Nonresponse Bias on Inpatient Rehabilitation Hospitals’ Experience of Care Quality Measure Scores

Archives of Rehabilitation Research and Clinical Translation, 2024 · DOI: https://doi.org/10.1016/j.arrct.2024.100363 · Published: January 1, 2024

Patient Experience Healthcare Rehabilitation

Simple Explanation

Inpatient rehabilitation facilities (IRFs) aim to help patients with major illnesses or injuries regain functional abilities and participate in their communities. Understanding nonresponse bias is crucial when assessing IRF quality, as neurologic conditions can affect a patient's ability to respond to surveys. This study compares data from routine IRF surveys and research project surveys to evaluate the representativeness of survey respondents and the impact of proxy responses.

Study Duration

Not specified

Participants

1055 patients with neurologic disorders

Evidence Level

Cohort study

Key Findings

1
IRF Survey respondents had higher cognitive function than nonrespondents; patients with spinal cord injuries were more likely to complete the IRF Survey than other patients.
2
There were subtle differences in quality measure results across surveys, reflecting the extent to which patients are encouraged to complete experience of care surveys.
3
Agreement was higher on questions about global hospital perceptions than specific aspects of patients’ experience.

Research Summary

This study examined nonresponse bias in inpatient rehabilitation facilities (IRFs) by comparing routine IRF survey data with research survey data from patients with neurologic conditions. The findings revealed subtle differences in quality measure scores between the two survey methods and identified factors such as cognitive function and primary medical condition as influencing survey response rates. The study suggests that nonresponse bias may be more significant in IRFs than in general acute hospitals due to the higher prevalence of motor and cognitive limitations in IRF patients.

Practical Implications

Quality Measure Development

Consider variables associated with top-box variations as risk adjusters when developing quality measures for IRFs.

Improved Response Rates

Efforts to improve response rates will result in quality measure results that are more generalizable to IRFs’ entire patient populations; they also may be less favorable.

Future Research

Future research should collect data from a larger sample of IRFs and simultaneously collect responses from patients and their proxies.

Study Limitations

1
Sample data were collected from 2 IRFs in the Midwestern United States and are not representative of all IRFs.
2
Questions were similar but not identical in the Research Survey and the IRF Survey, and rating scales were not the same.
3
We do not know to what extent proxy respondents obtained patient input to provide answers to survey questions.

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