Medical Care最新文献

{"title":"Favorable Selection of Veterans in Medicare Advantage: Risk-Adjusted Cost Differences of Dual Veteran Health Administration Enrollees.","authors":"Allison Dorneo, Steven D Pizer, Melissa M Garrido, Paul R Shafer, Austin B Frakt, Yevgeniy Feyman","doi":"10.1097/MLR.0000000000002226","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002226","url":null,"abstract":"<p><strong>Background: </strong>Prior literature has shown that favorable selection of enrollees in Medicare Advantage (MA) that is not accounted for under the Hierarchical Condition Category (HCC) risk adjustment model can result in significant overpayments to MA plans. Detailed data from the Veterans Health Administration's (VHA) Nosos risk score can measure previously undetected favorable selection in a unique cohort of patients.</p><p><strong>Objective: </strong>To analyze characteristics associated with Veteran enrollment in MA versus Traditional Medicare (TM) and quantify previously undetected favorable selection.</p><p><strong>Research design: </strong>Pooled, cross-sectional study using nationally representative VHA survey data and VHA administrative data, 2016-2019.</p><p><strong>Subjects: </strong>Dual VHA-Medicare enrollees.</p><p><strong>Measures: </strong>Enrollee characteristics, risk scores, and VHA inpatient and outpatient costs.</p><p><strong>Results: </strong>Compared with VHA-TM enrollees, VHA-MA enrollees were older [73.8 (8.5) vs. 72.2 (8.2) y; SMD=0.19], more likely to have Medicaid coverage (13.7% vs. 4.7%; SMD=0.31), less likely to use VHA care (67.4% vs. 74.3%; SMD=0.26), and more likely to be in the lowest priority group (facing VHA copays) (21.4% vs. 17.6%; SMD=0.15). However, in 2019, MA enrollees had Nosos scores that were 25.6 percentage points lower (95% CI: -35.7, -15.5) than TM enrollees, signaling a healthier population. In adjusted comparisons, MA enrollees had $453.79 lower VHA costs (95% CI: $832.30, $75.27) than TM enrollees.</p><p><strong>Conclusions: </strong>MA plans enroll Veterans who are healthier and less costly than TM-enrolled Veterans. Our findings underscore plans' potential selection of enrollees based on characteristics unobservable in the HCC risk adjustment model. Policymakers may consider opportunities to adopt additional risk-adjustment factors specifically for dual VHA-MA enrollees.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventive Drug Lists Reduce Income-Related Disparities in Medication Adherence Over 2 Years: A Natural Experiment for Translation in Diabetes (NEXT-D) Study.","authors":"Dennis Ross-Degnan, Stephanie Argetsinger, Christine Y Lu, Anita Wagner, Matt Lakoma, Fang Zhang, J Frank Wharam","doi":"10.1097/MLR.0000000000002186","DOIUrl":"10.1097/MLR.0000000000002186","url":null,"abstract":"<p><strong>Background: </strong>Employers add Preventive Drug Lists (PDLs) to commercial insurance plans to reduce out-of-pocket payments for medicines that treat important chronic illnesses.</p><p><strong>Objective: </strong>This study examined the impact of PDLs among patients with pre-existing diabetes.</p><p><strong>Research design: </strong>Interrupted time series design with difference-in-difference analysis.</p><p><strong>Subjects: </strong>We identified 5575 patients aged 12-64 with diabetes whose employers adopted PDL coverage for 2 years after a baseline year without; an equivalent number of matched and weighted controls were selected from employers that did not offer PDL plans.</p><p><strong>Measures: </strong>Utilization, out-of-pocket payments, and medication adherence overall, among lower-income patients, and for those paying full cost for medicines under high-deductible plans.</p><p><strong>Results: </strong>Compared with controls, patients with PDL coverage experienced large, statistically significant 35%-55% relative reductions in OOP payments. The PDL group experienced significant relative increases in 30-day fills in follow-up year 1 for noninsulin antidiabetics (+9.5) and a nonsignificant increase for insulin (+6.2%); these were matched by similar increases in percentage of days in which medicines were available. Increases were all substantially greater in the second follow-up year, larger among lower-income patients, and greatest by year 2 for lower-income patients in high-deductible plans with health savings accounts.</p><p><strong>Conclusions: </strong>PDL coverage was associated with substantial reductions in OOP payments for medications to manage diabetes and cardiovascular risk. Patients on antidiabetic medications, especially those with lower incomes, experienced improvements in adherence, which grew over time.