RAND Corporation, Santa Monica.
Division of General Internal Medicine & Health Services Research, University of California, Los Angeles, Los Angeles, CA.
Med Care. 2021 Mar 1;59(3):202-205. doi: 10.1097/MLR.0000000000001489.
Patient surveys are the primary tool to measure patient experiences of care. Caution must be taken when analyzing these data, as responses can be influenced by factors that do not reflect the quality of care received.
To provide a practical overview of adjusting patient experience survey results to address bias related to patient case-mix, extreme response tendency, and mode of survey administration.
We discuss options for adjustment for biases in how people respond to patient experience surveys.
Case-mix adjustment (CMA) aims to compare provider performance that would have been observed if all providers had treated the same set of patients by removing the effects of patient characteristics that vary across providers. Extreme response tendency can bias the measurement of the disparities in patient experiences even after typical CMAs, since differences in patients' use of extreme response options may affect patient experience scores when they have a skewed distribution. Survey mode may affect scores for the provider entity being evaluated (eg, hospital) more than CMA if survey mode differs at the provider level.
It is best practice to evaluate known source of bias when analyzing patient experience surveys. Failure to adjust for patient case-mix, extreme response tendency, and survey mode in patient experience surveys may lead to erroneous comparisons of providers.
患者调查是衡量患者护理体验的主要工具。在分析这些数据时必须谨慎，因为患者的反应可能受到与所接受护理质量无关的因素的影响。
提供一个实用的概述，介绍如何调整患者体验调查结果，以解决与患者病例组合、极端反应倾向和调查管理模式相关的偏差。
我们讨论了针对患者体验调查中人们反应偏差的调整选项。
病例组合调整（CMA）旨在通过消除提供者之间存在差异的患者特征的影响，来比较在所有提供者都治疗相同一组患者的情况下观察到的提供者绩效。即使在进行了典型的 CMA 之后，极端反应倾向也可能会使患者体验差异的测量产生偏差，因为患者对极端反应选项的使用差异可能会影响到具有偏态分布的患者体验得分。如果在提供者层面上存在调查模式差异，调查模式可能比病例组合调整对正在评估的提供者实体（例如医院）的评分产生更大的影响。
在分析患者体验调查时，评估已知的偏差来源是最佳实践。如果患者体验调查中不调整患者病例组合、极端反应倾向和调查模式，可能会导致对提供者的错误比较。
