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Kast K, Carl L. Transition from hospital to nursing home: Discharge planners as a potential lever for quality improvements? Z Gerontol Geriatr 2024:10.1007/s00391-024-02325-0. [PMID: 39017717 DOI: 10.1007/s00391-024-02325-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 06/06/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Public reporting is supposed to be helpful in differentiating between well and poorly performing nursing homes; however, hospital patients often have difficulties to deal with quality information. Discharge planners (DP) can support them in comparing quality and, by influencing patients' decision, lead to better provision of care in nursing homes. OBJECTIVE This study investigated the choice behavior of DP, their use of quality information and the potential to impact the decision-making of patients. MATERIAL AND METHODS A total of 70 DP from German hospitals with a geriatric department participated in an online survey. They were asked about information preferences and tools used for nursing home searches. In addition, they assessed quality information items from the new German quality reporting on a Likert scale. To test their comprehension participants were given a case scenario of a typical patient, were shown nursing homes displayed based on a medical comparison portal navigator (AOK-Pflegenavigator) and were asked to select nursing homes in a 3-round experiment. RESULTS When looking for a nursing home, DP primarily rely on internal nursing home directories (n = 62; 92.5%). The 3 preferred criteria for decision are: distance to the family (n = 55; 28.80%), bed availability (n = 51; 26.7%) and wishes of patients/relatives (n = 41; 21.47%). The consent score for public reporting was 46.28% and the comprehension ratio was 82.24%. DISCUSSION The DP do not advise hospital patients on the performance of nursing homes and rely on the decision-making of patients. This results in a lack of impact on patients' decisions and consequently in a loss of potential for public reporting to lead to better care in nursing homes.
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Affiliation(s)
- Kristina Kast
- Department of Healthcare Management, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nürnberg, Germany.
| | - Lukas Carl
- Medical Valley EMN e. V., Henkestraße 91, 91052, Erlangen, Germany
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Kast K, Otten SM, Konopik J, Maier CB. Web-Based Public Reporting as a Decision-Making Tool for Consumers of Long-Term Care in the United States and the United Kingdom: Systematic Analysis of Report Cards. JMIR Form Res 2023; 7:e44382. [PMID: 38096004 PMCID: PMC10755662 DOI: 10.2196/44382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/09/2023] [Accepted: 11/22/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Report cards can help consumers make an informed decision when searching for a long-term care facility. OBJECTIVE This study aims to examine the current state of web-based public reporting on long-term care facilities in the United States and the United Kingdom. METHODS We conducted an internet search for report cards, which allowed for a nationwide search for long-term care facilities and provided freely accessible quality information. On the included report cards, we drew a sample of 1320 facility profiles by searching for long-term care facilities in 4 US and 2 UK cities. Based on those profiles, we analyzed the information provided by the included report cards descriptively. RESULTS We found 40 report cards (26 in the United States and 14 in the United Kingdom). In total, 11 of them did not state the source of information. Additionally, 7 report cards had an advanced search field, 24 provided simplification tools, and only 3 had a comparison function. Structural quality information was always provided, followed by consumer feedback on 27 websites, process quality on 15 websites, prices on 12 websites, and outcome quality on 8 websites. Inspection results were always displayed as composite measures. CONCLUSIONS Apparently, the identified report cards have deficits. To make them more helpful for users and to bring public reporting a bit closer to its goal of improving the quality of health care services, both countries are advised to concentrate on optimizing the existing report cards. Those should become more transparent and improve the reporting of prices and consumer feedback. Advanced search, simplification tools, and comparison functions should be integrated more widely.
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Affiliation(s)
- Kristina Kast
- Chair of Health Care Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Sara-Marie Otten
- Chair of Health Care Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Jens Konopik
- Chair of Health Care Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Claudia B Maier
- School of Public Health, Universität Bielefeld, Bielefeld, Germany
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Chen M, Zhang X, Liu C, Chen H, Wang D, Liu C. Effects of public reporting of prescription indicators on patient choices: evidence from propensity scores matching. Front Pharmacol 2023; 14:1110653. [PMID: 37876730 PMCID: PMC10591321 DOI: 10.3389/fphar.2023.1110653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Background: Public reporting on health providers' performance (PRHPP) is increasingly used for empowering patients. This study aimed to test the effect of PRHPP using the theory of the consumer choice model. Methods: The study was conducted in 10 primary care institutions in Hubei province, China. Information related to the percentage of prescriptions requiring antibiotics, the percentage of prescriptions requiring injections, and average costs per prescription for each prescriber was calculated, ranked and displayed in a public place on a monthly basis. A questionnaire survey was undertaken on 302 patients 10 months after the initiation of the PRHPP, tapping into patient awareness, understanding, perceived value and use of the information in line with the theory of the consumer choice model. The fitness of data with the model was tested using structural equation modelling. The patients who were aware of the PRHPP were compared with those who were unaware of the PRHPP. The propensity score method (considering differences between the two groups of patients in age, gender, education, health and income) was used for estimating the effects of the PRHPP. Results: About 22% of respondents were aware of the PRHPP. Overall, the patients showed limited understanding, perceived value and use of the disclosed information. The data fit well into the consumer choice model. Awareness of the PRHPP was found to be associated with increased understanding of the antibiotic (p = 0.028) and injection prescribing indictors (p = 0.030). However, no significant differences in perceived value and use of the information (p > 0.097) were found between those who were aware and those who were unaware of the PRHPP. Conclusion: Although PRHPP may improve patient understanding of the prescribing performance indicators, its impacts on patient choices are limited due to low levels of perceived value and use of information from patients. Additional support is needed to enable patients to make informed choices using the PRHPP.
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Affiliation(s)
- Manli Chen
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
- Research Center for the Development of Traditional Chinese Medicine, Key Research Institute of Humanities and Social Sciences of Hubei Province, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Haihong Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Dan Wang
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
- Research Center for the Development of Traditional Chinese Medicine, Key Research Institute of Humanities and Social Sciences of Hubei Province, Wuhan, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Pei C, Han X, Liu Q, Hu G. Case-mix adjustment of patient-reported experience measures in National Regional Center for Pediatric. Pediatr Res 2023; 94:1562-1569. [PMID: 36690747 DOI: 10.1038/s41390-023-02488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/25/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND The aim of the study was to identify case-mix adjusters for the Chinese version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) and assess the impact of case-mix adjustment on patient experience measures in China. METHODS This study analyzed data collected from six National Regional Center for Pediatric across China retrospectively. Participants were children aged ≤17 years and their guardians who completed the survey. The Chinese Child-HCAHPS was used to measure pediatric inpatient care experience. Candidate case-mix adjusters were assessed using a summary measure of explanatory power. Changes in scores and rankings of the six centers were quantified to assess the impact of adjustment. RESULTS A total of 2708 respondents completed the survey from January to March 2021, with a response rate of 7-15%. The child's global health status and the respondent being the child's mother were identified as case-mix adjusters, and case-mix adjustment models for 18 patient experience items were constructed. Kendall's τ correlation of hospital rankings before and after adjustment ranged from 0.73 to 1.00. CONCLUSIONS Although the impact of case-mix adjustment may appear modest in our sample, it demonstrated the feasibility, necessity, and methodology for further development of case-mix adjustment models in pediatric healthcare facilities in China. IMPACT Case-mix adjustment models adjust for factors that are unamendable by healthcare providers that may affect patient experience ratings, thereby improving the comparability of institutional-level ratings. Standardized case-mix adjustment protocols for quality measures need to be modified in different settings. This is the first study to identify adjustment variables and the possible impact of case-mix adjustment on pediatric inpatients' experience measures in a Chinese population. This study provided evidence on the feasibility and necessity for further development of case-mix adjustment models for pediatric healthcare facilities in China.
