Web-based emergency department patient satisfaction surveys may introduce potential for bias.
BACKGROUND
Emergency departments (ED) have proposed utilizing a Web-based format to distribute patient satisfaction surveys, but the potential for bias in this distribution method has not been assessed.


OBJECTIVE
The aim of this study was to evaluate the characteristics of ED patients who have access to the Internet to better understand potential bias in Web-based patient satisfaction surveys.


METHODS
We distributed a 20-question survey to consenting, English-speaking adult patients presenting to the ED from December 2010 to March 2012. Patients reported demographic information and answered questions related to their access and use of the Internet.


RESULTS
Seven hundred four patients participated in the study; 90% of Whites reported Internet access, vs. 82% of Hispanics (p = 0.034). Ninety-two percent of patients with at least some college education had Internet access, compared to 79% of those with a high school education level or lower (p ≤ 0.001). Of households reporting an income of > $22,000/year, 95% had Internet access, compared to 77% of those reporting a household income < $22,000/year (p ≤ 0.001). Ninety-four percent of participants < 40 years of age had Internet access, compared to 83% between the ages of 40 and 56 years, and 77% for those over 56 years of age (p < 0.001).


CONCLUSIONS
A Web-based distribution of ED patient satisfaction surveys may underrepresent minorities, patients without college education, those with lower income, and patients older than 40 years. This information may provide guidance in interpreting results of Web-based patient satisfaction surveys and may suggest the need for multiple sampling methods.
Division of Emergency Medicine, University of Utah, Salt Lake City, Utah.
Camille
C
Broadwater-Hollifield
Division of Emergency Medicine, University of Utah, Salt Lake City, Utah.
James
J
Fair
Division of Emergency Medicine, University of Utah, Salt Lake City, Utah.
Susan
S
Podolsky
Division of Emergency Medicine, University of Utah, Salt Lake City, Utah.
Jessica
J
Carey
Division of Emergency Medicine, University of Utah, Salt Lake City, Utah.
Kajsa
K
Vlasic
Division of Emergency Medicine, University of Utah, Salt Lake City, Utah.
Robert
R
Stephen
Division of Emergency Medicine, University of Utah, Salt Lake City, Utah.
Troy
T
Madsen
Division of Emergency Medicine, University of Utah, Salt Lake City, Utah.
Michael
M
Mallin
D000328:Adult; D000367:Age Factors; D015982:Bias; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019538:Health Care Surveys / Q000379:methods*; D006630:Hispanic or Latino; D006801:Humans; D007182:Income; D020407:Internet / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D044465:White People
Internet access; patient demographics; patient satisfaction; survey bias