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Adjustment of Patient Experience Surveys for How People Respond.



Patient surveys are the primary tool to measure patient experiences of care. Caution must be taken when analyzing these data, as responses can be influenced by factors that do not reflect the quality of care received.


To provide a practical overview of adjusting patient experience survey results to address bias related to patient case-mix, extreme response tendency, and mode of survey administration.

Research design

We discuss options for adjustment for biases in how people respond to patient experience surveys.


Case-mix adjustment (CMA) aims to compare provider performance that would have been observed if all providers had treated the same set of patients by removing the effects of patient characteristics that vary across providers. Extreme response tendency can bias the measurement of the disparities in patient experiences even after typical CMAs, since differences in patients' use of extreme response options may affect patient experience scores when they have a skewed distribution. Survey mode may affect scores for the provider entity being evaluated (eg, hospital) more than CMA if survey mode differs at the provider level.


It is best practice to evaluate known source of bias when analyzing patient experience surveys. Failure to adjust for patient case-mix, extreme response tendency, and survey mode in patient experience surveys may lead to erroneous comparisons of providers.

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