10-0503_Justification B final

SURVEY OF HEALTHCARE EXPERIENCES

Dental Patient Satisfaction Survey
OMB FORM 2900-XXXX
VA Form 10-0503

B. COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS

1. Provide a numerical estimate of the potential respondent universe and describe any sampling or other respondent selection method to be used. Data on the number of entities (e.g., households or persons) in the universe and the corresponding sample are to be provided in tabular format for the universe as a whole and for each strata. Indicate expected response rates. If this has been conducted previously include actual response rates achieved.

Veteran patient population receiving medical care: 5,387,000 patients/year*

Potential respondent universe receiving dental care: 329,000 patients/year**

Expected response rate (based upon experience

of VA Office of Quality and Performance): 50%

Sampling methodology: a random selection of Social Security numbers of all veterans receiving dental care at VA facilities will receive surveys. This information is derived from the Dental Encounter System which is a subset of the Patient Care Encounter System (PCE).

* from the Unique Patients Cube, VSSC

** from the Dental Encounter System

2. Describe the procedures for the collection of information, including:

• Statistical methodology for stratification and sample selection

• Estimation procedure

• Degree of accuracy needed

• Unusual problems requiring specialized sampling procedures

• Any use of less frequent than annual data collection to reduce burden

The total number of responses at each facility is estimated to be 180. This is required to be 90% certain that the estimates for each facility will be no more than 5 points from the true value of Overall Rating (the main metric of interest). 180=fpc(1.64²)(.6)(1-.6) / (.05²) where fpc is the Finite Population Factor given an average of 350 patients available in each facility.

Letters are sent to selected veterans soliciting their response to a variety of questions concerning their care at VA facilities. Veterans are asked to return the survey to the Office of Dentistry contracted data collection vendor. The sample size has been determined to be of a sufficient size to give statistically reliable data for each VISN and VA facility. The monthly data collection provides for sufficiently timely identification of problem areas and undertaking of steps toward remediation. This allows VA to provide quality medical services to veterans.

VHA’s Office of Quality and Performance (OQP) conducted a study of the Dillman Total Design Methodology (TDM) is used (Reference:Dillman, D. A. Mail and telephone surveys: The total design method. New York: Wiley, 1978), considered to be the most effective mailed survey data collection protocol in the industry, and validated Dillman’s methods in the VHA population. Indeed, OQP has shown that the elimination of the second survey mailing not only was more cost effective and shorted the data collection period (thus allowing faster data turn-around), but did so in a way that did substantively increase either non-response or bias.

The survey questionnaire is translated into Puerto Rican Spanish for those veterans seeking services at or through the VA Medical Center San Juan, Puerto Rico and its affiliated facilities. The questionnaire is provided in both English and Spanish, allowing the veteran to choose the version that they are most comfortable responding with.

3. Describe methods to maximize response rate and to deal with issues of non-response. The accuracy and reliability of information collected must be shown to be adequate for intended uses. For collections based on sampling, a special justification must be provided for any collection that will not yield “reliable” data that can be generalized to the universe studied.

Survey questionnaire is mailed to veterans via first class mail; a postage-paid return envelope is included. A modified Dillman Total Design Methodology (TDM) is used. The TDM process incorporates several strategies designed to minimize the burdens of survey participation and establish trust. Procedurally the TDM involves three carefully spaced mailings:

Week 0 Pre-survey notification letter

Week 1 Initial questionnaire

Week 2 Thank you/reminder postcard

VA Office of Quality and Performance has found the first mailing adequate to achieve very good (60 percent range) response rates among similar veterans receiving ambulatory care services. Sociodemographic information for the survey sample is obtained from central files in the VA Austin Automation Center. Individual identifiers are subsequently stripped from the database to maintain respondent confidentiality.

4. Describe any tests of procedures or methods to be undertaken. Testing is encouraged as an effective means of refining collections to minimize burden and improve utility. Tests must be approved if they call for answers to identical questions of 10 or more individuals.

With the exception of question #19, this survey is entirely comprised of questions taken from two separate well-researched surveys; slight alterations were made to reflect care in the dental setting, e.g., “dentist” in place of “doctor”, or “dental hygienist” in place of “nurse”. Approximately 34% or 12 out of a total 35 questions were taken from the VA Nation-wide Customer Satisfaction Survey: Survey of Health Experience of Patients (SHEP). The SHEP survey has OMB approval under clearance number 2900-0712. Approximately 40% or 14 out of 35 questions were taken from the DCAHPS survey developed by AHRQ to assess patient satisfaction with dental care provided by TRICARE. Eight of the questions, or 23%, were common to both SHEP and DCAHPS surveys; not surprising as both surveys were developed as part of the AHRQ family of consumer assessment of healthcare surveys. The final question #19 was developed by the Office of Dentistry Quality Committee who is responsible for developing the VA Dental Patient Satisfaction Survey. Please see Table 1 for a synopsis of the survey question sources.

Source of Survey Questions – Total 35 Questions	Question #’s
VA SHEP (34%)	3, 20, 21, 22, 23, 24, 25, 26, 27, 31, 32, 33
DCAHPS (40%)	1, 2, 5, 11, 12, 13, 15, 16, 17, 28, 29, 30, 34, 35
VA SHEP plus DCAHPS (23%)	4, 6, 7, 8, 9, 10, 14, 18
New Question (3%)	19

Table 1. Source of questions for VA Dental Patient Satisfaction Survey

5. Provide the name and telephone number of individuals consulted on statistical aspects of the design and the name of the agency unit, contractor(s), grantee(s), or other person(s) who will actually collect and/or analyze the information for the agency.

Timothy Ward, MA, DDS

Office of Dentistry

VA Central Office

Washington, DC

202-461-6954

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