Survey Protocols, Response Rates, and Representation of Underserved Patients: A Randomized Clinical Trial.

Area of Science:

• Health Services Research
• Survey Methodology
• Health Equity

Background:

• Patient surveys are crucial for assessing healthcare quality and equity.
• Traditional survey methods often underrepresent underserved patient populations, limiting the generalizability of findings.
• Improving response rates (RRs) and representativeness is essential for accurate quality assessment and targeted interventions.

Purpose of the Study:

• To evaluate the impact of incorporating an initial web mode and extending the fielding period on HCAHPS survey RRs and the representativeness of underserved patient groups.
• To compare the effectiveness of standard HCAHPS protocols versus web-enhanced protocols.

Main Methods:

• A randomized clinical trial involving 36,001 patients across 46 US hospitals.
• Patients were assigned to one of six protocols: three standard (mail-only, phone-only, mail-phone) and three web-enhanced (web-mail, web-phone, web-mail-phone).
• Response rates and respondent yield were analyzed overall and stratified by patient demographics (age, sex, race, ethnicity) and service line.

Main Results:

• The web-mail-phone protocol achieved the highest overall RR (36.5%), significantly outperforming single-mode protocols.
• Multimode approaches, particularly web-enhanced ones, showed substantially larger gains in RRs for racial and ethnic minority groups compared to White patients.
• The web-mail-phone protocol demonstrated the highest yield for Black, Hispanic, and White patients, and the second highest for multiracial patients.

Conclusions:

• Web-first multimode survey protocols substantially improve patient survey response rates and representativeness, particularly for underserved populations.
• The web-mail-phone protocol emerged as the most effective strategy for enhancing survey participation and inclusivity.
• These findings support the adoption of web-enhanced multimode protocols for future patient surveys, with the Centers for Medicare & Medicaid Services approving their use for HCAHPS starting in 2025.