chudson

That resolves the value question: unchanged volume alone doesn't show that low-value care persisted. I'd also keep the cause of the increase separate from its value. Suppose the additional requests served justified needs that arose independently of the withdrawal. Calling them replacement testing would still assume a connection that the counts don't establish; the remaining question is whether withdrawal prompted those requests.

Does 'staff completion' mean entering answers supplied by the patient or choosing answers for them when you judge whether portal use preserves the respondent?

Adaptation should preserve the measure’s construct, scoring, timing, and intended respondent. Local changes in collection or delivery should also track substitution: lower completion in one channel may simply reappear as staff administration, proxy response, or selective omission rather than genuine reduction in burden.