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Affiliation(s)
- Chenyang Pei
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xueyan Han
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Qiannan Liu
- National Institute of Hospital Administration, NHC, Beijing, China
| | - Guangyu Hu
- Institute of Medical Information/Center for Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Sočan G, De Boer D, Murko E, Kralj M, Ropret N, Zaletel M. Psychometric Validation of an Instrument for Measuring Patient Experiences with Outpatient Healthcare. Zdr Varst 2023; 62:153-161. [PMID: 37327137 PMCID: PMC10263366 DOI: 10.2478/sjph-2023-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/11/2023] [Indexed: 06/18/2023] Open
Abstract
Aim Recently, a patient-reported experience measure (PREM) was developed in Slovenia to assess patients' experiences with outpatient specialist healthcare clinics. The aim of this study was to evaluate the psychometric properties (including factor structure, reliability, convergent validity, and response distribution) of the questionnaire. Methods The sample consisted of 8,406 adult participants treated in 171 specialist clinics from different medical fields. Participants voluntarily and anonymously responded to either the paper or online survey. Results Descriptive statistics show meaningful response patterns with a general tendency towards favourable assessments. The psychometric analyses of the scales evaluating doctor's and nurses' work, respectively, generally showed a good fit of the unidimensional factor model as well as the Rasch model, high factor loadings and very good to satisfactory reliability. The Rasch scaling showed that these scales were most informative for patients with relatively unfavourable experience ratings. Conclusions The results are similar to those found in previous evaluations of PREMs in other countries. Given its good psychometric properties, the Slovenian PREM can be recommended for healthcare evaluations in Slovenia and as a model for the development of similar PREMs in other countries.
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Affiliation(s)
- Gregor Sočan
- University of Ljubljana, Department of Psychology, Aškerčeva cesta 2, 1000Ljubljana, Slovenia
| | - Dolf De Boer
- Netherlands Institute for Health Services Research, Otterstraat 118, 3513CRUtrecht, The Netherlands
| | - Eva Murko
- National Institute of Public Health, Trubarjeva cesta 2, 1000Ljubljana, Slovenia
| | - Marcel Kralj
- National Institute of Public Health, Trubarjeva cesta 2, 1000Ljubljana, Slovenia
| | - Nina Ropret
- National Institute of Public Health, Trubarjeva cesta 2, 1000Ljubljana, Slovenia
| | - Metka Zaletel
- National Institute of Public Health, Trubarjeva cesta 2, 1000Ljubljana, Slovenia
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Hospital rating websites play a minor role for uro-oncologic patients when choosing a hospital for major surgery: results of the German multicenter NAVIGATOR-study. World J Urol 2023; 41:601-609. [PMID: 36633651 PMCID: PMC9947074 DOI: 10.1007/s00345-022-04271-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Hospital rating websites (HRW) offer decision support in hospital choice for patients. To investigate the impact of HRWs of uro-oncological patients undergoing elective surgery in Germany. METHODS From 01/2020 to 04/2021, patients admitted for radical prostatectomy, radical cystectomy, or renal tumor surgery received a questionnaire on decision-making in hospital choice and the use of HRWs at 10 German urologic clinics. RESULTS Our study includes n = 812 completed questionnaires (response rate 81.2%). The mean age was 65.2 ± 10.2 years; 16.5% were women. Patients were scheduled for prostatectomy in 49.1%, renal tumor surgery in 20.3%, and cystectomy in 13.5% (other 17.1%). Following sources of information influenced the decision process of hospital choice: urologists' recommendation (52.6%), previous experience in the hospital (20.3%), recommendations from social environment (17.6%), the hospital's website (10.8%) and 8.2% used other sources. Only 4.3% (n = 35) used a HRW for decision making. However, 29% changed their hospital choice due to the information provided HRW. The most frequently used platforms were Weisse-Liste.de (32%), the AOK-Krankenhausnavigator (13%) and Qualitaetskliniken.de (8%). On average, patients rated positively concerning satisfaction with the respective HRW on the Acceptability E-Scale (mean values of the individual items: 1.8-2.1). CONCLUSION In Germany, HRWs play a minor role for uro-oncologic patients undergoing elective surgery. Instead, personal consultation of the treating urologist seems to be far more important. Although patients predominantly rated the provided information of the HRW as positive, only a quarter of users changed the initial choice of hospital.
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Yılmaz NG, Timmermans DR, Van Weert JC, Damman OC. Breast cancer patients' visual attention to information in hospital report cards: An eye-tracking study on differences between younger and older female patients. Health Informatics J 2023; 29:14604582231155279. [PMID: 36840473 DOI: 10.1177/14604582231155279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
To (1) explore how women visually attend to a hospital report card (HRC), (2) explore whether visual attention of younger and older women (patients and non-patients) differs. Eye-tracking study with a short survey. Participants (N = 37) were provided with a hypothetical realistic HRC. Total dwell times and fixation counts were measured while participants viewed the information. Overall, no differences existed between younger and older women. Visual attention to the hospital of choice (vs not of choice) and to indicators perceived as most important (vs least important) did not differ. However, women with higher health literacy looked longer at the HRC than women with lower health literacy. Also, per fixation, older patients (vs younger patients) looked longer at the hospital of choice and at indicators perceived most important. Pre-existing conceptions of what information is relevant might result in more in-depth information processing among older patients than younger patients. In general, differences in level of health literacy, rather than (chronological) age, seem to be relevant to take into account when designing and/or updating HRCs.
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Affiliation(s)
- Nida Gizem Yılmaz
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands; Department of Communication Science, Amsterdam School of Communication Research/ASCoR, 118065University of Amsterdam, Netherlands
| | - Danielle Rm Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands
| | - Julia Cm Van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, 118065University of Amsterdam, Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands
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Yılmaz NG, Timmermans DRM, Portielje J, Van Weert JCM, Damman OC. Testing the effects on information use by older versus younger women of modality and narration style in a hospital report card. Health Expect 2022; 25:567-578. [PMID: 34953006 PMCID: PMC8957735 DOI: 10.1111/hex.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/28/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Hospital report cards (HRCs) are usually presented in a textual and factual format, likely hampering information processing. OBJECTIVE This study aimed to investigate the effects of audiovisual and narrative information in HRCs on user responses, and to test differences between older and younger women. DESIGN A 2 (modality [textual vs. audiovisual]) × 3 (narration style [factual vs. process narrative vs. experience narrative]) online experiment was conducted. Information about breast cancer care was used as a case example. Age (younger [<65] vs. older [≥65]) was included as a potential effect modifier. SETTING AND PARTICIPANTS A total of 631 disease-naïve women (Mage = 56.06) completed an online survey. The outcomes were perceived cognitive load, satisfaction, comprehension, information recall and decisional conflict. Data were analysed using AN(C)OVAs. RESULTS Audiovisual (vs. textual) information resulted in higher information satisfaction across age groups, but was associated with lower comprehension in older women. An experience narrative (vs. factual information) increased satisfaction with attractiveness and emotional support of the information only in older women. A three-way interaction effect was found, suggesting that older women were most satisfied with the comprehensibility of audiovisual factual or textual process narrative information. Younger women were most satisfied with the comprehensibility of audiovisual process narrative or textual factual information. DISCUSSION AND CONCLUSION Audiovisual and narrative information in an HRC showed beneficial effects on satisfaction measures. In particular, audiovisual information could be incorporated into HRCs to increase satisfaction with information. PUBLIC CONTRIBUTION Lay persons helped in optimizing the visuals used in the stimulus materials by checking for clarity.
