Secret shopper studies: an unorthodox design that measures inequities in healthcare access

Rankin, Kelsey A; Mosier-Mills, Alison; Hsiang, Walter; Wiznia, Daniel H.

doi:10.1186/s13690-022-00979-z

Cited by 18 publications

(15 citation statements)

References 45 publications

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“…Selection of in‐person or telephonic audit methodology can be influenced by many factors 2 . The primary advantage of telephonic audits is the ability to reach a larger, more geographically distributed sample with less time and cost.…”

Section: Live Audit Methodsmentioning

confidence: 99%

“…Selection of in-person or telephonic audit methodology can be influenced by many factors. 2 The primary advantage of telephonic audits is the ability to reach a larger, more geographically distributed sample with less time and cost. Additionally, telephonic audits may require less auditor training, feature a lower risk for detection because auditors can read directly from a script, and facilitate more reliable data collection because auditors can document responses during the interaction rather than relying on recall.…”

Section: Live Audit Methodsmentioning

confidence: 99%

“…In some cases, such as institutional quality improvement or studies pairing audits with training, investigators might choose to inform subjects of an impending audit 2,14 . Conducting an announced audit can allow investigators to engage directly with the subjects to inform audit logistics and obtain informed consent.…”

Section: Live Audit Methodsmentioning

confidence: 99%

“…These materials must be tailored to the audit methodology and closely mimic the real‐world scenario being investigated. Once materials are prepared, pilot testing can inform necessary critical revisions before the formal audit by exposing methodological flaws and unanticipated opportunities 2,35 . When our team was designing the first telephonic audit of buprenorphine availability in United States of America (U.S.) pharmacies, the pilot audit prompted us to increase specificity regarding the product requested and bolster the auditor backstory 10,35 .…”

Section: Planning and Conducting An Auditmentioning

confidence: 99%

“…Audit studies are sometimes referred to as "secret shopper," "mystery shopper," or "simulated patient" studies because they often employ a researcher simulating a scenario within a real-world practice setting (e.g., presenting to the pharmacy requesting medication for a reported illness that the researcher may not be experiencing in reality) and analyzing the subsequent response. 2 Such a scenario allows the researchers to assess the pharmacist's response in a real-world environment and within conditions of day-to-day practice, whereas a survey response may reflect bias from misremembering past situations or providing a more ideal response. 3 While some have voiced concern regarding the potentially deceptive nature of this approach, it is generally considered justified when obtaining informed consent would inhibit the research and the study does not pose more than minimal risk to the subjects.…”

mentioning

confidence: 99%

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Research and scholarly methods: Audit studies

Loera

Hill

Evoy

et al. 2023

J Am Coll Clin Pharm

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Audit study methodologies have been utilized in pharmacy field research to obtain greater understanding of potential gaps in real‐world care and assess the accessibility of medications, services, and providers. Many audit studies utilize a secret‐shopper approach in which auditors follow specific assessment protocols and the subjects being audited are unaware of the audit taking place. The benefit of utilizing this approach, as compared to surveys or interviews, is that researchers are able to collect real‐world measures with minimized social desirability and recall biases. There are multiple audit study approaches investigators must consider. Additionally, successful audit studies often rely upon congruence of multiple auditors, and it is therefore essential to develop a study protocol that includes detailed guidance documents, data collection tools, and rigorous training and fidelity assessments. Audit methodologies must be conducted with meticulous auditor training and oversight, especially when investigators seek to audit a large sample and rely on auditors who may be participating on an unpaid volunteer basis. The purpose of this review is to provide an orientation to audit study methodologies and to describe best practices for conducting a successful audit study.

