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Propensity scores for proxy reports of care experience and quality: are they useful? (306705)

Roee Gutman, Brown University 
Nancy L. Keating, Harvard Medical School 
Vince Mor, Brown University 
*Jessica Roydhouse, Brown University 
Ira B Wilson, Brown University School of Public Health 

Keywords: quality of care, care experience, cancer, survey, proxy

Patient-reported experience measures are increasingly important in health care. 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 patient’s spouse or child to complete the measure on their behalf. Proxy reporting is used in health experience surveys, including those used in pay-for-performance approaches. As patients requiring proxies likely differ in important ways from those who can self-report, adjusting for these differences is important. We evaluate the use of propensity score models when adjusting for proxy-reported data, including weighting, matching with replacement, and non-parametric multiple imputation. We tested the sensitivity of our results to the inclusion of respondent-sensitive variables such as proxy reports of patient health status. Under all methods, estimates obtained from propensity scores using respondent-insensitive variables differed from those obtained when respondent-sensitive variables were incorporated in the propensity score. Propensity scores have limitations in these contexts, and other approaches need to be considered.