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Affiliation(s)
- Nida Gizem Yılmaz
- Department of Public and Occupational HealthAmsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Communication ScienceAmsterdam School of Communication Research/ASCoR, University of AmsterdamAmsterdamThe Netherlands
| | - Danielle R. M. Timmermans
- Department of Public and Occupational HealthAmsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Johanneke Portielje
- Department of Medical OncologyLeiden University Medical CenterLeidenThe Netherlands
| | - Julia C. M. Van Weert
- Department of Communication ScienceAmsterdam School of Communication Research/ASCoR, University of AmsterdamAmsterdamThe Netherlands
| | - Olga C. Damman
- Department of Public and Occupational HealthAmsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Kugler CM, De Santis KK, Rombey T, Goossen K, Breuing J, Könsgen N, Mathes T, Hess S, Burchard R, Pieper D. Perspective of potential patients on the hospital volume-outcome relationship and the minimum volume threshold for total knee arthroplasty: a qualitative focus group and interview study. BMC Health Serv Res 2021; 21:633. [PMID: 34210298 PMCID: PMC8249216 DOI: 10.1186/s12913-021-06641-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/16/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is performed to treat end-stage knee osteoarthritis. In Germany, a minimum volume threshold of 50 TKAs/hospital/year was implemented to ensure outcome quality. This study, embedded within a systematic review, aimed to investigate the perspectives of potential TKA patients on the hospital volume-outcome relationship for TKA (higher volumes associated with better outcomes). METHODS A convenience sample of adults with knee problems and heterogeneous demographic characteristics participated in the study. Qualitative data were collected during a focus group prior to the systematic review (n = 5) and during telephone interviews, in which preliminary results of the systematic review were discussed (n = 16). The data were synthesised using content analysis. RESULTS All participants (n = 21) believed that a hospital volume-outcome relationship exists for TKA while recognising that patient behaviour or the surgeon could also influence outcomes. All participants would be willing to travel longer for better outcomes. Most interviewees would choose a hospital for TKA depending on reputation, recommendations, and service quality. However, some would also choose a hospital based on the results of the systematic review that showed slightly lower mortality/revision rates at higher-volume hospitals. Half of the interviewees supported raising the minimum volume threshold even if this were to increase travel time to receive TKA. CONCLUSIONS Potential patients believe that a hospital volume-outcome relationship exists for TKA. Hospital preference is based mainly on subjective factors, although some potential patients would consider scientific evidence when making their choice. Policy makers and physicians should consider the patient perspectives when deciding on minimum volume thresholds or recommending hospitals for TKA, respectively.
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Affiliation(s)
- Charlotte M Kugler
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| | - Karina K De Santis
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany.,Leibniz Institute for Prevention Research and Epidemiology- BIPS, Department: Prevention and Evaluation, Achterstr. 30, 28359, Bremen, Germany
| | - Tanja Rombey
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Kaethe Goossen
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Jessica Breuing
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Nadja Könsgen
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - René Burchard
- Department of Trauma Surgery and Orthopaedics, Lahn-Dill-Kliniken, Rotebergstr. 2, 35683, Dillenburg, Germany.,Department of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.,School of Medicine, Univerity of Marburg, Baldingerstraße, 35032, Marburg, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
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Tao D, Yuan J, Qu X. Presenting self-monitoring test results for consumers: the effects of graphical formats and age. J Am Med Inform Assoc 2019; 25:1036-1046. [PMID: 29762686 DOI: 10.1093/jamia/ocy046] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/11/2018] [Indexed: 02/05/2023] Open
Abstract
Objective To examine the effects of graphical formats and age on consumers' comprehension and perceptions of the use of self-monitoring test results. Methods Participants (36 older and 36 young adults) were required to perform verbatim comprehension and value interpretation tasks with hypothetical self-monitoring test results. The test results were randomly presented by four reference range number lines: basic, color enhanced, color/text enhanced, and personalized information enhanced formats. We measured participants' task performance and eye movement data during task completion, and their perceptions and preference of the graphical formats. Results The 4 graphical formats yielded comparable task performance, while text/color and personalized information enhanced formats were believed to be easier and more useful in information comprehension, and led to increased confidence in correct comprehension of test results, compared with other formats (all p's < .05). Perceived health risk increased as the formats applied more information cues (p = .008). There were age differences in task performance and visual attention (all p's < .01), while young and older adults had similar perceptions for the 4 formats. Personalized information enhanced format was preferred by both groups. Conclusions Text/color and personalized information cues appear to be useful for comprehending test results. Future work can be directed to improve the design of graphical formats especially for older adults, and to assess the formats in clinical settings.
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Affiliation(s)
- Da Tao
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen, China
| | - Juan Yuan
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen, China
| | - Xingda Qu
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen, China
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Tao D, Yuan J, Qu X. Effects of presentation formats on consumers' performance and perceptions in the use of personal health records among older and young adults. PATIENT EDUCATION AND COUNSELING 2019; 102:578-585. [PMID: 30318383 DOI: 10.1016/j.pec.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine the effects of presentation formats on consumers' performance and perceptions in the use of personal health records (PHRs) and to compare the effects between older and young adults. METHODS A two-factor, mixed design experiment was conducted, where 36 older and 36 young participants were presented with hypothetical PHRs. The PHRs were randomly presented by six presentation formats: three tables and three line graphs, varying by visual cues. Participants' performance and perceptions in the use of PHRs were measured. RESULTS Presentation formats affected participants' performance and perceptions. Visual cue-enhanced line graphs and tables yielded less time and fewer errors, were considered easier and more useful in information comprehension, and resulted in higher confidence in correct comprehension of PHRs (all p's < 0.01), compared with their basic counterparts. There were age-related differences in task performance (all p's < 0.05), while young and older adults had similar perceptions for the six formats. Line graph with colored background was most preferred by both groups. CONCLUSION Visual cue-enhanced presentation formats appear effective in facilitating comprehension and eliciting favorable perceptions of PHRs for both young and older adults. PRACTICE IMPLICATIONS Consumer-facing displays of PHRs could use visual cue-enhanced presentation formats to facilitate comprehension.
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Affiliation(s)
- Da Tao
- Institute of Human Factors and Ergonomics, Shenzhen University, Shenzhen, China
| | - Juan Yuan
- Institute of Human Factors and Ergonomics, Shenzhen University, Shenzhen, China
| | - Xingda Qu
- Institute of Human Factors and Ergonomics, Shenzhen University, Shenzhen, China.
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Metcalfe D, Rios Diaz AJ, Olufajo OA, Massa MS, Ketelaar NABM, Flottorp SA, Perry DC. Impact of public release of performance data on the behaviour of healthcare consumers and providers. Cochrane Database Syst Rev 2018; 9:CD004538. [PMID: 30188566 PMCID: PMC6513271 DOI: 10.1002/14651858.cd004538.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers. OBJECTIVES To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies. SELECTION CRITERIA We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis. MAIN RESULTS We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects. AUTHORS' CONCLUSIONS The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes.
