How Survey Collection Method Affects QCE Refusal Rates

In Q4 2025, based on NQIP data submitted by MOA on behalf of members, 31.7% of residents declined to complete the Quality of Care Experience (QCE) survey. This is a gap in quality indicator data that raises questions about who is being missed and why. This article examines one contributing factor: services that delivered surveys via MOA’s QCE/QOL survey tool had substantially lower refusal rates than those using other collection methods.

Data and Methods

For services using MOA’s QCE/QOL survey tool, refusal rates were derived from responses to the question “How would you like to complete the survey?”. The proportion of “Resident declined” responses was used as the refusal rate. For services not using the tool, refusal proportions were computed from the reported count of residents who declined to complete the QCE-ACC survey, divided by the total number of residents who either completed or refused. Residents absent from the service were not included in either group.

Results

In Q4 2025 the refusal rate among those who used MOA’s QCE/QOL was 23.1% while the refusal rate was 39.0% among other MOA members. A substantial difference between these groups is present across all quarters (Figure 1). The pattern is consistent with the survey tool facilitating higher response rates.

Figure 1: QCE refusal rates over time for services using MOA’s QCE/QOL survey tool compared with those using other collection methods.

The lower refusal rates among services using MOA’s QCE/QOL tool are partly driven by higher rates of proxy completion (Figure 2). In a proxy completion, someone who knows the resident well and sees them regularly completes the survey on their behalf. This allows responses to be captured from residents who are unable to complete the survey independently and might otherwise go unrepresented.

Figure 2: Proxy completion rates over time for services using MOA’s QCE/QOL survey tool compared with those using other collection methods.

Figure 3 shows that the proportion of surveys self-completed or interview administered is similar between services using MOA’s QCE/QOL survey tool and those using other collection methods.

Figure 3: Resident self-completed and interview-administered completion rates over time.

Conclusion

MOA’s QCE/QOL survey tool is associated with lower refusal rates, with proxy completion emerging as a key mechanism. By enabling surveys to be completed on behalf of residents who cannot respond independently, the tool captures data that would otherwise be missing, improving both the completeness and representativeness of QCE/QOL data.