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"740-748"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Medicaid Expansion on Care for Patients With Diabetes by Primary Care Provider Supply.","authors":"Mahmoud Manouchehri Amoli, Peter J Cunningham, Masoudeh Masoud Bahnamiri, Mohammad Javad Najafi, Atousa Mortazavi Milani, Bassam Dahman","doi":"10.1097/MLR.0000000000002174","DOIUrl":"10.1097/MLR.0000000000002174","url":null,"abstract":"<p><strong>Objective: </strong>We examined whether Medicaid expansion led to improvements in health, access, and preventive care for low-income adults with diabetes, varying by primary care provider (PCP) supply.</p><p><strong>Research design and methods: </strong>Using 2011-2021 Behavioral Risk Factor Surveillance System data and a difference-in-differences approach, we compared outcomes before and after expansion in states classified by PCP supply. The sample included 85,375 adults aged 18-64 with incomes below 138% of the federal poverty level and a diabetes diagnosis. Outcomes were self-reported: health insurance coverage, personal doctor, cost-related delays in care, routine checkups, flu shots, and days with poor mental or physical health.</p><p><strong>Results: </strong>Across all states, Medicaid expansion was associated with a 3.2 and 3.5 percentage-point (pp) increase in insurance coverage and checkup visits, respectively. High-PCP-supply states realized larger gains in coverage (6.4 pp) as well as improvements in routine checkups (3.3 pp) and flu vaccination (3.5 pp). They also showed a reduction of nearly one day of poor mental health per month. In contrast, low-PCP-supply states experienced a marginally significant increase in poor mental health days.</p><p><strong>Conclusions: </strong>Medicaid expansion improved coverage, preventive care, and mental health outcomes for low-income adults with diabetes, with more pronounced benefits in high-PCP-supply states. These findings underscore the importance of adequate PCP capacity to optimize the impact of coverage expansions in managing chronic conditions such as diabetes. Policymakers aiming to enhance care for vulnerable patients with diabetes should consider investing in primary care infrastructure alongside coverage expansions.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 10","pages":"724-730"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Pharmacy Copayment Increase on Medication Use in the Military Health System.","authors":"Ira B Wilson, Roee Gutman, Yoojin Lee, Beth A Dana, Jeff Hiris, Tingting Zhang, Kathryn Thompson, Richard Gromadzki, Theresa I Shireman","doi":"10.1097/MLR.0000000000002176","DOIUrl":"10.1097/MLR.0000000000002176","url":null,"abstract":"<p><strong>Background: </strong>We analyzed the impact of a copayment increase instituted February 1, 2018 for persons covered by the retail or mail order Military Health System (MHS) pharmacy benefit.</p><p><strong>Methods: </strong>We compared medication use in 2 cohorts in the 12 months before and after the copayment increase: MHS beneficiaries between 18 and 64 years old (MHS cohort), and MHS beneficiaries older than or equal to 65 years old with Medicare (Medicare cohort). Subjects with diabetes, hypertension and hypercholesterolemia were eligible. Using propensity score matching, we compared the control group of those who obtained medications at military pharmacies ($0 copay) to those who experienced a copay increase. The outcome variable was any use of condition-specific medication.</p><p><strong>Results: </strong>In the MHS cohort there were 30,753, 46,965, and 59,783 non-unique persons with diabetes, hyperlipidemia, and hypertension, respectively, in the intervention and control groups. In the Medicare cohort there were 45,977, 205,363, and 365,628 non-unique persons, respectively. The post-period mPDC differences for the MHS cohort were 0.02 (95% CI: 0.01, 0.03), 0.03 (95% CI: 0.02, 0.03), and 0.03 (95% CI: 0.01, 0.03) for the diabetes, hyperlipidemia, and hypertension cohorts, respectively. The post-period mPDC differences for the Medicare cohort were 0.01 (95% CI: 0.01, 0.02), 0.03 (95% CI: 0.03, 0.04), and 0.01 (95% CI: 0.01, 0.02), respectively.</p><p><strong>Conclusions: </strong>The small (1-3 percentage point) copayment increases are unlikely to have had adverse clinical effects. Insurers and policy-makers should understand that even small copayment increases can impact the use of clinically important medications and should carefully consider the tradeoffs.