title: Disparities in preventive procedures: comparisons of self-report and Medicare claims data.
abstract: BACKGROUND
  Racial/ethnic disparities are assessed using either self-report or claims data. We compared these two data sources and examined contributors to discrepancies in estimates of disparities.
  
  
  METHODS
  We analyzed self-report and matching claims data from Medicare Beneficiaries 65 and older who participated in the Medicare Current Beneficiary Survey, 1999-2002. Six preventive procedures were included: PSA testing, influenza vaccination, Pap smear testing, cholesterol testing, mammography, and colorectal cancer testing. We examined predictors of self-reports in the absence of claims and claims in the absence of self-reports.
  
  
  RESULTS
  With the exception of PSA testing, racial/ethnic disparities in preventive procedures are generally larger when using Medicare claims than when using patients' self-report. Analyses adjusting for age, gender, income, educational level, health status, proxy response and supplemental insurance showed that minorities were more likely to self-report preventive procedures in the absence of claims. Adjusted odds ratios ranged from 1.07 (95% CI: 0.88 - 1.30) for PSA testing to 1.83 (95% CI: 1.46 - 2.30) for Pap smear testing. Rates of claims in the absence of self-report were low. Minorities were more likely to have PSA test claims in the absence of self-reports (1.55 95% CI: 1.17 - 2.06), but were less likely to have influenza vaccination claims in the absence of self-reports (0.69 95% CI: 0.51 - 0.93).
  
  
  CONCLUSIONS
  These findings are consistent with either racial/ethnic reporting biases in receipt of preventive procedures or less efficient Medicare billing among providers with large minority practices.
authors.affiliation: Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. Kevin_Fiscella@urmc.rochester.edu
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.forename: Kathleen
authors.initials: K
authors.lastname: Holt
authors.forename: Sean
authors.initials: S
authors.lastname: Meldrum
authors.forename: Peter
authors.initials: P
authors.lastname: Franks
mesh_terms: D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003625:Data Collection / Q000379:methods; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys / Q000379:methods*; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008913:Minority Groups / Q000523:psychology / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D012650:Self Disclosure; D012959:Socioeconomic Factors; D014481:United States