Do Differential Response Rates to Patient Surveys Between Organizations Lead to Unfair Performance Comparisons?: Evidence From the English Cancer Patient Experience Survey
Response rates to patient surveys
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Saunders, C., Elliott, M. N., Lyratzopoulos, G., & Abel, G. (2016). Do Differential Response Rates to Patient Surveys Between Organizations Lead to Unfair Performance Comparisons?: Evidence From the English Cancer Patient Experience Survey. Medical Care, 54 45-54. https://doi.org/10.1097/MLR.0000000000000457
Background: Patient surveys typically have variable response rates between organizations, leading to concerns that such differences may affect the validity of performance comparisons. Objective: To explore the size and likely sources of associations between hospital-level survey response rates and patient experience. Research Design, Subjects and Measures: Cross-sectional mail survey including 60 patient experience items sent to 101,771 cancer survivors recently treated by 158 English NHS hospitals. Age, gender, race/ethnicity, socio-economic status, clinical diagnosis, hospital type, and region were available for respondents and nonrespondents. Results: Overall response rate was 67% (range 39-77% between hospitals). Hospitals with higher response rates had higher scores for all items (Spearman correlation range 0.03-0.44), particularly questions regarding hospital-level administrative processes, e.g. procedure cancellations or medical note availability. From multivariable analysis, associations between individual patient experience and hospital-level response rates were statistically significant (p<0.05) for 53/59 analysed questions, decreasing to 37/59 after adjusting for case-mix, and 25/59 after further adjusting for hospital-level characteristics. Predicting responses of nonrespondents, and re-estimating hypothetical hospital scores assuming a 100% response rate, we found currently low performing hospitals would have attained even lower scores. Overall nationwide attainment would have decreased slightly to that currently observed. Conclusions: Higher response rate hospitals have more positive experience scores, and this is only partly explained by patient case-mix. High response rates may be a marker of efficient hospital administration, and higher quality that should not, therefore, be adjusted away in public reporting. While nonresponse may result in slightly underestimating overall levels of performance, it does not appear to meaningfully bias comparisons of case-mix adjusted results.
GL is supported by a Cancer Research UK Clinician Scientist Fellowship (A18180).
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External DOI: https://doi.org/10.1097/MLR.0000000000000457
This record's URL: https://www.repository.cam.ac.uk/handle/1810/251158
Attribution 2.0 UK: England & Wales
Licence URL: http://creativecommons.org/licenses/by/2.0/uk/