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"731-739"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonprofit Hospital CEO Compensation: Does Quality Matter?","authors":"Derek Jenkins, Marah Short, Vivian Ho","doi":"10.1097/MLR.0000000000002198","DOIUrl":"10.1097/MLR.0000000000002198","url":null,"abstract":"<p><strong>Background: </strong>Past research has documented that increases in profits and health system size, as well as increases in the reward generosity for improving these metrics play an important role in explaining increases in nonprofit hospital CEO pay between 2012 and 2019.</p><p><strong>Objectives: </strong>To test whether hospital quality measures play a supplemental role in determining CEO pay.</p><p><strong>Research design: </strong>We estimated linear regressions for 2012 and 2019 of the log of CEO wages on system or independent hospital characteristics, including quality. The regressions were used to construct a Oaxaca decomposition of factors associated with CEO compensation.</p><p><strong>Subjects: </strong>One thousand forty-seven nonprofit health systems and independent hospitals in 2012 and 812 in 2019.</p><p><strong>Measures: </strong>CEO compensation, hospital profits, charity care, hospital size, teaching status, system status, 30-day mortality rate for pneumonia patients, hospital-wide 30-day readmission rate.</p><p><strong>Results: </strong>We find that better quality was more closely associated with higher pay among hospital CEOs in 2012 versus 2019. The inclusion of these quality measures in the analysis somewhat reduced the observed relative return for leading larger hospitals or health systems in 2012, but not in 2019. The link between quality and CEO pay is weaker in 2019 than in 2012.</p><p><strong>Conclusions: </strong>The results suggest that nonprofit hospital CEOs are being rewarded more for leading large hospitals or systems, but not for providing higher quality care.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"787-793"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Selection Patterns for Emergency Surgical Care: Structural Barriers as a Contributor to Surgical Outcomes.","authors":"Jiuying Han, Neng Wan, Joshua J Horns, Simon Brewer, Marta L McCrum","doi":"10.1097/MLR.0000000000002182","DOIUrl":"10.1097/MLR.0000000000002182","url":null,"abstract":"<p><strong>Background: </strong>Structural inequities are pervasive in the US emergency care system and disproportionately affect socially vulnerable neighborhoods. Spatial patterns of hospital access for patients requiring emergency surgical care are influenced by health system structure; however, neighborhood-level variation and its association with clinical outcomes has not yet been characterized.</p><p><strong>Objective: </strong>Examine variation in spatial patterns of hospital access for adults with nontraumatic surgical emergencies and its association with clinical outcomes.</p><p><strong>Design: </strong>Retrospective analysis of California State Inpatient Discharge Data (2014-2015) of adults admitted with 1 of 8 emergency general surgery (EGS) conditions. We visualized patient home-to-hospital flows, then assessed Zip Code Tabulation Areas (ZCTA) patterns of spatial access using the Dispersion Index (DI), measured by the coefficient of variation of patient travel times where higher values indicate greater dispersion. Mixed-effect regression analysis was used to examine the association of DI with in-hospital mortality, nonhome discharge, and length of stay, adjusting for relevant patient, hospital, and neighborhood characteristics.</p><p><strong>Results: </strong>Among 337,695 EGS admissions, increasing DI was associated with greater neighborhood social deprivation index (SDI). After adjusting for relevant covariates, greater dispersion was associated with an increase in in-hospital mortality in the highest decile of dispersion (aOR: 1.14; 95% CI: 1.03-1.26). The magnitude of effect was greater for patients from high-SDI neighborhoods: mortality (aOR: 1.27; 95% CI: 1.11-1.44).</p><p><strong>Conclusions: </strong>High dispersion was associated with unfavorable clinical outcomes among EGS patients, with a greater effect for underserved groups. High variation in patterns of hospital access for emergency care likely reflects structural barriers to care and may be one mechanism contributing to the relationship between neighborhood social vulnerability and surgical outcomes.