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Supplemental Items Reduce HCAHPS Response Rates, but Response Rates Do Not Affect HCAHPS Scores: A Randomized

Megan K Beckett1, Katrin Hambarsoomian1, Julie Brown1

  • 1RAND, Santa Monica, CA.

Medical Care
|August 22, 2025
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Summary
This summary is machine-generated.

A longer survey reduced patient response rates (RRs), particularly with mixed-mode surveys. However, these lower RRs did not impact hospital HCAHPS scores, suggesting survey length is a trade-off worth considering.

Keywords:
health survey researchpatient surveysrandomized trialsurvey research

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Area of Science:

  • Health Services Research
  • Patient Experience Measurement

Background:

  • Longer surveys are associated with lower response rates (RRs).
  • Previous studies show mixed associations between RRs and HCAHPS scores at hospital and patient levels.
  • Experimental evidence on the impact of hospital RR on HCAHPS scores is lacking.

Purpose of the Study:

  • To estimate the effect of survey length (32-item vs. 59-item) on RRs across different survey modes.
  • To assess whether changes in RR due to survey length affect HCAHPS scores.

Main Methods:

  • A randomized controlled trial involving 10,099 adult patients across 51 US hospitals.
  • Patients were assigned to mail-only or mixed-mode (MM) surveys with either 32 or 59 items.
  • Regression models analyzed the impact of survey length and mode on RRs and HCAHPS scores, controlling for patient characteristics.

Main Results:

  • Mixed-mode surveys yielded higher RRs than mail-only surveys for the 32-item version.
  • The 59-item survey significantly reduced RRs compared to the 32-item survey in both mail-only and MM modes.
  • Reduced RRs resulting from increased survey length did not alter standard adjusted HCAHPS scores.

Conclusions:

  • Increasing survey length, especially with telephone follow-up in MM surveys, decreases response rates.
  • Hospitals and vendors should weigh the benefits of additional survey items against potential RR declines and the RR advantages of MM.
  • Lowering response rates within a hospital does not affect standard adjusted HCAHPS scores.