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Improving Response Rates and Representation of Hard-to-Reach Groups in Family Experience Surveys
Sara L Toomey1, Marc N Elliott2, Alan M Zaslavsky3
1Division of General Pediatrics, Department of Medicine (SL Toomey, J Quinn, DJ Klein, S Wagner, C Thomson, MWu, S Onorato, and MA Schuster), Boston Children's Hospital; Department of Pediatrics (SL Toomey and MA Schuster), Department of Health Care Policy (AM Zaslavsky), Harvard Medical School, Boston, Mass.
Insights
Using tablets for patient surveys on discharge day significantly boosts response rates and includes more diverse patient families. This method enhances data collection for improving pediatric hospital care quality.
Area of Science:
- Pediatric Healthcare Quality Improvement
- Health Services Research
- Patient Experience Measurement
Background:
- Traditional mail/telephone surveys yield low pediatric response rates, particularly from minority and low-income populations.
- Low response rates limit the representativeness and utility of patient experience data for quality improvement.
- Assessing patient-centeredness of care is crucial for hospital quality assessment.
Purpose of the Study:
- To investigate if using tablets for surveys on discharge day improves response rates and respondent representativeness compared to traditional mail surveys.
- To evaluate the feasibility of administering the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) using tablets.
- To compare demographic characteristics and survey scores between tablet and mail survey respondents.
Main Methods:
- A quasi-experimental study involving parents of pediatric patients discharged from four hospital units.
- Parents were assigned to receive the Child HCAHPS survey via an audio-enabled tablet before discharge or via mail approximately one week postdischarge.
- Response rates, respondent characteristics, and mean top-box scores were compared between the tablet and mail-only groups.
Main Results:
- Tablet administration was feasible, with a median completion time of 12.4 minutes, and did not disrupt the discharge process.
- The response rate for tablet surveys was 71.1%, significantly higher than the 16.3% for mail-only surveys.
- Tablet respondents showed greater diversity, including more fathers, individuals with lower educational attainment, fewer white respondents, and more publicly insured individuals compared to mail respondents.
Conclusions:
- Day-of-discharge tablet surveys achieved over a four-fold increase in response rates compared to mail-only surveys.
- This method improved participation among hard-to-reach demographic groups, enhancing data representativeness.
- Tablet administration shows promise for real-time feedback and quality improvement initiatives in inpatient settings.
Objective:
Most US hospitals conduct patient experience surveys by mail or telephone after discharge to assess patient/family centeredness of care. Pediatric response rates are usually very low, especially for black, Latino, and low-income respondents. We investigated whether day of discharge surveying using tablets improves response rates and respondent representativeness.
Methods:
This was a quasi-experimental study of parents of patients discharged from 4 units of a children's hospital. Parents were assigned to receive the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) via an audio-enabled tablet before discharge or via mail at approximately 1 week postdischarge. Intervention and control conditions alternated by week. We compared response rates, child/respondent characteristics, and mean top-box scores between tablet and mail only arms.
Results:
Administering Child HCAHPS on a tablet was administratively feasible and did not interfere with the discharge process (median completion time, 12.4 minutes). The response rate was 71.1% (424 of 596) for tablet versus 16.3% (96 of 588) for mail only. Although the tablet response rate was higher in every subgroup, tablet respondents were more likely to be fathers (20.4% vs 6.4%; P = .006), more likely to have a high school education or less (17.5% vs 8.4%; P = .002), less likely to be white (56.8% vs 71.9%; P = .006), and more likely to be publicly insured (31.4% vs 19.8%; P = .02). Tablet scores were significantly higher than mail only scores for 3 of 17 measures.
Conclusions:
The response rate for day of discharge tablet survey administration was >4-fold higher than with single-wave mail-only administration, with greater participation of hard-to-reach groups. These findings suggest tablet administration before discharge shows great promise for real-time feedback and QI and may transform the field of inpatient survey administration.
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