title: Medicare claims versus beneficiary self-report for influenza vaccination surveillance.
abstract: BACKGROUND
  Although self-reported influenza vaccination status is routinely used in surveillance to estimate influenza vaccine coverage, Medicare data are becoming a promising resource for influenza surveillance to inform vaccination program management and planning.
  
  
  OBJECTIVE
  To evaluate the concordance between self-reported influenza vaccination and influenza vaccination claims among Medicare beneficiaries.
  
  
  METHODS
  This study compared influenza vaccination based upon Medicare claims and self-report among a sample of Medicare beneficiaries (N=9,378) from the 2011 Medicare Current Beneficiary Survey, which was the most recent year of data at the time of analysis (summer 2013). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using self-reported data as the referent standard. Logistic regression was used to compute the marginal mean proportions for whether a Medicare influenza vaccination claim was present among beneficiaries who reported receiving the vaccination.
  
  
  RESULTS
  Influenza vaccination was higher for self-report (69.4%) than Medicare claims (48.3%). For Medicare claims, sensitivity=67.5%, specificity=96.3%, positive predictive value=97.6%, and negative predictive value=56.7%. Among beneficiaries reporting receiving an influenza vaccination, the percentage of beneficiaries with a vaccination claim was lower for beneficiaries who were aged <65 years, male, non-Hispanic black or Hispanic, and had less than a college education.
  
  
  CONCLUSIONS
  The classification of influenza vaccination status for Medicare beneficiaries can differ based upon survey and claims. To improve Medicare claims-based surveillance studies, further research is needed to determine the sources of discordance in self-reported and Medicare claims data, specifically for sensitivity and negative predictive value.
authors.affiliation: Centers for Medicare & Medicaid Services, Sam Nunn Atlanta Federal Center, Atlanta, Georgia; Office of Information Products and Data Analytics, Baltimore, Maryland. Electronic address: kimberly.lochner@CMS.hhs.gov.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Lochner
authors.affiliation: Center for Medicare, Baltimore, Maryland.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Wynne
authors.affiliation: Office of Information Products and Data Analytics, Baltimore, Maryland.
authors.forename: Gloria H
authors.initials: GH
authors.lastname: Wheatcroft
authors.affiliation: Center for Medicare, Baltimore, Maryland.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Worrall
authors.affiliation: Center for Medicare, Baltimore, Maryland.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kelman
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control; D007344:Insurance Claim Reporting; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D011159:Population Surveillance; D057566:Self Report; D014481:United States
chemical_list: D007252:Influenza Vaccines