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Affiliation(s)
- David Metcalfe
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)John Radcliffe HospitalHeadley WayOxfordUKOX3 9DU
| | - Arturo J Rios Diaz
- Thomas Jefferson University HospitalDepartment of Surgery1100 Walnut StreetPhiladelphiaPAUSA19107
| | - Olubode A Olufajo
- Howard‐Harvard Health Sciences Outcomes Research Center Howard University College of MedicineDepartment of Surgery2041 Georgia Ave, NWWashingtonDCUSA20060
| | - M. Sofia Massa
- University of OxfordNuffield Department of Population HealthBig Data Institute, Old Road CampusOxfordUKOX3 7LF
| | - Nicole ABM Ketelaar
- Saxion University of Applied SciencesSocial Work Research GroupEnschedeNetherlands
| | - Signe A. Flottorp
- Norwegian Institute of Public HealthPO box 222 SkøyenOsloNorway0213
- University of OsloInstitute of Health and SocietyP.O box 1130 BlindernOsloNorway0318
| | - Daniel C Perry
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)John Radcliffe HospitalHeadley WayOxfordUKOX3 9DU
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Prang KH, Canaway R, Bismark M, Dunt D, Kelaher M. The use of public performance reporting by general practitioners: a study of perceptions and referral behaviours. BMC FAMILY PRACTICE 2018; 19:29. [PMID: 29433449 PMCID: PMC5810107 DOI: 10.1186/s12875-018-0719-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 01/29/2018] [Indexed: 11/14/2022]
Abstract
Background Public performance reporting (PPR) of hospital data aims to improve quality of care in hospitals and to inform consumer choice. In Australia, general practitioners (GPs) are gatekeepers to secondary care with patients requiring their referral for non-emergency access. Despite their intermediary role, GPs have been generally overlooked as potential users of PPR of hospital data, with the majority of the PPR research focussing on consumers, surgeons and hospitals. Methods We examined the use of PPR of hospital data by GPs when referring patients to hospitals. Semi-structured interviews were conducted with 40 GPs, recruited via the Victorian Primary Care Practice-Based Research Network and GP teaching practices in Victoria, Australia. The interviews were recorded, transcribed and analysed thematically. Results We found that the majority of GPs did not use PPR when referring patients to hospitals. Instead, they relied mostly on informal sources of information such as their own or patients’ previous experiences. Barriers that prevented GPs’ use of PPR in their decision making included: lack of awareness and accessibility; perceived lack of data credibility; restrictive geographical catchments for certain hospitals; limited choices of public hospitals in regional and rural areas; and no mandatory PPR for private hospitals. Conclusions Our findings suggest that lack of PPR awareness prevented GPs from using it in their referral practice. As gatekeepers to secondary care, GPs are in a position to guide patients in their treatment decisions and referrals using available PPR data. We suggest that there needs to be greater involvement by GPs in the development of hospital performance and quality indicators in Australia if GPs are to make greater use of them. The indicators require further development before GPs perceive them as valid, credible, and of use for informing their referral practices. Electronic supplementary material The online version of this article (10.1186/s12875-018-0719-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia.
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Health System in The Netherlands. Health Serv Res 2018. [DOI: 10.1007/978-1-4614-6419-8_14-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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15
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de Cruppé W, Geraedts M. Hospital choice in Germany from the patient's perspective: a cross-sectional study. BMC Health Serv Res 2017; 17:720. [PMID: 29132430 PMCID: PMC5683328 DOI: 10.1186/s12913-017-2712-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 11/07/2017] [Indexed: 11/11/2022] Open
Abstract
Background In many countries health policy encourages patients to choose their hospital, preferably by considering information of performance reports. Previous studies on hospital choice mainly have focused on patients undergoing elective surgery. This study examined a representative sample of hospital inpatients across disciplines and treatment interventions in Germany. Its research questions were: How many patients decide where to go for hospital treatment? How much time do patients have before admission? Which sources of information do they use, and which criteria are relevant to their decision? Methods Cross-sectional observational study covering 1925 inpatients of 46 departments at 17 hospitals in 2012. The stratified survey comprised 11 medical disciplines (internal medicine, gynaecology, obstetrics, paediatrics, psychiatry, orthopaedics, neurology, urology, ENT and geriatrics) on 3 hospital care levels representing 91.9% of all hospital admissions to inpatient care in Germany in 2012. The statistical analysis calculated the frequency distributions and 95% confidence intervals of characteristics related to the hospital choice. Results 63.0% [60.9–65.2] of patients in Germany chose the hospital themselves, but only 21.1% [19.3–22.9] had more than one week to decide prior to admission. Major sources of information were personal knowledge of hospitals, relatives, outpatient health professionals and the Internet. Main criteria for the decision were personal experience with a hospital, recommendations from relatives and providers of outpatient services, a hospital’s reputation and distance from home. Specific quality information as provided by performance reports were of secondary importance. Conclusions A majority of patients in the German health system choose their hospital freely. Providers of outpatient health care can have an important “agent” function in the quality-oriented hospital choice especially for patients with little time prior to admission and those who do not decide themselves. Hospitals have an impact on patients’ future hospital choices by the treatment experience they provide to patients. Electronic supplementary material The online version of this article (10.1186/s12913-017-2712-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Werner de Cruppé
- Institute for Health Systems Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany.
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Karl-von-Frisch-Strasse 4, 35043, Marburg, Germany
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Emmert M, Wiener M. What factors determine the intention to use hospital report cards? The perspectives of users and non-users. PATIENT EDUCATION AND COUNSELING 2017; 100:1394-1401. [PMID: 28189471 DOI: 10.1016/j.pec.2017.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/10/2017] [Accepted: 01/28/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Hospitals report cards (HRC) are publicly available Internet websites that provide patients with quality-related information on hospitals and enable hospital comparisons. We aim to identify factors that explain the (intended) use of HRC, including differences between current users and non-users. METHODS Drawing on UTAUT (Unified Theory of Acceptance and Use of Technology), a cross-sectional study was conducted. Data were derived from an online survey with 1350 respondents and analyzed using structural equation modeling. RESULTS 42% of the survey participants had already used HRC to search for a hospital. Performance expectancy, facilitating conditions, and attitude were found to be significantly related to HRC use intention, with notable differences between users and non-users. Effort expectancy and social influence did not show any significant effects in both subsamples. CONCLUSION Patients consider HRC to be a useful instrument and are willing to make the efforts it takes to use HRC. The greater effect of performance expectancy in the non-user sample (compared to the user sample) indicates a certain disillusion among users. PRACTICE IMPLICATIONS Health policy makers should focus on reviewing and restructuring the information content of HRC. In addition, coordinated efforts are still required to facilitate HRC access, especially for the 'less fortunate'.
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Affiliation(s)
- Martin Emmert
- Department of Health Policy and Management, Yale University, New Haven, CT, USA; School of Business and Economics, Friedrich-Alexander-University of Erlangen-Nuremberg, Nuremberg, Germany.
| | - Martin Wiener
- Department of Information and Process Management (IPM), Bentley University, Waltham, MA, USA
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Emmert M, Schlesinger M. Hospital Quality Reporting in the United States: Does Report Card Design and Incorporation of Patient Narrative Comments Affect Hospital Choice? Health Serv Res 2017; 52:933-958. [PMID: 27324087 PMCID: PMC5441500 DOI: 10.1111/1475-6773.12519] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore the impact of hospital report card design and incorporation of patient narrative comments on consumers' choices of hospitals. DATA SOURCES Primary data collected from an online survey with 1,350 respondents in February, 2015. STUDY DESIGN A randomized 2 (narrative comments: yes, no) × 3 (design: representation of clinical performance in textual, star, numerical formats) between-subject online-based cross-sectional experiment. PRINCIPAL FINDINGS In 51 percent of all cases, respondents selected the hospital with the best clinical results. Report cards with a numerical design induced choices more focused on clinical ratings (56.0 percent chose the highest rated hospital) than those with textual information (48.1 percent) or star ratings (47.3 percent) (p < .001). Report cards without narrative comments (49.7 percent) and with narratives (51.4 percent) were not associated with significant difference in selecting top-rated clinical hospitals (p = .376). But there were significant interactions affecting choice of hospitals among exposure to narratives, formatting of clinical performance, and respondents' education. CONCLUSIONS Consumers have a difficult time synthesizing quality data in various formats. Hospital report cards continue to pose challenging choices, especially for those with limited education. Narrative comments in their earliest emerging forms do not seem to be altering hospital choice as much as the literature has suggested for other providers, but they may have consequential impact on the choices of certain subsets of consumers.
