title: Voice response system to measure healthcare costs: a STAR*D report.
abstract: OBJECTIVE
  To evaluate a telephone-operated, interactive voice response (IVR) system designed to collect use-of-care data from patients with major depression (UAC-IVR).
  
  
  METHODS
  Patient self-reports from repeated IVR surveys were compared with provider records for 3789 patients with major depression at 41 clinical sites participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.
  
  
  METHODS
  UAC-IVR responses were examined for consistency and compared with provider records to compute reporting biases and intraclass correlation coefficients. Predictors of inconsistent responses and reporting biases were based on mixed logistic and regression models adjusted for need and predisposing and enabling covariates, and corrected for nesting and repeated measures.
  
  
  RESULTS
  Inconsistent responses were found for 10% of calls and 21% of patients. Underreporting biases (-20%) and moderate agreement (intraclass correlation of 68%) were found when UAC-IVR responses were compared with medical records. IVR reporting biases were less for patients after 3 calls or more (experience), for patients with severe baseline symptoms (motivation), and for patients who gave consistent IVR responses (reliability). Bias was unrelated to treatment outcomes or demographic factors.
  
  
  CONCLUSIONS
  Clinical managers should use IVR systems to collect service histories only after patients are properly trained and responses monitored for consistency and reporting biases.
authors.affiliation: Department of Psychiatry, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390-9086, USA. michael.kashner@utsouthwestern.edu
authors.forename: T Michael
authors.initials: TM
authors.lastname: Kashner
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: Annie
authors.initials: A
authors.lastname: Wicker
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: John H
authors.initials: JH
authors.lastname: Greist
authors.forename: James C
authors.initials: JC
authors.lastname: Mundt
authors.forename: Kathy
authors.initials: K
authors.lastname: Shores-Wilson
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
mesh_terms: D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015203:Reproducibility of Results; D012650:Self Disclosure; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D013689:Telephone