Randomized trial showed that an "embedded" survey strategy optimized authorization rates compared with two "after survey" strategies in veterans with PTSD

Objectives: To test methods to optimize mail survey response and authorization rates (i.e., allowing one's survey to be linked to medical records) when the survey is sensitive and the targeted population has a mental disorder. Study Design and Setting: Randomized controlled trial of 1,099 veterans treated for posttraumatic stress disorder (PTSD) at a Midwestern Veteran Affairs Medical Center. Subjects were randomized to one of three groups: (1) Health Insurance Portability and Accountability Act (HIPAA) authorization form embedded in the survey (checking "yes" for consent); (2) HIPAA form requiring signature for consent sent after the survey; or (3) HIPAA form requiring a signature and social security number (SSN) for consent sent after the survey. Results: The "embedded" strategy yielded the lowest survey response rate (67.5%) but highest authorization rate (59.1%). Requiring respondents' signatures and SSNs after the survey was returned generated the highest survey response rate (74.2%) but lowest authorization rate (48.7%). However, the response rate difference was not statistically significant. Reported emotional upset was low (1.5%) and primarily directed to the survey, not the HIPAA form. Older age and greater trustfulness were associated with higher authorization rates. Conclusion: Even with our most optimized strategy, authorization rates were disappointingly low.