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Affiliation(s)
- Martin Emmert
- Department of Health Policy and ManagementYale University School of Public HealthNew HavenCT
- School of Business and EconomicsInstitute of Management (IFM)Friedrich‐Alexander‐University Erlangen‐NurembergNurembergGermany
| | - Mark Schlesinger
- Department of Health Policy and ManagementYale University School of Public HealthNew HavenCT
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18
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Liu C, Tang Y, Wang D, Zhang X. The effect of public reporting presentation on patients' decision making: An experimental survey in Yunan Province, China. Medicine (Baltimore) 2017; 96:e7203. [PMID: 28614266 PMCID: PMC5478351 DOI: 10.1097/md.0000000000007203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 04/28/2017] [Accepted: 05/18/2017] [Indexed: 12/04/2022] Open
Abstract
Public reporting of comparative performance information (PRCPI) influence patients' decision making and optimal presentation of PRCPI is urgently required for successful patients' engagement and quality improvement. This study was to explore the presentation of PRCPI impacting on consumers' decision making.This research applied a controlled design, with participants allocated randomly to 6 groups, and a total of 515 participants were recruited in Yunnan province. Five aspects of PRCPI presentations were evaluated, including display (star rating vs numeric information), and whether information was simplified, interpreted, overload, or ranked. Participants were stimulated to identify the best or worst physicians with a hypothetical scenario. Main outcome measures were correct choices rate of best/worst physicians, indicating participants fully understood and correctly used PRCPI. χ test and logistic regression were applied to assess the effect between different presentations on consumers' decision making.The correct choices rate is only 48.93%. Compared with star rating, numerical information helped participants differentiate low-performance physicians (OR = 2.573, P = .029), including low-performance physicians in antibiotics (OR = 2.974, P = .031) and low-performance physicians in injections (OR = 2.369, P = .035). Disordered information impeded participants to fully understand and correctly use PRCPI (OR = 0.519, P = .041). The effect was mainly reflected on participants differentiating low-performance physicians (OR = 0.491, P = .039) and low-performance physicians in injections (OR = 0.440, P = .016). Other aspects of PRCPI showed nonsignificant impacts on consumers' decision making.Presentation, including information display and ranking, can influence patients' correct usage of PRCPI and the effect was mainly observed when the patients were identifying poorly performing physicians. The present study demonstrated that numerical and ranked PRCPI, combined with sufficient patient education, could be most effective to facilitate patient use.
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Zwijnenberg NC, Hendriks M, Delnoij DMJ, de Veer AJE, Spreeuwenberg P, Wagner C. Understanding and using quality information for quality improvement: The effect of information presentation. Int J Qual Health Care 2016; 28:689-697. [PMID: 27591268 DOI: 10.1093/intqhc/mzw092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 06/29/2016] [Indexed: 12/14/2022] Open
Abstract
Objective To examine how information presentation affects the understanding and use of information for quality improvement. Design An experimental design, testing 22 formats, and showing information on patient safety culture. Formats differed in visualization, outcomes and benchmark information. Intervention(s) Respondents viewed three randomly selected presentation formats in an online survey, completing several tasks per format. Setting The hospital sector in the Netherlands. Participants A volunteer sample of healthcare professionals, mainly nurses, working in hospitals. Main Outcome Measure(s): The degree to which information is understandable and usable (accurate choice for quality improvement, sense of urgency to change and appraisal of one's own performance). Results About 115 healthcare professionals participated (response rate 25%), resulting in 345 reviews. Understandability Information in tables (P = 0.007) and bar charts (P < 0.0001) was better understood than radars. Presenting outcomes on a 5-point scale (P < 0.001) or as '% positive responders' (P < 0.001) was better understood than '% negative responders'. Formats without benchmarks were better understood than formats with benchmarks. Use: Bar charts resulted in more accurate choices than tables (P = 0.003) and radars (P < 0.001). Outcomes on a 5-point scale resulted in more accurate choices than '% negative responders' (P = 0.007). Presenting '% positive responders' resulted in a higher sense of urgency to change than outcomes on a 5-point scale (P = 0.002). Benchmark information had inconsistent effects on the appraisal of one's own performances. Conclusions Information presentation affects healthcare professionals' understanding and use of quality information. Our findings supplement the further understanding on how quality information can be best communicated to healthcare professionals for realizing quality improvements.
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Affiliation(s)
- Nicolien C Zwijnenberg
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Michelle Hendriks
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Diana M J Delnoij
- Institute for Healthcare Quality, P.O. Box 320, 1110 AH Diemen, the Netherlands.,Tilburg University, Tilburg School of Social and Behavioural Sciences, Tranzo, P.O. Box 90153 5000 LE Tilburg, the Netherlands
| | - Anke J E de Veer
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Peter Spreeuwenberg
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Cordula Wagner
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands.,EMGO + Institute for Health and Care Research, VU University Medical Center (VUmc), Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
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Zwijnenberg NC, Hendriks M, Bloemendal E, Damman OC, de Jong JD, Delnoij DM, Rademakers JJ. Patients' Need for Tailored Comparative Health Care Information: A Qualitative Study on Choosing a Hospital. J Med Internet Res 2016; 18:e297. [PMID: 27895006 PMCID: PMC5153531 DOI: 10.2196/jmir.4436] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/15/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Internet is increasingly being used to provide patients with information about the quality of care of different health care providers. Although online comparative health care information is widely available internationally, and patients have been shown to be interested in this information, its effect on patients' decision making is still limited. OBJECTIVE This study aimed to explore patients' preferences regarding information presentation and their values concerning tailored comparative health care information. Meeting patients' information presentation needs might increase the perceived relevance and use of the information. METHODS A total of 38 people participated in 4 focus groups. Comparative health care information about hip and knee replacement surgery was used as a case example. One part of the interview focused on patients' information presentation preferences, whereas the other part focused on patients' values of tailored information (ie, showing reviews of patients with comparable demographics). The qualitative data were transcribed verbatim and analyzed using the constant comparative method. RESULTS The following themes were deduced from the transcripts: number of health care providers to be presented, order in which providers are presented, relevancy of tailoring patient reviews, and concerns about tailoring. Participants' preferences differed concerning how many and in which order health care providers must be presented. Most participants had no interest in patient reviews that were shown for specific subgroups based on age, gender, or ethnicity. Concerns of tailoring were related to the representativeness of results and the complexity of information. A need for information about the medical specialist when choosing a hospital was stressed by several participants. CONCLUSIONS The preferences for how comparative health care information should be presented differ between people. "Information on demand" and information about the medical specialist might be promising ways to increase the relevancy and use of online comparative health care information. Future research should focus on how different groups of people use comparative health care information for different health care choices in real life.
