title: Understanding nonresponse to the 2007 Medicare CAHPS survey.
abstract: OBJECTIVE
  The Medicare Consumer Assessments of Healthcare Providers and Systems (MCAHPS) survey, a primarily English-language mail survey with English and Spanish telephone follow-up, is the primary means of assessing the health care experiences of American seniors. We examine unit (whole survey) and item nonresponse for this survey to explore issues regarding surveying seniors about their health care.
  
  
  METHODS
  We describe overall rates and analyze predictors of unit and item nonresponse for the 695,197 Medicare beneficiaries selected for the 2007 MCAHPS survey (335,249 unit respondents, 49% overall response rate).
  
  
  RESULTS
  Asians, African Americans, and Hispanics responded at adjusted response rates 7-17 percentage points lower than non-Hispanic Whites (p < .001 for each). Among seniors, response rates dropped beyond age 75. Asians and older beneficiaries were especially likely to respond by mail, and African Americans and Hispanics by phone. Breakoff from telephone surveys was most common among African Americans and older respondents. Among respondents, older age was the strongest predictor of item missingness (e.g., those 85 years and older failed to answer items at twice the rate of those aged 65-74 years, p < .001). Non-Hispanic Whites had lower rates of item missingness than other racial/ethnic groups (p < .001 for each; one-third lower than African Americans).
  
  
  CONCLUSIONS
  Survey research on older adults, especially regarding racial/ethnic disparities in health care, could benefit from improved response rates. These results suggest that targeted prenotification materials and campaigns, tailored follow-up, targeted Spanish mailings, Chinese translations/calls, and adjustments to telephone protocols may improve representation and response.
authors.affiliation: General Pediatrics, Children's Hospital Boston, Harvard Medical School, Massachusetts, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Klein
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.forename: Amelia M
authors.initials: AM
authors.lastname: Haviland
authors.forename: Debra
authors.initials: D
authors.lastname: Saliba
authors.forename: Q
authors.initials: Q
authors.lastname: Burkhart
authors.forename: Carol
authors.initials: C
authors.lastname: Edwards
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data*; D003144:Communication Barriers; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007802:Language; D008297:Male; D006278:Medicare / Q000458:organization & administration*; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards*; D014481:United States / Q000453:epidemiology; D055815:Young Adult