Division of Health Care Policy and Research, Department of Health Sciences Research, Survey Research Center, Mayo Clinic, Rochester, MN 55905, USA.
Med Care. 2011 Apr;49(4):365-70. doi: 10.1097/MLR.0b013e318202ada0.
To extend earlier work (Beebe et al, Med Care. 2007;45:959-965) that demonstrated Health Insurance Portability and Accountability Act authorization form (HAF) introduced potential nonresponse bias (toward healthier respondents).
The sample frame from the earlier experiment was linked to administrative medical record data, enabling the comparison of background and clinical characteristics of each set of respondents (HAF and No HAF) to the sample frame.
A total of 6939 individuals residing in Olmsted County, Minnesota who were mailed a survey in September 2005 assessing recent gastrointestinal symptoms with an embedded HAF experiment comprised the study population.
The outcomes of interest were response status (survey returned vs. not) by HAF condition (randomized to receive HAF or not). Sociodemographic indicators included gender, age, and race. Health status was measured using the severity-weighted Charlson Score and utilization was measured using emergency room visits, hospital admissions, clinic office visits, and procedures.
Younger and nonwhite residents were under-represented and those with more clinical office visits were over-represented in both conditions. Those responding to the survey in the HAF condition were significantly more likely to be in poor health compared with the population (27.3% with 2+ comorbidities vs. 24.6%, P=0.02).
The HAF did not influence the demographic composition of the respondents. However, in contrast to earlier findings based on self-reported health status (Beebe et al, Med Care. 2007;45:959-965), responders in the HAF condition were slightly sicker than in the non-HAF condition. The HAF may introduce a small amount of measurement error by suppressing reports of poor health. Furthermore, researchers should consider the effect of the HAF on resultant precision, respondent burden, and available financial resources.
扩展早期工作（Beebe 等人，医疗保健。2007 年；45:959-965），证明健康保险可携带性和问责法案授权表（HAF）引入了潜在的无应答偏差（对更健康的应答者有利）。
早期实验的样本框架与行政医疗记录数据相关联，使每个应答者组（HAF 和无 HAF）与样本框架的背景和临床特征进行比较成为可能。
2005 年 9 月，明尼苏达州奥姆斯特德县的 6939 名居民邮寄了一份调查，评估最近的胃肠道症状，其中嵌入了 HAF 实验，构成了研究人群。
感兴趣的结果是 HAF 条件（随机接受 HAF 或不接受 HAF）下的应答状态（调查返回与未返回）。社会人口指标包括性别、年龄和种族。健康状况用严重加权 Charlson 评分衡量，利用急诊室就诊、住院、诊所就诊和程序衡量利用率。
年轻和非白人居民代表性不足，在两种情况下，临床就诊次数较多的居民代表性过高。在 HAF 条件下应答调查的居民与人群相比，健康状况明显较差（2 种以上合并症的比例为 27.3%，而 24.6%，P=0.02）。
HAF 并未影响应答者的人口构成。然而，与基于自我报告健康状况的早期发现（Beebe 等人，医疗保健。2007 年；45:959-965）相反，HAF 条件下的应答者比非 HAF 条件下的应答者稍微病得更重。HAF 可能通过抑制对健康状况不佳的报告引入少量测量误差。此外，研究人员应考虑 HAF 对结果精度、应答者负担和可用财务资源的影响。