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Affiliation(s)
| | - Michelle Hendriks
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Evelien Bloemendal
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health and EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
| | - Judith D de Jong
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Diana Mj Delnoij
- Quality Institute, National Health Care Institute, Diemen, Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo, Tilburg University, Tilburg, Netherlands
| | - Jany Jd Rademakers
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
- School for Public Health and Primary Care (CAPHRI), Department of Family Medicine, Maastricht University, Maastricht, Netherlands
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21
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Zwijnenberg NC, Hendriks M, Hoogervorst-Schilp J, Wagner C. Healthcare professionals' views on feedback of a patient safety culture assessment. BMC Health Serv Res 2016; 16:199. [PMID: 27316921 PMCID: PMC4912740 DOI: 10.1186/s12913-016-1404-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By assessing patient safety culture, healthcare providers can identify areas for improvement in patient safety culture. To achieve this, these assessment outcomes have to be relevant and presented clearly. The aim of our study was to explore healthcare professionals' views on the feedback of a patient safety culture assessment. METHODS Twenty four hospitals participated in a patient safety culture assessment in 2012. Hospital departments received feedback in a report and on a website. In a survey, we evaluated healthcare professionals' views on this feedback and the effect of additional information about patient safety culture improvement strategies on the appraisal of the feedback. 20 hospitals participated in part I (evaluation of the report), 13 hospitals participated in part II (evaluation of the website). RESULTS Healthcare professionals (e.g. members of staff and department heads/managers) rated the feedback in the report and on the website positively (average mean on different aspects = 7.2 on a scale from 1 to 10). Interpreting results was sometimes difficult, and information was sometimes lacking, like specific recommendations and improvement strategies. The provision of additional general information on patient safety culture improvement strategies resulted only in a higher appraisal of the attractiveness (lay-out) of the report and the understandability of the feedback report. The majority (84 %) of the healthcare professionals agreed or partly agreed that the feedback on patient safety culture stimulated actions to improve patient safety culture. However, a quarter also stated that although the feedback report provided insight into the patient safety culture, they did not know how to improve patient safety culture in their hospital. CONCLUSIONS Healthcare professionals seem to be positive about the feedback on patient safety culture and its effect on stimulating patient safety culture improvement. To optimally tune feedback on patient safety culture towards healthcare professionals, the following might help: 1) pay attention to the understandability of outcomes for its intended users; and 2) create feedback that is tailored towards specific hospital departments.
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Affiliation(s)
- Nicolien C Zwijnenberg
- Netherlands Institute for Health Services Research, P.O. Box 1568, 3500, BN, Utrecht, The Netherlands.
| | - Michelle Hendriks
- Netherlands Institute for Health Services Research, P.O. Box 1568, 3500, BN, Utrecht, The Netherlands
| | | | - Cordula Wagner
- Netherlands Institute for Health Services Research, P.O. Box 1568, 3500, BN, Utrecht, The Netherlands.,Department of Public and Occupation Health, EMGO + Institute for Health and Care Research, VU University Medical Center (VUmc), Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
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Victoor A, Delnoij D, Friele R, Rademakers J. Why patients may not exercise their choice when referred for hospital care. An exploratory study based on interviews with patients. Health Expect 2016; 19:667-78. [PMID: 24938761 PMCID: PMC5055249 DOI: 10.1111/hex.12224] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Various north-western European health-care systems encourage patients to make an active choice of health-care provider. This study explores, qualitatively, patients' hospital selection processes and provides insight into the reasons why patients do or do not make active choices. METHODS Semi-structured individual interviews were conducted with 142 patients in two departments of three Dutch hospitals. Interviews were recorded, transcribed and analysed in accordance with the grounded theory approach. RESULTS Three levels of choice activation were identified - passive, semi-active and active. The majority of the patients, however, visited the default hospital without having used quality information or considered alternatives. Various factors relating to patient, provider and health-care system characteristics were identified that influenced patients' level of choice activation. On the whole, the patients interviewed could be classified into five types with regard to how they chose, or 'ended up at' a hospital. These types varied from patients who did not have a choice to patients who made an active choice. CONCLUSIONS A large variation exists in the way patients choose a hospital. However, most patients tend to visit the default without being concerned about choice. Generally, they do not see any reason to choose another hospital. In addition, barriers exist to making choices. The idea of a patient who actively makes a choice originates from neoclassical microeconomic theory. However, policy makers may try in vain to bring principles originating from this theory into health care. Even so, patients do value the opportunity of attending 'their' own hospital.
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Affiliation(s)
- Aafke Victoor
- Netherlands Institute for Health Services Research (NIVEL)Utrechtthe Netherlands
| | - Diana Delnoij
- Quality Institute of the National Health Care InstituteDiementhe Netherlands
- ‘Transparency in Health Care’Tilburg UniversityTilburgthe Netherlands
| | - Roland Friele
- Netherlands Institute for Health Services Research (NIVEL)Utrechtthe Netherlands
- ‘Social Impact of Health Law’Tilburg UniversityTilburgthe Netherlands
| | - Jany Rademakers
- Netherlands Institute for Health Services Research (NIVEL)Utrechtthe Netherlands
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Damman OC, De Jong A, Hibbard JH, Timmermans DRM. Making comparative performance information more comprehensible: an experimental evaluation of the impact of formats on consumer understanding. BMJ Qual Saf 2015; 25:860-869. [PMID: 26543066 PMCID: PMC5136725 DOI: 10.1136/bmjqs-2015-004120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 09/22/2015] [Accepted: 10/13/2015] [Indexed: 11/07/2022]
Abstract
Study objectives We aimed to investigate how different presentation formats influence comprehension and use of comparative performance information (CPI) among consumers. Methods An experimental between-subjects and within-subjects design with manipulations of CPI presentation formats. We enrolled both consumers with lower socioeconomic status (SES)/cognitive skills and consumers with higher SES/cognitive skills, recruited through an online access panel. Respondents received fictitious CPI and completed questions about interpretation and information use. Between subjects, we tested (1) displaying an overall performance score (yes/no); (2) displaying a small number of quality indicators (5 vs 9); and (3) displaying different types of evaluative symbols (star ratings, coloured dots and word icons vs numbers and bar graphs). Within subjects, we tested the effect of a reduced number of healthcare providers (5 vs 20). Data were analysed using descriptive analysis, analyses of variance and paired-sampled t tests. Results A total of 902 (43%) respondents participated. Displaying an overall performance score and the use of coloured dots and word icons particularly enhanced consumer understanding. Importantly, respondents provided with coloured dots most often correctly selected the top three healthcare providers (84.3%), compared with word icons (76.6% correct), star ratings (70.6% correct), numbers (62.0%) and bars (54.2%) when viewing performance scores of 20 providers. Furthermore, a reduced number of healthcare providers appeared to support consumers, for example, when provided with 20 providers, 69.5% correctly selected the top three, compared with 80.2% with five providers. Discussion Particular presentation formats enhanced consumer understanding of CPI, most importantly the use of overall performance scores, word icons and coloured dots, and a reduced number of providers displayed. Public report efforts should use these formats to maximise impact on consumers.
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Affiliation(s)
- Olga C Damman
- Department of Public and Occupational Health and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Anco De Jong
- Dutch National Health Care Institute, Diemen, The Netherlands
| | - Judith H Hibbard
- Department of Planning, Public Policy & Management, University of Oregon, Eugene, OR, USA
| | - Danielle R M Timmermans
- Department of Public and Occupational Health and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Sander U, Emmert M, Dickel J, Meszmer N, Kolb B. Information presentation features and comprehensibility of hospital report cards: design analysis and online survey among users. J Med Internet Res 2015; 17:e68. [PMID: 25782186 PMCID: PMC4381815 DOI: 10.2196/jmir.3414] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 10/03/2014] [Accepted: 01/22/2015] [Indexed: 11/23/2022] Open
Abstract
Background Improving the transparency of information about the quality of health care providers is one way to improve health care quality. It is assumed that Internet information steers patients toward better-performing health care providers and will motivate providers to improve quality. However, the effect of public reporting on hospital quality is still small. One of the reasons is that users find it difficult to understand the formats in which information is presented. Objective We analyzed the presentation of risk-adjusted mortality rate (RAMR) for coronary angiography in the 10 most commonly used German public report cards to analyze the impact of information presentation features on their comprehensibility. We wanted to determine which information presentation features were utilized, were preferred by users, led to better comprehension, and had similar effects to those reported in evidence-based recommendations described in the literature. Methods The study consisted of 5 steps: (1) identification of best-practice evidence about the presentation of information on hospital report cards; (2) selection of a single risk-adjusted quality indicator; (3) selection of a sample of designs adopted by German public report cards; (4) identification of the information presentation elements used in public reporting initiatives in Germany; and (5) an online panel completed an online questionnaire that was conducted to determine if respondents were able to identify the hospital with the lowest RAMR and if respondents’ hospital choices were associated with particular information design elements. Results Evidence-based recommendations were made relating to the following information presentation features relevant to report cards: evaluative table with symbols, tables without symbols, bar charts, bar charts without symbols, bar charts with symbols, symbols, evaluative word labels, highlighting, order of providers, high values to indicate good performance, explicit statements of whether high or low values indicate good performance, and incomplete data (“N/A” as a value). When investigating the RAMR in a sample of 10 hospitals’ report cards, 7 of these information presentation features were identified. Of these, 5 information presentation features improved comprehensibility in a manner reported previously in literature. Conclusions To our knowledge, this is the first study to systematically analyze the most commonly used public reporting card designs used in Germany. Best-practice evidence identified in international literature was in agreement with 5 findings about German report card designs: (1) avoid tables without symbols, (2) include bar charts with symbols, (3) state explicitly whether high or low values indicate good performance or provide a “good quality” range, (4) avoid incomplete data (N/A given as a value), and (5) rank hospitals by performance. However, these findings are preliminary and should be subject of further evaluation. The implementation of 4 of these recommendations should not present insurmountable obstacles. However, ranking hospitals by performance may present substantial difficulties.