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"713-723"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Leader Views on the Family-Centeredness of Pediatric Care: A Global Survey.","authors":"Linda S Franck, Renée Mehra, Beverley H Johnson, Marie Abraham, Nicole Rubin, Thomas J Hoffmann","doi":"10.1097/MLR.0000000000002203","DOIUrl":"10.1097/MLR.0000000000002203","url":null,"abstract":"<p><strong>Background: </strong>Family-centered care (FCC) contributes to improved health care delivery and outcomes in pediatrics.</p><p><strong>Objective: </strong>To conduct a global survey of hospital leaders' views on FCC culture, policies, and practices in health care organizations serving children, including in the post-COVID-19 pandemic era.</p><p><strong>Research design: </strong>A cross-sectional electronic survey.</p><p><strong>Results: </strong>Surveys were received from 256 leaders from 215 hospitals in 38 countries. Preliminary psychometric analysis yielded a 44-item instrument wherein a higher total score indicated leaders had more positive views of their hospital's FCC. A majority reported high levels of FCC culture at bedside and supportive policies for family presence and participation. Fewer leaders reported family partnership at the organizational level, health professional education on FCC, or organizational accountability for FCC. In multivariable analyses, having an active patient and family advisory council (PFAC) was associated with higher FCC scores. Free-text comments reflected respondents' commitment to family presence and participation in care and decision-making, factors that facilitated or impeded active PFACs, variability in FCC practices, and the COVID-19 pandemic's impact on FCC.</p><p><strong>Conclusions: </strong>These findings suggest a commitment to FCC by leaders in hospitals providing pediatric care globally, and that an active PFAC is associated with higher ratings of hospital FCC culture, policies, and practices. Expanded adoption of PFACs, along with standardized measurement and quality improvement monitoring, may improve the family-centeredness of pediatric health care, and thereby contribute to quality and safety. Barriers such as a lack of organizational accountability for FCC must be addressed so that FCC can function optimally in pediatric settings.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"749-757"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Telehealth Payment Parity on Recommended Care and Emergency Department Service Utilization Among Workers With Chronic Conditions.","authors":"Zhang Zhang, M Kate Bundorf, Qing Gong, Justin G Trogdon, Donna Gilleskie, Sean Y Sylvia","doi":"10.1097/MLR.0000000000002185","DOIUrl":"10.1097/MLR.0000000000002185","url":null,"abstract":"<p><strong>Background and objective: </strong>State-level telehealth payment parity, requiring equal payment rates for telehealth and in-person visits, played an important role in ensuring access to telehealth services. The objective of our study is to evaluate how improved access, driven by telehealth payment parity, affected the utilization of disease-specific recommended care management services and emergency department (ED) services among insured patients with chronic conditions.</p><p><strong>Research design: </strong>We adopted a 2-way fixed-effect difference-in-differences approach using the Merative Commercial Claims and Encounters database from 2019 to 2021.</p><p><strong>Subjects: </strong>We focused on insured workers aged 19-64 with pre-existing mental health disorders or cardiometabolic risks (CMRs).</p><p><strong>Measures: </strong>Outcomes include psychotherapy for mental health disorders, preventive care counseling for CMRs, and ED visits.</p><p><strong>Results: </strong>Telehealth payment parity was associated with a significant increase in the number of psychotherapy visits and tele-psychotherapy by 0.221 visits (95% CI: 0.050-0.391) and 0.411 visits (95% CI: 0.003-0.818) per patient per quarter, respectively. The regulation significantly reduced E.D. visits among individuals with mental health disorders by 0.003 visits (95% CI: -0.007 to 0.000) per quarter, a 25% relative decrease compared with the control at preperiod. However, payment parity was not statistically associated with increasing preventive care visits and lowering ED visits among individuals with CMRs.</p><p><strong>Conclusion: </strong>Telehealth payment parity has effectively promoted the adoption of psychotherapy and reduced ED visits among insured workers with mental health disorders. However, it has not significantly improved the uptake of preventive care counseling for individuals with CMRs.