Dataset Information

Methodological issues in using multiple years of the Medicare current beneficiary survey.

ABSTRACT:

Background

The analysis presented in this paper examines the multi-year capacity of the Medicare Current Beneficiary Survey (MCBS).

Methods

We systematically reviewed the literature for methodological approaches in research using multiple years of the MCBS and categorized the studies by study design, use of survey sampling weights, and variance adjustments. We then replicated the approaches in an empirical demonstration using functional status (activities of daily living (ADL) and 2005-2007 MCBS data.

Results

In the systematic review, we identified 22 pooled, 17 repeated cross-sectional, and 17 longitudinal studies. Less than half of these studies explicitly described the weighting approach or variance estimation. In the empirical demonstration, we showed that different study designs and weighting approaches will yield statistically different estimates.

Conclusion

There is a variety of methodological approaches when using multiple years of the MCBS, and some of them provide biased results. Research needs to improve in describing the methods and preferred approaches for using these complex data.

SUBMITTER: Briesacher BA

PROVIDER: S-EPMC4006385 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Publications

Methodological issues in using multiple years of the Medicare current beneficiary survey.

Briesacher Becky A BA Tjia Jennifer J Doubeni Chyke A CA Chen Yong Y Rao Sowmya R SR

Medicare & medicaid research review 20120208 1

<h4>Background</h4>The analysis presented in this paper examines the multi-year capacity of the Medicare Current Beneficiary Survey (MCBS).<h4>Methods</h4>We systematically reviewed the literature for methodological approaches in research using multiple years of the MCBS and categorized the studies by study design, use of survey sampling weights, and variance adjustments. We then replicated the approaches in an empirical demonstration using functional status (activities of daily living (ADL) and ...[more]

PMID: 24800135

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Project description:ImportanceDespite substantial geographic variation in Medicare per beneficiary spending in the US, little is known about the extent to which social determinants of health (SDoH) are associated with this variation.ObjectiveTo determine the associations between SDoH and county-level price-adjusted Medicare per beneficiary spending.Design, setting, and participantsThis cross-sectional study used county-level data on 2017 Medicare fee-for-service (FFS) spending, patient demographic characteristics (eg, age and gender) and clinical risk score, supply of health care resources (eg, number of hospital beds), and SDoH measures (eg, median income and unemployment rate) from multiple sources. Multivariable regressions were used to estimate the association of the variation in spending across quintiles with SDoH.Main outcomes and measures2017 county-level price-adjusted Medicare Parts A and B spending per beneficiary. SDoH measures included socioeconomic position, race/ethnicity, social relationships, and residential and community context.ResultsAmong 3038 counties with 33 495 776 Medicare FFS beneficiaries (18 352 336 [54.8%] women; mean [SD] age, 72 [1.5] years), mean Medicare price-adjusted per beneficiary spending for counties in the highest spending quintile was $3785 (95% CI, $3706-$3862) higher, or 49% higher, than spending for bottom-quintile counties (mean [SD] spending per beneficiary, $11 464 [735] vs $7679 [522]; P < .001). The total contribution (including through both direct and indirect pathways) of SDoH was 37.7% ($1428 of $3785) of this variation, compared with 59.8% ($2265 of $3785) by patient clinical risk, 14.5% ($549 of $3785) by supply of health care resources, and 19.8% ($751 of $3785) by patient demographic characteristics. When all factors were included within the same model, the direct contribution of SDoH was associated with 5.8% of the variation, compared with 4.6% by supply, 4.7% by patient demographic characteristics, and 62.0% by patient clinical risk.Conclusions and relevanceThese findings suggest social determinants of health are associated with considerable proportions of geographic variation in Medicare spending. Policies addressing SDoH for disadvantaged patients in certain regions have the potential to contain health care spending and improve the value of health care; patient SDoH may need to be accounted for in publicly reported physician performance, and in value-based purchasing incentive programs for health care professionals.

Dataset Information

Methodological issues in using multiple years of the Medicare current beneficiary survey.

Background

Methods

Results

Conclusion

Publications

Methodological issues in using multiple years of the Medicare current beneficiary survey.

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