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Affiliation(s)
- Uwe Sander
- Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts Hannover, Hannover, Germany
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Krol MW, de Boer D, Delnoij DM, Rademakers JJDJM. The Net Promoter Score--an asset to patient experience surveys? Health Expect 2014; 18:3099-109. [PMID: 25345554 DOI: 10.1111/hex.12297] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In the search for more straightforward ways of summarizing patient experiences and satisfaction, there is growing interest in the Net Promoter Score (NPS): How likely is it that you would recommend our company to a friend or colleague? OBJECTIVE To assess what the NPS adds to patient experience surveys. The NPS was tested against three other constructs already used in current surveys to summarize patient experiences and satisfaction: global ratings, recommendation questions and overall scores calculated from patient experiences. To establish whether the NPS is a valid measure for summarizing patient experiences, its association with these experiences should be assessed. METHODS Associations between the NPS and the three other constructs were assessed and their distributions were compared. Also, the association between the NPS and patient experiences was assessed. Data were used from patient surveys of inpatient hospital care (N = 6018) and outpatient hospital care (N = 10 902) in six Dutch hospitals. RESULTS Analyses showed that the NPS was moderately to strongly correlated with the other three constructs. However, their distributions proved distinctly different. Furthermore, the patient experiences from the surveys showed weaker associations with the NPS than with the global rating and the overall score. CONCLUSIONS Because of the limited extent to which the NPS reflects the survey results, it seems less valid as a summary of patient experiences than a global rating, the existing recommendation question or an overall score calculated from patient experiences. In short, it is still unclear what the NPS specifically adds to patient experience surveys.
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Affiliation(s)
- Maarten W Krol
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Dolf de Boer
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Diana M Delnoij
- TRANZO, Tilburg University, Tilburg, The Netherlands.,Institute for Quality in Health Care, Diemen, The Netherlands
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Clark MD, Determann D, Petrou S, Moro D, de Bekker-Grob EW. Discrete choice experiments in health economics: a review of the literature. PHARMACOECONOMICS 2014; 32:883-902. [PMID: 25005924 DOI: 10.1007/s40273-014-0170-x] [Citation(s) in RCA: 503] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Discrete choice experiments (DCEs) are increasingly used in health economics to address a wide range of health policy-related concerns. OBJECTIVE Broadly adopting the methodology of an earlier systematic review of health-related DCEs, which covered the period 2001-2008, we report whether earlier trends continued during 2009-2012. METHODS This paper systematically reviews health-related DCEs published between 2009 and 2012, using the same database as the earlier published review (PubMed) to obtain citations, and the same range of search terms. RESULTS A total of 179 health-related DCEs for 2009-2012 met the inclusion criteria for the review. We found a continuing trend towards conducting DCEs across a broader range of countries. However, the trend towards including fewer attributes was reversed, whilst the trend towards interview-based DCEs reversed because of increased computer administration. The trend towards using more flexible econometric models, including mixed logit and latent class, has also continued. Reporting of monetary values has fallen compared with earlier periods, but the proportion of studies estimating trade-offs between health outcomes and experience factors, or valuing outcomes in terms of utility scores, has increased, although use of odds ratios and probabilities has declined. The reassuring trend towards the use of more flexible and appropriate DCE designs and econometric methods has been reinforced by the increased use of qualitative methods to inform DCE processes and results. However, qualitative research methods are being used less often to inform attribute selection, which may make DCEs more susceptible to omitted variable bias if the decision framework is not known prior to the research project. CONCLUSIONS The use of DCEs in healthcare continues to grow dramatically, as does the scope of applications across an expanding range of countries. There is increasing evidence that more sophisticated approaches to DCE design and analytical techniques are improving the quality of final outputs. That said, recent evidence that the use of qualitative methods to inform attribute selection has declined is of concern.
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Affiliation(s)
- Michael D Clark
- Department of Economics, University of Warwick, Coventry, CV4 7AL, UK,
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Emmert M, Hessemer S, Meszmer N, Sander U. Do German hospital report cards have the potential to improve the quality of care? Health Policy 2014; 118:386-95. [PMID: 25074783 DOI: 10.1016/j.healthpol.2014.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 06/12/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hospitals report cards have been put in place within the past few years to increase the amount of publicly reported quality information in Germany. OBJECTIVE The aim of this study was to assess the potential of German hospital report cards to improve quality of care. METHODS First, a systematic Internet search aimed at identifying available report cards was conducted. Second, cross-sectional data (August/September 2013) were analyzed with respect to awareness, comprehension, and impact of report cards by using descriptive analysis and binary multivariate logistic regression models. RESULTS Hospital report cards (N=62) have become broadly available. However, awareness remains low, about one third (35.6%) of all respondents (N=2027) were aware of German hospital report card. Regarding comprehensibility, in 60.7% of all experiments (N=6081), respondents selected the hospital with the lowest risk-adjusted mortality; significant differences could be determined between the report cards (p<.001) with scores ranging from 27.5% to 77.2%. Binary multivariate logistic regression analysis revealed different significant respondent-related predictors on each report card. Finally, an impact on hospital choice making was determined. CONCLUSIONS To increase the potential of hospital report cards, health policy makers should promote the availability of report cards. In addition, the comprehensibility of German hospital report cards cannot be regarded as satisfying and should be enhanced in the future.
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Affiliation(s)
- Martin Emmert
- Institute of Management (IFM), Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
| | - Stefanie Hessemer
- Institute of Management (IFM), Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - Nina Meszmer
- Institute of Management (IFM), Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - Uwe Sander
- University of Applied Sciences and Arts, Hannover, Germany
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Krol MW, de Boer D, Rademakers JJDJM, Delnoij DM. Overall scores as an alternative to global ratings in patient experience surveys; a comparison of four methods. BMC Health Serv Res 2013; 13:479. [PMID: 24245726 PMCID: PMC3842791 DOI: 10.1186/1472-6963-13-479] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 11/13/2013] [Indexed: 11/10/2022] Open
Abstract
Background Global ratings of healthcare by patients are a popular way of summarizing patients’ experiences. Summary scores can be used for comparing healthcare provider performance and provider rankings. As an alternative, overall scores from actual patient experiences can be constructed as summary scores. This paper addresses the statistical and practical characteristics of overall scores as an alternative to a global rating in summarizing patient survey results. Methods Data from a 2010 patient experience survey for approximately 12,000 nursing home residents (7.5% of all Dutch nursing home residents at the time) from 464 nursing homes in the Netherlands (25% of the Dutch nursing homes) was used. Data was collected through specifically designed standardized interview surveys. The respondents’ scores for 15 established quality indicators (or composites) for nursing home care were used to calculate overall scores for each nursing home, using four different strategies. The characteristics of the overall scores were compared against each other and with the respondents’ global rating. Results The individual indicators showed stronger associations with each of the four overall strategies than with the global ratings. Furthermore, the dispersion of the overall scores across nursing homes was greater. Differences between overall scores appeared limited. Conclusions Overall scores proved more valid than global ratings as a summary of the indicator scores, and also showed more pronounced differences between nursing homes. Because of the limited statistical differences between the strategies, and for practical reasons, a straightforward averaging of quality indicator scores may be preferred as an overall score.
