CHA News Article

Analysis Finds HCAHPS Response Rates Matter
Higher response rate linked to increased performance ratings

California hospitals are currently ranked in the bottom tier nationwide on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In its examination of methods to improve these scores, the Hospital Quality Institute (HQI) analytics team found that a percent increase in response rate is predictive of a one-half percent increase in overall mean score. Therefore, HQI has set a target for hospitals to increase their overall response rate by at least 3 percent, which would advance statewide performance ratings to a score of 68 — and out of the bottom quartile. In California, response rates range from 8 to 60 percent. HQI urges hospitals with response rates of less than 25 percent to consider the following evidence-based recommendations:

  • Timing: Patients surveyed sooner after discharge are more likely to respond and give higher scores. Optimal practice involves hospitals sending daily information on eligible discharges to their HCAHPS vendors.
  • Language: Limited-English proficient (LEP) patients often do not respond to surveys because they are not administered in their preferred language. Spanish-speaking patients as a group tend to contribute higher scores on the HCAHPS survey, yet are significantly less likely to respond. Hospitals should provide their vendors with information on the preferred language of patients eligible for discharge and ensure that vendors in turn administer the survey in the patients’ preferred languages. 
  • Convey the importance of giving feedback: Hospitals should consider developing an awareness campaign to give patients clear messages about why it is important to give feedback by completing the HCAHPS survey.
  • Survey method: Surveys administered via telephone tend to result in higher response rates, particularly among younger patients, LEP patients and populations with lower levels of literacy. Many patients no longer have landline phones, making it essential for hospitals to capture their mobile phone numbers. 
  • Optimizing the vendor relationship: Most HCAHPS survey vendors can recommend and deploy effective solutions to increase survey response rates, many at low additional costs. Hospitals, particularly those with response rates lower than 25 percent, are encouraged to engage their vendors and discuss options for achieving higher response rates. This may include setting a minimum response rate threshold as a contractual performance requirement. 
  • Sample size: In addition to improving their response rates, hospitals are encouraged to examine the adequacy of their sample size. Surveying the entire census of patients eligible for discharge is the preferred method, which tends to result in more reliable HCAHPS data. This is particularly important for smaller-size hospitals.

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