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Section: Live Audit Methodsmentioning

confidence: 99%

Section: Live Audit Methodsmentioning

confidence: 99%

Section: Live Audit Methodsmentioning

confidence: 99%

Section: Planning and Conducting An Auditmentioning

confidence: 99%

mentioning

confidence: 99%

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Research and scholarly methods: Audit studies

Loera

Hill

Evoy

et al. 2023

J Am Coll Clin Pharm

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Access to Sudden Hearing Loss Care at Urgent Care Centers

Haleem,

Rosenthal,

Lee

2024

The Laryngoscope

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ObjectivesTo compare patient access to urgent care centers (UCCs) with a diagnosis of sudden hearing loss based on insurance.MethodsOne hundred twenty‐five random UCCs in states with Medicaid expansion and 125 random UCCs in states without Medicaid expansion were contacted by a research assistant posing as a family member seeking care on behalf of a patient with a one‐week history of sudden, unilateral hearing loss. Each clinic was called once as a Medicaid patient and once as a private insurance (PI) patient for 500 total calls. Each phone encounter was evaluated for insurance acceptance and self‐pay price. Secondary outcomes included other measures of timely/accessible care. Chi‐square/McNemar's tests and independent/paired sample t‐tests were performed to determine whether there were statistically significant differences between expansion status and insurance type. Calls ended before answering questions were not included in the analysis.ResultsMedicaid acceptance rate was significantly lower than PI (68.1% vs. 98.4%, p < 0.001). UCCs in Medicaid expansion states were significantly more likely to accept Medicaid (76.8% vs. 59.2%, p = 0.003). The mean wage‐adjusted self‐pay price was significantly greater in states with Medicaid expansion at $169.84 than in states without at $145.34 when called as a Medicaid patient (mean difference: $24.50, 95% Confidence Interval: $0.45–$48.54, p = 0.046). The rates of referral to an emergency department and self‐pay price nondisclosure rates were greater for Medicaid calls than for private insurance calls (8.2% vs. 0.4% and 17.4% vs. 5.8%; p < 0.001 for both).ConclusionMedicaid patients with otologic emergencies face reduced access to care at UCCs.Level of EvidenceNA Laryngoscope, 2024

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Access to Sudden Sensorineural Hearing Loss Care at Private Equity‐Owned Otolaryngology Clinics

Haleem,

Garcia,

Khan

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveCharacterizing access to sudden sensorineural hearing loss (SSNHL) care at private practice otolaryngology clinics of varying ownership models.Study DesignCross‐sectional prospective review.SettingPrivate practice otolaryngology clinics.MethodsWe employed a Secret Shopper study design with private equity (PE) owned and non‐PE‐owned clinics within 15 miles of one another. Using a standardized script, researchers randomly called 50% of each clinic type between October 2021 and January 2022 requesting an appointment on behalf of a family member enrolled in either Medicaid or private insurance (PI) experiencing SSNHL. Access to timely care was assessed between clinic ownership and insurance type.ResultsSeventy‐eight total PE‐owned otolaryngology clinics were identified across the United States. Only 40 non‐PE clinics could be matched to the PE clinics; 39 PE and 28 non‐PE clinics were called as Medicaid patients; 39 PE and 25 non‐PE clinics were called as PI patients; 48.7% of PE and 28.6% of non‐PE clinics accepted Medicaid. The mean wait time to new appointment ranged between 9.55 and 13.21 days for all insurance and ownership types but did not vary significantly (P > .480). Telehealth was significantly more likely to be offered for new Medicaid patients at non‐PE clinics compared to PE clinics (31.8% vs 0.0%, P = .001). The mean cost for an appointment was significantly greater at PE clinics than at non‐PE clinics ($291.18 vs $203.75, P = .004).ConclusionsPatients seeking SSNHL care at PE‐owned otolaryngology clinics are likely to face long wait times prior to obtaining an initial appointment and reduced telehealth options.

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Secret shopper studies: an unorthodox design that measures inequities in healthcare access

Cited by 18 publications

References 45 publications

Research and scholarly methods: Audit studies

Research and scholarly methods: Audit studies

Access to Sudden Hearing Loss Care at Urgent Care Centers

Access to Sudden Sensorineural Hearing Loss Care at Private Equity‐Owned Otolaryngology Clinics

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