Does Nonresponse Bias the Results of Retrospective Surveys of End-of-Life Care?
ABSTRACT To evaluate the effect of nonresponse bias on reports of the quality of end-of-life care that older adults receive.
Nationwide retrospective survey of end-of-life care.
Sixty-two Veterans Affairs Medical Centers.
Patients were eligible if they died in a participating facility. One family member per patient was selected from medical records and invited to participate.
The telephone survey included 14 items describing important aspects of the patient's care in the last month of life. Scores (0-100) reflect the percentage of items for which the family member reported that the patient received the best possible care, and a global item defined the proportion of families who said the patient received "excellent" care. To examine the effect of nonresponse bias, a model was created to predict the likelihood of response based on patient and family characteristics; then this model was used to apply weights that were equivalent to the inverse of the probability of response for that individual.
Interviews were completed with family members of 3,897 of 7,110 patients (55%). Once results were weighted to account for nonresponse bias, the change in mean individual scores was 2% of families reporting "excellent" care. Of the 62 facilities in the sample, the scores of only 19 facilities (31%) changed more than 1% in either direction, and only 10 (16%) changed more than 2%.
Although nonresponse bias is a theoretical concern, it does not appear to have a significant effect on the facility-level results of this retrospective family survey.
- SourceAvailable from: Thomas Volken[Show abstract] [Hide abstract]
ABSTRACT: Background: Unit non-response occurs in sample surveys when a target subject does not respond to a survey. Potential implications are decreased power, increased standard error, and non-response bias. The objective of this study was to assess the factors associated with participation in a written survey (MSHS) of subjects who had previously participated in the Swiss Health Survey (SHS) and to evaluate to what extent non-participation could impact the estimation of various MSHS health outcomes. Methods: Multivariate logistic regression was used to assess the factors associated with MSHS participation (n=14,393) by eligible SHS participants (n=17,931). Crude participation rates and the adjusted odds ratios of participation (OR) were reported. In order to report potential bias in MSHS outcomes, the average age-standardized and sex-specific outcome values in non-participants were predicted based on several different linear regression models which had been previously fitted on MSHS participants. Results: Adjusting for all other variables, women (OR=1.63) as compared with men, subjects with a secondary (OR=1.48) or tertiary education (OR=1.76) as compared with those with primary education, white-collar workers (high level non-manual workers OR=1.29, medium and low level non-manual workers OR=1.26 and OR=1.25 respectively) as compared with unskilled manual workers, Swiss nationals (OR=1.60) as compared to non-Swiss, and subjects with very good or good self-rated health (OR=1.35) were more likely to participate in the MSHS. People who work full-time were less likely to participate than those without paid work (OR=0.76). There were no statistically significant differences in the likelihood of participation between rural and urban areas, different geographic regions of Switzerland and household income quartiles. Except for myocardial infarction, all age-standardized and sex-specific average outcomes (influenza vaccination, arthrosis, osteoporosis, high blood pressure, depression, mastery, and sense of coherence) were significantly different between MSHS non-participants and participants. Conclusions: Subjects who participated in the MSHS had a higher socio-economic status, reported a better subjective health, and were more likely to be Swiss nationals. Small to moderate bias was found for most age-adjusted and sex-specific average outcomes. Consequently, these MSHS outcomes should be used and interpreted with care.BMC Public Health 02/2013; 13. DOI:10.1186/1471-2458-13-167 · 2.32 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Abstract Background: The quality of end-of-life (EOL) care at Veterans Affairs Medical Centers (VAMC) has improved. To date, however, the quality and outcomes of end-of-life care delivered to women veterans have not been examined. Objective: The goal of this study was to evaluate gender differences in the quality of EOL care received by patients in VAMCs nationwide. Design: The study was conducted via retrospective medical chart review and telephone survey with next of kin of recently deceased inpatients. Setting/subjects: The chart review included records for all patients who died in acute and long-term care units in 145 VAMCs nationwide (n=36,618). For the survey, the documented next of kin were invited to respond on behalf of the deceased veteran; a total of 25,638 next of kin completed the survey. Measurements: Chart review measures included five indicators of optimal end-of-life care. Bereaved family survey items included one global and nine specific items (e.g., bereavement care, pain management) describing care in the last month of life. Results: Receipt of optimal end-of-life care did not differ significantly between women and men with respect to frequency of discussion of treatment goals with a family member, receipt of palliative consult, bereavement contact, and chaplain contact with a family member. Family members of women were more likely than those of men to report that the overall care provided to the veteran had been "excellent" (adjusted proportions: 63% versus 56%; odds ratio (OR)=1.33; 95% confidence interval (CI) 1.10-1.61; p=0.003). Conclusions: In this nationwide study of all inpatient deaths in VAMCs, women received comparable and on some metrics better quality EOL care than that received by male patients.Journal of palliative medicine 05/2013; 16(7). DOI:10.1089/jpm.2012.0537 · 2.06 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Most patients will lose decision-making capacity at the end of life. Little is known about the quality of care received by patients who have family involved in their care. To evaluate differences in the receipt of quality end-of-life care for patients who died with and without family involvement. We retrospectively reviewed the charts of 34,290 decedents from 146 acute and long-term care VA facilities between 2010-2011. Outcomes included: 1) palliative care consult; 2) chaplain visit; and 3) death in an inpatient hospice/palliative care unit. We also assessed DNR orders. Family involvement was defined as documented discussions with the health care team in the last month of life. We used logistic regression adjusted for demographics, comorbidity, and clustered by facility. For chaplain visit, hospice/palliative care unit death, and DNR, we additionally adjusted for palliative care consults. Mean (SD) age was 74(± 12) years, 98% were men, and 19% were non-White. Most decedents (94.2%) had involved family. Veterans with involved family were more likely to have had a palliative consult, AOR 4.31 (95% CI 3.90-4.76), a chaplain visit, AOR 1.18 (95% CI 1.07-1.31), and a DNR order, AOR 4.59 (95% CI 4.08-5.16), but not more likely to die in a hospice/palliative care unit. Family involvement at the end of life is associated with receipt of palliative care consultation and a chaplain visit, and a higher likelihood of a DNR order. Clinicians should support early advance care planning for vulnerable patients who may lack family or friends.Journal of pain and symptom management 05/2014; DOI:10.1016/j.jpainsymman.2014.04.001 · 2.74 Impact Factor