General Pediatrics, Children's Hospital Boston, Harvard Medical School, Massachusetts, USA.
Gerontologist. 2011 Dec;51(6):843-55. doi: 10.1093/geront/gnr046. Epub 2011 Jun 23.
The Medicare Consumer Assessments of Healthcare Providers and Systems (MCAHPS) survey, a primarily English-language mail survey with English and Spanish telephone follow-up, is the primary means of assessing the health care experiences of American seniors. We examine unit (whole survey) and item nonresponse for this survey to explore issues regarding surveying seniors about their health care.
We describe overall rates and analyze predictors of unit and item nonresponse for the 695,197 Medicare beneficiaries selected for the 2007 MCAHPS survey (335,249 unit respondents, 49% overall response rate).
Asians, African Americans, and Hispanics responded at adjusted response rates 7-17 percentage points lower than non-Hispanic Whites (p < .001 for each). Among seniors, response rates dropped beyond age 75. Asians and older beneficiaries were especially likely to respond by mail, and African Americans and Hispanics by phone. Breakoff from telephone surveys was most common among African Americans and older respondents. Among respondents, older age was the strongest predictor of item missingness (e.g., those 85 years and older failed to answer items at twice the rate of those aged 65-74 years, p < .001). Non-Hispanic Whites had lower rates of item missingness than other racial/ethnic groups (p < .001 for each; one-third lower than African Americans).
Survey research on older adults, especially regarding racial/ethnic disparities in health care, could benefit from improved response rates. These results suggest that targeted prenotification materials and campaigns, tailored follow-up, targeted Spanish mailings, Chinese translations/calls, and adjustments to telephone protocols may improve representation and response.
医疗保险消费者评估医疗保健提供者和系统（MCAHPS）调查是评估美国老年人医疗保健体验的主要手段，它主要采用英语邮件调查，并辅以英语和西班牙语电话随访。我们考察了该调查的单位（整个调查）和项目无回答情况，以探讨有关调查老年人医疗保健的问题。
我们描述了总体率，并分析了 2007 年 MCAHPS 调查中选择的 695197 名医疗保险受益人的单位和项目无回答的预测因素（335249 个单位应答者，总体应答率为 49%）。
亚洲人、非裔美国人和西班牙裔的应答调整后反应率比非西班牙裔白人低 7-17 个百分点（p<0.001）。在老年人中，年龄超过 75 岁后，应答率下降。亚洲人和年长的受益人更有可能通过邮件应答，而非裔美国人和西班牙裔更有可能通过电话应答。在电话调查中，非裔美国人和年长的应答者最容易中断。在应答者中，年龄是项目缺失的最强预测因素（例如，85 岁及以上的人未回答项目的比率是 65-74 岁的两倍，p<0.001）。非西班牙裔白人的项目缺失率低于其他种族/族裔群体（p<0.001，每个群体都低 1/3）。
针对老年人的调查研究，尤其是关于医疗保健中的种族/族裔差异的研究，可以从提高应答率中受益。这些结果表明，有针对性的预先通知材料和活动、定制的后续行动、有针对性的西班牙语邮件、中文翻译/电话和调整电话协议可能会提高代表性和应答率。
