Recent work involving survey administration among emergency department (ED) patients has demonstrated very low response rates using single-mode (e.g., mail-only or web-only) approaches. In this study, the authors tested several mixed-mode protocols that focus on a push-to-web approach for survey administration in this challenging but important setting. A random sample of 26,991 ED discharged-to-community (DTC) patients discharged in January 2018-March 2018 from 16 hospital-based EDs nationwide were randomized to nine survey arms, eight of which involved a web survey with one or more of the following methods of invitation to the web survey: an emailed link to the web survey, a texted link to the web survey, and/or a mailed paper invitation with information on how to access the web survey. The reference arm was standard mixed mode (mailed survey with telephone follow-up). Invitation(s) to the web survey was followed by (1) a mailed survey, (2) telephone follow-up, or (3) both. The overall response rate across all arms was 18.6% (American Association for Public Opinion Research [AAPOR] RR1). None of the tested web-survey arms had significantly higher response rates than standard mixed mode (25.5%). Protocol comparisons demonstrated that both text outreach and including a telephone mode increased response rates. When examining response by completion mode, the arms involving text invitation had a higher percentage of completed surveys that were completed by web than arms not involving text invitation. Characteristics (e.g., age) of telephone and web respondents were more representative of the sampled population than mail respondents. Older patients and male patients were significantly less likely to be reachable by email or text. These results demonstrate that sequential multi-mode approaches involving web, mail, and telephone with multiple methods of web survey invitation show the greatest promise for obtaining higher response rates and more representative respondents from the ED population.

Standard single survey mode approaches, such as mail-only or telephone-only, generally produce lower response rates than sequential mixed mode (SMM) approaches. SMM approaches may be particularly important when lower response propensities and/or poor contact information exist, as with emergency department (ED) patients. Results were examined from a randomized feasibility study testing five survey administration modes among ED patients who are discharged-to-community. A total of 4,017 discharged patients from eight EDs during February 2016 were randomized in equal numbers to five modes: on-site distribution of a paper survey; mail notification of a web survey; email notification of a web survey; two-stage SMM (mailed survey with telephone follow-up); and three-stage SMM (email notification of a web survey with mail follow-up and then telephone follow-up). Sampled patients received a 43-item instrument focusing on ED patient experience. The two-stage SMM, commonly used for other patient experience surveys, was the reference mode. Three-stage SMM had a higher response rate (30.7%) than two-stage SMM (25.3%); the other three experimental modes had significantly lower response rates (0.8-9.6%; p<0.001 for all comparisons). On-site distribution was difficult to operationalize, possibly promoting selection bias. Valid email capture rates ranged from 4.0% to 48.3% by hospital and 30.1% overall, even though participating hospitals reported capture rates of at least 20%; the odds of having a valid email address were significantly lower for older and male patients. Findings highlight the limitations of web-only and on-site approaches, and identify SMM with a web-based component as a promising approach for survey administration in the ED setting. introduction Survey response rates are generally declining, particularly for surveys of young adults (Sheldon et al. 2007) and in settings with poor contact information (Brick and Williams 2012). The emergency department (ED) setting has both features, making this patient population particularly challenging to survey.