Jeanette Ziegenfuss

Are lower response rates hazardous to your health survey? An analysis of three state telephone health surveys.

OBJECTIVE To examine the impact of response rate variation on survey estimates and costs in three health telephone surveys. DATA SOURCE Three telephone surveys of noninstitutionalized adults in Minnesota and Oklahoma conducted from 2003 to 2005. STUDY DESIGN We examine differences in demographics and health measures by number of call attempts made before completion of the survey or whether the household initially refused to participate. We compare the point estimates we actually obtained with those we would have obtained with a less aggressive protocol and subsequent lower response rate. We also simulate what the effective sample sizes would have been if less aggressive protocols were followed. PRINCIPAL FINDINGS Unweighted bivariate analyses reveal many differences between early completers and those requiring more contacts and between those who initially refused to participate and those who did not. However, after making standard poststratification adjustments, no statistically significant differences were observed in the key health variables we examined between the early responders and the estimates derived from the full reporting sample. CONCLUSIONS Our findings demonstrate that for the surveys we examined, larger effective sample sizes (i.e., more statistical power) could have been achieved with the same amount of funding using less aggressive calling protocols. For some studies, money spent on aggressively pursuing high response rates could be better used to increase statistical power and/or to directly examine nonresponse bias.

Local Access to Care Programs (LACPs) : New Developments in the Access to Care for the Uninsured

CONTEXT New, locally based health care access programs are emerging in response to the growing number of uninsured, providing an alternative to health insurance and traditional safety net providers. Although these programs have been largely overlooked in health services research and health policy, they are becoming an important local supplement to the historically overburdened safety net. METHODS This article is based on a literature review, Internet search, and key actor interviews to document programs in the United States, using a typology to classify the programs and document key characteristics. FINDINGS Local access to care programs (LACPs) fall outside traditional private and publicly subsidized insurance programs. They have a formal enrollment process, eligibility determination, and enrollment fees that give enrollees access to a network of providers that have agreed to offer free or reduced-price health care services. The forty-seven LACPs documented in this article were categorized into four general models: three-share programs, national-provider networks, county-based indigent care, and local provider-based programs. CONCLUSIONS New, locally based health access programs are being developed to meet the health care needs of the growing number of uninsured adults. These programs offer an alternative to traditional health insurance and build on the tradition of county-based care for the indigent. It is important that these locally based, alternative paths to health care services be documented and monitored, as the number of uninsured adults is continuing to grow and these programs are becoming a larger component of the U.S. health care safety net.

Persistent disparities in health insurance coverage: Hispanic children, 1996 to 2005

Objective. To identify how health insurance coverage trends changed for Hispanic children between 1996 and 2005.Methods. Data from the Current Population Survey Annual Social and Economic Supplement were analyzed to determine health insurance coverage rates for Hispanic children and logistic regression was used to determine the role of race/ethnicity on health insurance status, adjusting for citizenship status, child characteristics, migration status, and geography.Results. The proportion of uninsured Hispanic children decreased significantly. However, the increased likelihood of a Hispanic child being uninsured relative to non-Hispanic White children did not change during this period.Conclusions. Expansions in public health insurance programs between 1996 and 2005 increased health insurance coverage for Hispanic children but disparities between Hispanic and non-Hispanic White children persist.

Are surname telephone oversamples an efficient way to better understand the health and healthcare of minority group members

Objectives:Surname oversamples are commonly used in health research to increase the number of persons from minority racial and ethnic groups represented in general population surveys. This article considers the sample design efficiency in the use of Hispanic, Hmong, and Asian surname samples. Methods:The study uses 3 state surveys (Alabama, Missouri, and Minnesota) that used surname oversamples to increase the proportion of Hispanic, Hmong, or Asian respondents included in the studies. We examine whether surname oversamples lead to more completed surveys with the targeted minority groups than would have been achieved if surname oversamples had not been used. We also assess gains in terms of effective sample sizes from the use of surname oversampling. Results:The sensitivities of the Hispanic surname list ranged from 46% to 63% across the 3 surveys. The sensitivity of the Asian survey was 34%, and the sensitivity of the Hmong was 38%. Although the use of surname increased the number of targeted minority group members in the final study, the increased number had a very minimal impact on the effective sample size of the minority populations for the key survey estimates of interest in the 3 health surveys. Conclusions:The use of surname samples achieved the goal of having more persons who identify as Hispanic, Hmong, or Asian in the final sample. However, the use of surname oversamples is inefficient when considering the statistical power gained for minority group estimates.

Access to Health Care and Voting Behavior in the United States

This study examines the relationship between difficulties accessing health care and voting behavior, in order to assess the possible impact that increasing constraints on access to care will have on future voting behavior. Using data from the American National Election Study we found that the proportion of people with difficulty accessing care increased significantly from 27% in 2000 to 35% in 2004. A larger proportion of those with difficulties in accessing care voted in 2004 than in 2000 and their preferences also changed to more heavily favor the Democratic candidate. If the number of those experiencing difficulties accessing care continues to grow, access to care could become a more salient campaign issue. In 2004, Democratic candidates were favored by this group, which is likely to be a constituency that both parties will try to capture in future elections.

Perceptions of radiation oncologists and urologists on the type of evidence that informs and changes the clinical practice of prostate cancer.

167 Background: Physicians have a variety of resources available about the treatment of localized prostate cancer. Yet, it is largely unknown what resources and evidence radiation oncologists and urologists commonly use to inform patients and possibly alter clinical practice. In this national survey study, we assessed the types of resources prostate cancer specialists’ use and the level of evidence needed to change treatment recommendations in localized prostate cancer. Methods: From a random sample, 1,422 physicians were sent a mail survey assessing what type of information was used to guide prostate cancer treatment. The survey also queried what level of evidence could alter recommendations. Multivariable logistic regression models were used to identify for differences in physician characteristics for each outcome. Results: Survey response rates were similar for radiation oncologists and urologists (44% vs. 46%; p=0.46). Specialty-specific journals represented the most commonly used resource to inform t...