Nonresponse bias in a survey of patient perceptions of hospital care

Med Care. 2005 Apr;43(4):374-80. doi: 10.1097/01.mlr.0000156856.36901.40.


Background: Incomplete participation is of particular concern for surveys of patient perceptions of care because patients who have negative opinions may be least likely to participate.

Objective: We sought to examine indirect evidence of nonresponse bias.

Design: We re-analyzed data from a cross-sectional patient survey.

Subjects: Our subjects were patients discharged from a Swiss hospital (n = 2156).

Measures: We measured the following: (1) an observed problem score, based on 15 key items of the Picker Patient Experience questionnaire, (2) a predicted problem score, and (3) a participation propensity score. The latter scores were computed for all eligible patients, including those who did not return the survey, from routinely available baseline data.

Results: The participation rate was 70% (n = 1518), and the mean problem score was 29.9 (SD 23.8). Early respondents reported significantly fewer problems than late respondents (28.6 versus 32.9, P = 0.001). Participation propensity scores were progressively lower in early respondents (mean 74.2), late respondents (70.7), and nonrespondents (63.9, P < 0.001); the pattern was similar for predicted problem scores (early respondents: 29.5; late respondents: 30.5; nonrespondents: 33.4, P < 0.001). The propensity to participate was negatively associated with the problem score (Pearson r = -0.19). Finally, predictors of participation were similar to predictors of problem scores.

Conclusions: The tendency to participate in the survey was negatively associated with the report of problems during hospitalization. Nevertheless, increasing participation from 30% to 70% had only a modest influence on the final conclusions of the survey.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bias*
  • Cross-Sectional Studies
  • Female
  • Health Care Surveys / methods*
  • Hospitals / standards*
  • Humans
  • Inpatients / psychology*
  • Male
  • Middle Aged
  • Patient Satisfaction / statistics & numerical data*
  • Patient Selection
  • Quality of Health Care*
  • Surveys and Questionnaires
  • Switzerland / epidemiology