Propensity scores for proxy reports of care experience and quality: are they useful?
Roydhouse, J and Gutman, R and Keating, NL and Mor, V and Wilson, IB, Propensity scores for proxy reports of care experience and quality: are they useful?, Health Services and Outcomes Research Methodology, 20 pp. 40-59. ISSN 1387-3741 (2020) [Refereed Article]
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Patient-reported outcome and experience measures are increasingly important in health
care and health research. The use of these measures is growing in the US and overseas,
and performance measures that incorporate patient-reported outcomes are being considered,
particularly in cancer. A major challenge for the use of these measures is patient
non-response, especially for diseases such as cancer and dementia. A commonly used
approach is to ask a proxy such as the patientís spouse or child to complete the measure
on their behalf. Proxy reporting is used in major surveys, including those used in pay-forperformance
approaches. No standards exist regarding how to adjust for the use of proxyreported
measures in analyses. As patients requiring proxies likely differ in important ways
from those who can self-report, adjusting for these differences is important. In this paper,
we evaluate the use of propensity score models when adjusting for proxy-reported data,
including weighting, matching with replacement, and non-parametric multiple imputation.
Additionally, because previous analyses using propensity scores for proxy reports
have employed stepwise or p value based algorithms, we evaluated the sensitivity of our
results to the inclusion of respondent-sensitive variables such as proxy reports of patient
health status, as well as auxiliary covariates. Under all propensity score methods, estimates
obtained from propensity scores using respondent-insensitive variables were different from
those obtained when respondent-sensitive variables were incorporated in the propensity
score. Propensity score methods have limitations in these contexts and their assumptions
should be carefully examined.
proxy, patient, care experience, care quality, survey, propensity score