Survey Fatigue and How to Avoid it

In today’s healthcare market, there is an increasing demand for patient-reported information. As a company that administers patient-reported outcome (PRO) surveys, we can say with certainty that the phenomenon is VERY real. Survey fatigue can impact the quantity and quality of your data. This blog will give you an understanding of what survey fatigue is, and best practices to prevent it from happening. 

What is survey fatigue?

Survey fatigue is also known as respondent fatigue and refers to a survey respondent’s lack of interest or motivation to complete the questions posed in a survey. This can happen depending on the survey’s length, topic, difficulty, or whether there are open-ended questions. There are also different types of survey fatigue. Pre-survey fatigue can prevent patients from even beginning the survey in the first place. For those who are interested in obtaining a specific capture rate for research or reimbursement purposes, this could decrease your capture rate. Survey fatigue can also arise mid-questionnaire and cause patients to buzz through it thoughtlessly in order to finish quickly. This could have an impact on the quality of the data that you are collecting. No matter how large your data set is, having poor-quality data will have a negative impact. From a patient level, this can reflect an outcome that is not indicative of their true status. From a provider and organization level, poor quality data can make it impossible to analyze outcomes for strengths and areas of growth.

Background – Surveys in Healthcare

Whether it be to assess patients’ pain, function, and quality of life, or to obtain data on patients’ perspectives of their care, surveys are widely used throughout healthcare. In the past, PRO data was predominantly used by academic centers as part of prospective research projects. Over the past ten (10) years, the utilization of PROs has expanded beyond just research and is recognized as the gold standard for measuring the success of a treatment/intervention. In 2015, the American Academy of Orthopaedic Surgeons (AAOS) made a position statement on PROs that said it should be part of the standard of care (see image below). Many other specialties have since released similar recommendations/frameworks. Providers can use PRO data to track quality. At the bedside, the data is a valuable tool to foster shared decision-making.

Payers are also interested in PRO data, and there are many value-based healthcare programs that now require patient surveys. For example, Medicare included the 29-question HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) among the measures to be used to calculate value-based incentive payments in the Hospital Value-Based Purchasing program. Medicare also uses several validated PRO surveys as part of the PRO performance measure in CMS’s 2023 Hospital IPPS and requires a 50% response rate (which you can read more about here). 

Let’s remember our industry friends! Device manufacturers are also chomping at the bit for PRO data. They need it for FDA submission, and also to ‘prove’ their product is superior. Researchers and providers are using PRO data as part of studies. 

Patients are getting hit with surveys from every direction. It is something at CODE we always keep in mind and believe healthcare as a whole needs to start addressing it. If we don’t address it, widespread survey fatigue can set in and we can quickly lose this invaluable data that helps to improve and advance patient care. The proposed reporting threshold is based on average response rates for both pre-operative and post-operative surveys collected by participating hospitals in the CJR model. CMS has noted they will continue to consider the appropriate pre- and post-operative matched survey response rates and reporting thresholds. CMS plans to evaluate the proposed approach during the voluntary reporting period and consider adjustments based on feedback they receive prior to the mandatory reporting period. 

How can we avoid survey fatigue?

There is a combination of tricks you can implement to combat survey fatigue. 

Cut down on questions-

Long surveys can be too time-consuming for survey respondents to complete. Because of this, many popular PRO surveys are coming up with shortened versions. For example, the Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) is a validated PRO survey that was developed to be a more efficient alternative to the longer Hip Disability and Osteoarthritis Outcome Score (HOOS) reporting measure. Both measure joint pain and function in patients pre and post total hip arthroplasty (THA), however, the HOOS questionnaire contains 42 questions while the HOOS JR contains only six (6) questions. There are also (Computer Adaptive Tests (CAT) options available. However, do not compromise and choose a PRO tool just because it is short. Short surveys may help with survey fatigue but they will not always help in making healthcare better. CODE Tip: Consider all the options available and when possible, select the shorter PRO tools over the longer ones. Not sure what survey is best for your patient population? CODE can help!

Coordinate surveys with multiple parties-

Hospitals, private practices, and payers need to work together to cut down on sending multiple surveys for the same procedure. If each party is sending out the same survey, which happens very often, survey fatigue is bound to happen. CODE Tip: When possible, use a data share agreement so the patient only has to take the survey one time, and each party gets a copy of the results. Wondering how to organize that? CODE has you covered!

Perform regular survey audits-

The best way to see all the surveys a patient is receiving is to actually go through the process like you are a patient. At CODE, we enroll a “fake patient” during implementation and gather data on all the touch points they receive. It is amazing how much you can learn through this process. CODE Tip: Put yourself into your patients’ shoes to experience the surveys and the touchpoints. Our team also helps monitor that for your patients on an annual basis.

Explain the value-

Educate patients on how finishing the survey is helpful for tracking their health and beneficial for clinical and research purposes. When the education comes from the provider, it goes really far. At CODE, we have multiple providers in our registry with 80+ question surveys who have a super high capture rate and no signs of survey fatigue. Their secret? They talk to each patient about the survey process and how important it is. When the patient knows their provider cares and values their data, they are more likely to complete it. CODE Tip: Make sure the patients understand why their outcome data is valuable! We can help your providers craft a message to use when talking to patients. 

Manage expectations- 

Managing expectations is an important way to combat survey fatigue. Informing patients of exactly what they can expect is a helpful tactic. CODE Tip: Communicate to patients about when they should receive the survey and how long the survey will take them to fill out. We can provide you with flyers branded to your organization that can easily be put into pre-op packets, handed out at the front desk, or even hung up in clinic rooms.

Summary

PRO data is so valuable to understanding and improving healthcare. It is much-needed information, yet there is a fine line between what we as a healthcare system want and need, and what the patient is willing to do. Survey fatigue is real and if we don’t acknowledge and adapt it is likely we will see widespread survey fatigue. The great news? Survey fatigue can be addressed and prevented! At CODE, we’ve got some great tricks up our sleeves! To keep it simple, we recommend being thoughtful about what you are asking patients to do, understanding what others are asking your patients to do, and designing a PROs program that is a win-win for all parties.