title: Exploring Nonresponse Bias in the Department of Veterans Affairs' Bereaved Family Survey.
abstract: BACKGROUND
  Patients' and families' evaluations of health care, including palliative care, are widely used as performance measures. Survey scores may be affected by nonresponse bias, resulting in inaccurate performance evaluation.
  
  
  OBJECTIVE
  Our aim was to examine nonresponse bias for the mailed version of the Department of Veterans Affairs (VA) Bereaved Family Survey Performance Measure (BFS-PM) and evaluate the effect of nonresponse bias on facilities' BFS-PM scores.
  
  
  METHODS
  A cross-sectional analysis of a national sample was conducted. The sample consisted of 20,540 veterans who died in one of 146 VA Medical Centers (VAMCs) between October 2012 and September 2013. Next of kin (NOK) were asked to complete and return the survey. The BFS-PM is defined as the proportion of NOK who rated overall care for the veteran during the last month of life as "excellent." After creating a model to predict the likelihood of response based on patient and clinical characteristics, we applied inverse probability weights to examine their effect on facilities' scores. We also evaluated facility performance before and after weighting for nonresponse vis-à-vis varying benchmarks.
  
  
  RESULTS
  We received 8912 surveys (45% response rate). The mean change in facility BFS-PM scores after weighting was -2%, (range: -10% to+11%). The scores of 31% of facilities changed more than±2%. The number of facilities meeting hypothetical benchmarks of 60%, 70%, and 80% also changed as a result of weighting for nonresponse.
  
  
  CONCLUSIONS
  Our results underscore the importance of appropriately addressing nonresponse in the use of quality-of-care metrics based on Bereaved Family Survey (BFS) data.
authors.affiliation: 1 PROMISE Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania.|4 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.
authors.forename: Dawn
authors.initials: D
authors.lastname: Smith
authors.affiliation: 1 PROMISE Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania.|4 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.
authors.forename: Natalie
authors.initials: N
authors.lastname: Kuzla
authors.affiliation: 1 PROMISE Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania.|2 Center for Health Equity Research and Promotion, Department of Veterans Affairs Medical Center , Pittsburgh, Pennsylvania.|3 Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy , Pittsburgh, Pennsylvania.
authors.forename: Joshua
authors.initials: J
authors.lastname: Thorpe
authors.affiliation: 1 PROMISE Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania.
authors.forename: Laura
authors.initials: L
authors.lastname: Scott
authors.affiliation: 1 PROMISE Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania.|4 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.
authors.forename: Mary
authors.initials: M
authors.lastname: Ersek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001601:Bereavement; D015982:Bias; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D005190:Family / Q000523:psychology*; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D013727:Terminal Care / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D055815:Young Adult