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Affiliation(s)
- Maarten W Krol
- Netherlands Institute for Health Services Research (NIVEL), P,O, Box 1568, 3500 BN Utrecht, The Netherlands.
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Emmert M, Meier F, Pisch F, Sander U. Physician choice making and characteristics associated with using physician-rating websites: cross-sectional study. J Med Internet Res 2013; 15:e187. [PMID: 23985220 PMCID: PMC3758064 DOI: 10.2196/jmir.2702] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/12/2013] [Accepted: 06/14/2013] [Indexed: 11/21/2022] Open
Abstract
Background Over the past decade, physician-rating websites have been gaining attention in scientific literature and in the media. However, little knowledge is available about the awareness and the impact of using such sites on health care professionals. It also remains unclear what key predictors are associated with the knowledge and the use of physician-rating websites. Objective To estimate the current level of awareness and use of physician-rating websites in Germany and to determine their impact on physician choice making and the key predictors which are associated with the knowledge and the use of physician-rating websites. Methods This study was designed as a cross-sectional survey. An online panel was consulted in January 2013. A questionnaire was developed containing 28 questions; a pretest was carried out to assess the comprehension of the questionnaire. Several sociodemographic (eg, age, gender, health insurance status, Internet use) and 2 health-related independent variables (ie, health status and health care utilization) were included. Data were analyzed using descriptive statistics, chi-square tests, and t tests. Binary multivariate logistic regression models were performed for elaborating the characteristics of physician-rating website users. Results from the logistic regression are presented for both the observed and weighted sample. Results In total, 1505 respondents (mean age 43.73 years, SD 14.39; 857/1505, 57.25% female) completed our survey. Of all respondents, 32.09% (483/1505) heard of physician-rating websites and 25.32% (381/1505) already had used a website when searching for a physician. Furthermore, 11.03% (166/1505) had already posted a rating on a physician-rating website. Approximately 65.35% (249/381) consulted a particular physician based on the ratings shown on the websites; in contrast, 52.23% (199/381) had not consulted a particular physician because of the publicly reported ratings. Significantly higher likelihoods for being aware of the websites could be demonstrated for female participants (P<.001), those who were widowed (P=.01), covered by statutory health insurance (P=.02), and with higher health care utilization (P<.001). Health care utilization was significantly associated with all dependent variables in our multivariate logistic regression models (P<.001). Furthermore, significantly higher scores could be shown for health insurance status in the unweighted and Internet use in the weighted models. Conclusions Neither health policy makers nor physicians should underestimate the influence of physician-rating websites. They already play an important role in providing information to help patients decide on an appropriate physician. Assuming there will be a rising level of public awareness, the influence of their use will increase well into the future. Future studies should assess the impact of physician-rating websites under experimental conditions and investigate whether physician-rating websites have the potential to reflect the quality of care offered by health care providers.
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Affiliation(s)
- Martin Emmert
- Institute of Management-IFM, School of Business and Economics, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany.
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Victoor A, Delnoij DMJ, Friele RD, Rademakers JJDJM. Determinants of patient choice of healthcare providers: a scoping review. BMC Health Serv Res 2012; 12:272. [PMID: 22913549 PMCID: PMC3502383 DOI: 10.1186/1472-6963-12-272] [Citation(s) in RCA: 246] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 08/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice. METHODS We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information. RESULTS Our review shows that patients' choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics. CONCLUSIONS There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several knowledge gaps were identified that need follow-up research.
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Affiliation(s)
- Aafke Victoor
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, Netherlands
| | - Diana MJ Delnoij
- Tilburg School of Social and Behavioural Sciences, Tilburg University, Tranzo, P.O. Box 90153, 5000 LE, Tilburg, Netherlands
- Centre for Consumer Experience in Health Care (CKZ), P.O. Box 1568, 3500 BN, Utrecht, Netherlands
| | - Roland D Friele
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, Netherlands
- Tilburg School of Social and Behavioural Sciences, Tilburg University, Tranzo, P.O. Box 90153, 5000 LE, Tilburg, Netherlands
| | - Jany JDJM Rademakers
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, Netherlands
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Tritter J. The implications of patients and carers as active agents in health care and the consequences for their own health, the health of their families and health system. Health Expect 2012; 15:113-4. [PMID: 22616761 PMCID: PMC5060617 DOI: 10.1111/j.1369-7625.2012.00796.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ketelaar NABM, Faber MJ, Flottorp S, Rygh LH, Deane KHO, Eccles MP. Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations. Cochrane Database Syst Rev 2011:CD004538. [PMID: 22071813 PMCID: PMC4204393 DOI: 10.1002/14651858.cd004538.pub2] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is becoming increasingly common to release information about the performance of hospitals, health professionals or providers, and healthcare organisations into the public domain. However, we do not know how this information is used and to what extent such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers and purchasers, or to what extent the performance of professionals and providers can be affected. OBJECTIVES To determine the effectiveness of the public release of performance data in changing the behaviour of healthcare consumers, professionals and organisations. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE Ovid (from 1966), EMBASE Ovid (from 1979), CINAHL, PsycINFO Ovid (from 1806) and DARE up to 2011. SELECTION CRITERIA We searched for randomised or quasi-randomised trials, interrupted time series and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or individuals. The papers had to report at least one main outcome related to selecting or changing care. Other outcome measures were awareness, attitude, views and knowledge of performance data and costs. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers and healthcare purchasers), performance data, main outcomes (choice of healthcare provider and improvement by means of changes in care) and other outcomes (awareness, attitude, views, knowledge of performance data and costs). MAIN RESULTS We included four studies containing more than 35,000 consumers, and 1560 hospitals. Three studies were conducted in the USA and examined consumer behaviour after the public release of performance data. Two studies found no effect of Consumer Assessment of Healthcare Providers and Systems information on health plan choice in a Medicaid population. One interrupted time series study found a small positive effect of the publishing of data on patient volumes for coronary bypass surgery and low-complication outliers for lumbar discectomy, but these effects did not persist longer than two months after each public release. No effects on patient volumes for acute myocardial infarction were found.One cluster-randomised controlled trial, conducted in Canada, studied improvement changes in care after the public release of performance data for patients with acute myocardial infarction and congestive heart failure. No effects for the composite process-of-care indicators for either condition were found, but there were some improvements in the individual process-of-care indicators. There was an effect on the mortality rates for acute myocardial infarction. More quality improvement activities were initiated in response to the publicly-released report cards. No secondary outcomes were reported. AUTHORS' CONCLUSIONS The small body of evidence available provides no consistent evidence that the public release of performance data changes consumer behaviour or improves care. Evidence that the public release of performance data may have an impact on the behaviour of healthcare professionals or organisations is lacking.
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Affiliation(s)
- Nicole A B M Ketelaar
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University NijmegenMedical Centre, Nijmegen, Netherlands.
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