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"779-786"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting the Valuation of Child Health-Related Quality of Life: Replacing Paired Comparisons With Kaizen Tasks and QALY Scaling With Experience Scaling.","authors":"Maksat Jumamyradov, Benjamin M Craig, Michał Jakubczyk","doi":"10.1097/MLR.0000000000002200","DOIUrl":"10.1097/MLR.0000000000002200","url":null,"abstract":"<p><strong>Objectives: </strong>In 2013, the EQ-5D-Y-3L valuation study conducted by Craig and colleagues (ie, the original study) of child health-related quality of life (HRQoL) revealed that U.S. respondents often found it burdensome and guilt-inducing to choose between hypothetical health problems of children. This study introduces an alternative approach where respondents sequentially relieve the health problems of a 10-year-old child for 1 week.</p><p><strong>Methods: </strong>We conducted a discrete choice experiment (DCE) survey (N=631) with paired comparisons and kaizen tasks. Each kaizen task displayed a single profile of a child's HRQoL using the EQ-5D-Y-3L descriptive system and asked respondents to select first, second, and third improvements for the child's problems. Combining the preference evidence, a conditional logit model was estimated to produce EQ-5D-Y-3L values on an \"experience\" scale, where positive values signify experiences better than \"being in a coma\" and negative values worse.</p><p><strong>Results: </strong>All 10 main effects were statistically significant ( P <0.01), with the highest value placed on alleviating pain and discomfort. The worst-case scenario (33333) had a value of -0.337 on the experience scale, indicating it is worse than a coma. These new estimates highly correlate with the original U.S. EQ-5D-Y-3L values (Pearson correlation=0.726; Spearman correlation=0.794).</p><p><strong>Conclusion: </strong>This innovative approach to child health valuation replaces paired comparisons with Kaizen tasks, reducing respondent burden and study costs. Its use of experience scaling, instead of QALYs, aligns with U.S. guidelines (eg, the Inflation Reduction Act of 2022) and summarizes child HRQoL gains for health technology assessment.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"771-778"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supplemental Items Reduce HCAHPS Response Rates, but Response Rates Do Not Affect HCAHPS Scores: A Randomized Experiment.","authors":"Megan K Beckett, Katrin Hambarsoomian, Julie Brown, Paul D Cleary, Gary A Abel, Laura A Giordano, Marc N Elliott","doi":"10.1097/MLR.0000000000002197","DOIUrl":"10.1097/MLR.0000000000002197","url":null,"abstract":"<p><strong>Background: </strong>Longer surveys can reduce response rates (RRs). Observational data suggest a positive hospital-level association between RRs and HCAHPS scores, but a negative patient-level relationship. There is no experimental evidence of whether a hospital's RR affects its HCAHPS scores.</p><p><strong>Objectives: </strong>Estimate the effect of the 59-item versus 32-item survey on RR by survey mode; assess whether any reductions in RR change HCAHPS scores.</p><p><strong>Research design: </strong>Patients randomized within hospitals to 4 survey protocols [mail-only, mixed mode (MM; mail with telephone follow-up of nonrespondents)] and survey length [32-item or 59-item (32 core + 27 supplemental items)]. Regression models predicted (1) whether a patient responded to a survey and (2) responses to patient experience measures within hospital and survey mode from survey length, controlling for patient characteristics.</p><p><strong>Subjects: </strong>A total of 10,099 adult patients from 51 nationally representative US hospitals participating in a randomized HCAHPS mode experiment.</p><p><strong>Principal findings: </strong>Adjusted MM RRs were 21.9 percentage points higher than mail-only RR for the 32-item survey. The adjusted RR for the 59-item survey was 5.6 percentage points lower than the 32-item survey in MM and 2.9 percentage points lower in mail-only mode. The lower RR caused by greater length had no effect on standard adjusted HCAHPS scores in either mode.</p><p><strong>Conclusions: </strong>A longer survey reduced RRs, especially by telephone follow-up after a mail survey. HCAHPS hospitals and vendors may want to consider trade-offs when adding many supplemental items and the RR advantage of MM. Reducing RRs within a hospital does not change standard adjusted HCAHPS scores.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"764-770"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}