Understanding nonresponse to the 2007 Medicare CAHPS survey

Area of Science:

• Health Services Research
• Survey Methodology
• Gerontology

Background:

• The Medicare Consumer Assessments of Healthcare Providers and Systems (MCAHPS) survey is crucial for evaluating healthcare experiences among American seniors.
• This survey primarily uses English mailings with English and Spanish telephone follow-ups.
• Understanding nonresponse patterns is key to improving data quality and representation.

Purpose of the Study:

• To examine unit (whole survey) and item nonresponse within the MCAHPS survey.
• To identify predictors of nonresponse among Medicare beneficiaries.
• To explore challenges in surveying older adults about their healthcare.

Main Methods:

• Analysis of unit and item nonresponse data from 695,197 Medicare beneficiaries in the 2007 MCAHPS survey.
• Calculation of overall response rates (49%).
• Statistical analysis of demographic predictors for nonresponse and item missingness.

Main Results:

• Racial and ethnic minorities (Asians, African Americans, Hispanics) showed significantly lower response rates (7-17 percentage points lower) than non-Hispanic Whites.
• Response rates decreased with age, particularly after 75.
• Older beneficiaries and Asians preferred mail, while African Americans and Hispanics favored phone; phone survey breakoff was higher among African Americans and older individuals.
• Older age was the strongest predictor of item missingness; Non-Hispanic Whites had lower item missingness rates than other groups.

Conclusions:

• Improving survey response rates is essential for research on older adults and healthcare disparities.
• Strategies such as targeted prenotification, tailored follow-up, and language-specific mailings/calls can enhance representation.
• Adjustments to telephone survey protocols may also improve data collection from diverse senior populations.