Is telephone screening feasible? Accuracy and cost-effectiveness of identifying people medically eligible for home- and community-based services

Abstract

Purpose: To determine the accuracy of a telephone-screening system to identify persons eligible for home- and community-based long-term care. Design and 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. Implications: 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.