1 Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA 2 Pacific Business Group on Health, San Francisco, California, USA 3 Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts, USA 4 Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA.
Patient. 2009 Jun 1;2(2):135-41. doi: 10.2165/01312067-200902020-00009.
The use of item screeners is viewed as an essential feature of quality survey design because only respondents who are 'qualified' to answer questions that apply to a subset of the sample are directed to answer. However, empirical evidence supporting this view is scant.
This study compares data quality resulting from the administration of ambulatory care experience measures that use item screeners versus tailored 'not applicable' options in response scales.
Patients from the practices of 367 primary care physicians in 65 medical groups were randomly assigned to receive one of two versions of a well validated ambulatory care experience survey. Respondents (n = 2240) represent random samples of active established patients from participating physicians' panels.The 'screener' survey version included item screeners for five test items and the 'no screener' version included tailored 'not applicable' options in response scales instead of using screeners.The main outcomes measures were data quality resulting from the two item versions, including the mean item scores, the level of missing values, outgoing patient sample sizes needed to achieve adequate medical group-level reliability, and the relative ranking of medical groups.
Mean survey item scores generally did not differ by version. There were consistently fewer respondents to the 'screener' versions than 'no screener' versions. However, because the 'screener' versions improved measurement precision, smaller outgoing patient samples were needed to achieve adequate medical group-level reliability for four of the five items than for the 'no screener' version. The relative ranking of medical groups did not differ by item version.
Screeners appear to reduce noise by ensuring that respondents who are not 'qualified' to answer a question are screened out instead of providing unreliable responses. The increased precision resulting from 'screener' versions appears to more than offset the higher item non-response rates compared with 'no screener' versions.
项目筛选器的使用被视为质量调查设计的一个基本特征，因为只有那些“合格”回答适用于样本子集的问题的受访者才会被要求回答。然而，支持这种观点的经验证据很少。
本研究比较了使用项目筛选器和定制的“不适用”选项在应答量表中对门诊护理经验测量结果的数据质量。
从 65 个医疗组的 367 名初级保健医生的实践中随机抽取患者，随机分配接受两种版本的经过充分验证的门诊护理经验调查。受访者（n=2240）是参与医生小组中活跃的既定患者的随机样本。“筛选器”调查版本包括五个测试项目的项目筛选器，而“无筛选器”版本包括定制的“不适用”选项在应答量表中，而不是使用筛选器。主要结果衡量标准是两种项目版本的数据质量，包括平均项目分数、缺失值水平、为实现足够的医疗组水平可靠性所需的外出患者样本量以及医疗组的相对排名。
平均调查项目分数通常不因版本而异。“筛选器”版本的受访者始终少于“无筛选器”版本。然而，由于“筛选器”版本提高了测量精度，因此与“无筛选器”版本相比，需要较小的外出患者样本量即可为五个项目中的四个达到足够的医疗组水平可靠性。医疗组的相对排名不因项目版本而异。
筛选器似乎通过确保筛选出不符合回答问题条件的受访者而不是提供不可靠的答案来减少噪音。与“无筛选器”版本相比，“筛选器”版本的更高精度似乎足以弥补更高的项目无响应率。
