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The Gerontologist 44:680-688 (2004)
© 2004 The Gerontological Society of America

Is Telephone Screening Feasible? Accuracy and Cost-Effectiveness of Identifying People Medically Eligible for Home- and Community-Based Services

Brant E. Fries, PhD1,2,3,, Mary James, MA1, Susan S. Hammer, Lisa R. Shugarman, PhD4 and John N. Morris, MSW, PhD5

Correspondence: Address correspondence to Brant E. Fries, PhD, Institute of Gerontology, University of Michigan, 300 North Ingalls, Ann Arbor, MI 48109-2007. E-mail: bfries{at}

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.

Key Words: Long-term care • Preadmission screening • Eligibility • Nursing home • Home care • Assessment • MDS-HC

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Copyright © 2004 by The Gerontological Society of America.