title: Survey nonresponders incurred higher medical utilization and lower medication adherence.
abstract: OBJECTIVE
  To compare healthcare costs, utilization, and medication adherence between diabetic responders and nonresponders to a patient satisfaction survey.
  
  
  METHODS
  We performed a retrospective cohort study of 40,766 patients with diabetes who had been randomly selected to receive the 2006 Veterans Affairs' Survey of Healthcare Experiences of Patients. Outcomes were measured during the following year.
  
  
  METHODS
  We used multivariable models to compare healthcare costs (generalized linear models), utilization (negative binomial regression), and adherence to oral hypoglycemic medications (logistic regression) between survey responders and nonresponders.
  
  
  RESULTS
  There were 26,051 patients (64%) who responded to the survey. Survey nonresponders incurred significantly higher healthcare costs (incremental effect, $792; 95% CI, $599-$986; P < .01). Nonresponders had a modest increase in primary care (incidence rate ratio [IRR], 1.06; 95% CI, 1.05-1.08; P < .01) and specialty care visits (IRR, 1.17; 95% CI, 1.12-1.22; P < .01), but more substantial increases in mental health visits (IRR, 1.74; 95% CI, 1.62-1.87; P < .01) and hospitalizations (IRR, 1.60; 95% CI, 1.46-1.75; P < .01). Medication adherence was significantly lower among survey nonresponders (odds ratio, 0.68; 95% CI, 0.65-0.74; P < .01).
  
  
  CONCLUSIONS
  Nonresponders to a patient satisfaction survey incurred higher healthcare costs and utilization, but had lower medication adherence. Understanding these characteristics helps to assess the impact of nonresponse bias on patient satisfaction surveys and identifies clinical practices to improve care delivery.
authors.affiliation: 1100 Olive Way, Ste 1400, Seattle, WA 98104-3801. E-mail: srinne@uw.edu.
authors.forename: Seppo T
authors.initials: ST
authors.lastname: Rinne
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Wong
authors.forename: Jaclyn M
authors.initials: JM
authors.lastname: Lemon
authors.forename: Mark
authors.initials: M
authors.lastname: Perkins
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Bryson
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States; D016903:Drug Monitoring
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents