: BE
authors.lastname: Fries
authors.forename: Mary
authors.initials: M
authors.lastname: James
authors.forename: Susan S
authors.initials: SS
authors.lastname: Hammer
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Shugarman
authors.forename: John N
authors.initials: JN
authors.lastname: Morris
mesh_terms: 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