Mixed Mode Substantially Increases Hospital Consumer Assessment of Healthcare Providers and Systems Response Rates Relative to Single-Mode Protocols

Background: Low response rates (RRs) can affect hospitals' data collection costs for patient experience surveys and value-based purchasing eligibility. Most hospitals use single-mode approaches, even though sequential mixed mode (MM) yields higher RRs and perhaps better patient representativeness. Some hospitals may be reluctant to incur MM's potential additional cost and complexity without knowing how much RRs would increase. Objective: The aim of this study was to estimate the differences in RR and patient representation between MM and single-mode approaches and to identify hospital characteristics associated with the largest RR differences from MM of single-mode protocols (mail-only, phone-only). Research Design: Patients were randomized within hospitals to one of 3 modes (mail-only, phone-only, MM). Subjects: A total of 17,415 patients from the 51 nationally representative US hospitals participating in a randomized HCAHPS mode experiment. Results: Mail-only RRs were lowest for ages 18-24 (7%) and highest for ages 65+ (31%-35%). Phone-only RRs were 24% for ages 18-24, increasing to 37%-40% by ages 55+. MM RRs were 28% for ages 18-24, increasing to 50%-60% by ages 65-84. Lower hospital-level mail-only RRs strongly predicted greater gains from MM. For example, a hospital with a 15% mail-only RR has a predicted MM RR >40% (with >25% occurring in telephone follow-up). Conclusion: MM increased representation of hard-to-reach (especially young adult) patients and hospital RRs in all mode experiment hospitals, especially in hospitals with low mail-only RRs.