Consumer trust in sources of physician quality information

Customer Archetypes in Hearing Health Care

PURPOSE

The purpose of this study is to determine if there are unique customer archetypes that can describe the motivations behind consumer buying choice (in person or online) for hearing aids in hearing health care.

METHOD

A consumer survey was developed from themes that arose during 11 semistructured interviews with adults who had no previous hearing aid experience. Using Qualtrics research panels, a 28-item questionnaire was distributed online to U.S. residents above the age of 50 years with no previous hearing aid experience. A quota of 1,000 completed responses was set, with a maximum of 70% of respondents identifying as White. Completed surveys were obtained from 1,377 individuals. Three hundred forty responses were excluded due to ineligibility and/or poor response quality.

RESULTS

Two unique customer archetypes were developed using five factors identified in the data set: Physician Trust, Sociability, Comfort Buying Online, Verify Sources, and Reliance on Others. Eighty-four percent of respondents chose an in-person pathway for hearing health care. There was no association between customer archetype and pathway selection choice.

CONCLUSIONS

The two archetypes reflect those with greater comfort with consuming health care online and in person, respectively. However, both archetypes are likely to use in-person models of hearing health care at the present time.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24431212.

What Is the Flag We Rally Around? Trust in Information Sources at the Outset of the COVID-19 Pandemic in Latvia

Trust in information sources about COVID-19 may influence the public attitude toward the disease and the imposed restrictions, thus determining the course of the COVID-19 pandemic in a given country. Acknowledging an increase in trust in the government or the so-called rally ‘round the flag’ effect around the world at the beginning of the COVID-19 pandemic, this study explores possible determinants of this effect in Latvia, looking at such variables as the perceived disease risk, gender, age, education, income, and language spoken in the family. Presuming that risk perception may be amplified by trust in various information sources, we investigate a spill-over of the rally ‘round the flag’ effect on healthcare professionals, media, and interpersonal networks. Studying data from a nationally representative sociological survey conducted in September 2020, we confirm a positive relationship between trust in all information sources, except friends, relatives, and colleagues, and perceived disease risk. Correlations are also strong regarding trust in almost all information sources and the measured socio-demographic variables, except gender. Interpersonal trust seems to be relatively stable, and in most cases the correlations are statistically insignificant. With this study we suggest that increase in trust in government institutions as well as other information sources, even in crisis situations, does not depend on any single element, but instead presents a more complex phenomenon.

Consumer Engagement With Information on Performance: A Narrative Review

BACKGROUND AND OBJECTIVES

Efforts to provide information on quality of providers assume that consumers and patients are able to use information effectively to guide their decisions. We conducted a narrative literature review to better understand how consumers use information on quality to ultimately select a provider.

METHODS

We used Berwick's Pathways to Quality Improvement Framework to guide a narrative literature review to synthesize past research on consumer choice and to identify and evaluate factors affecting provider selection.

RESULTS

Reviewed articles reflected factors affecting provider selection, including: information needs, content and delivery of information, use and engagement with information, and social and behavioral mechanisms, such as trust. We also identified gaps in the literature for further study (eg, loyalty to physicians) that have been identified as important for optimal decision-making but are not well explored in the literature.

DISCUSSION

Health care providers and managers can learn from a more complete model of consumers' selection process to systematically evaluate and improve service provision and information for consumers. Administrators and providers may consider using patient feedback to identify ways to improve their quality and should streamline information for consumers to facilitate thorough, informed decision-making.

Trusting Sources of Information on Quality of Physician Care

Reporting healthcare quality has become an important factor in healthcare delivery. Prior research has shown that patient-consumers do not frequently use information on websites reporting physician quality to guide their choice of physicians. Our aim is to understand the contextual and personal characteristics that influence patient-consumers’ decisions to trust or ignore information sources about healthcare quality. We use data from Finding Quality Doctors: How Americans Evaluate Provider Quality in the US, 2014, to examine factors that explain trust in sources reporting healthcare quality provided by physicians. Using factor analysis, 3 overarching information sources were identified: (1) employers and healthcare providers; (2) user advocacy sources; and (3) insurance companies and government. We use multiple regression analysis to understand the factors that impact trust in these 3 information sources. Our study found that contrary to previous findings, health status was not a significant factor that affects trust in sources reporting care quality data. Also, age was the only factor that significantly correlated with trusting information from all 3 sources. Specifically, younger adults trusted information from all sources compared to older adults. Furthermore, political affiliation, employment status, income, and area of residence correlated with trusting care quality information from either companies and government agencies or family and social network sources. Results suggest that individual and contextual characteristics are significant factors in trusting information sources regardless of health status and these should be taken into consideration by those promoting public reporting of healthcare quality information.

Let the buyer beware: Content analysis of cosmetic surgery websites' provider information

Given that many consumers do not understand any licensed physician can perform cosmetic surgery, cosmetic procedure advertising regulation is lacking and differs by state; and consumers often search for providers online and rely on the site's information. Cosmetic surgery websites have the potential to be a threat to consumers' safety and health. This study asked what types of physician information do cosmetic surgery websites supply. A content analysis was conducted with 873 physicians' information provided on cosmetic surgery websites in the top 10 cosmetic surgery cities, finding members of plastic surgery associations and core providers were more likely to list medical qualifications. All physicians were unlikely to list experience. Two-thirds stated their specific board certification, and 15% to 30% in each city failed to follow their state's regulations for disclosing board certification. The study concludes by suggesting national ethical guidelines.

Effects of Public Reporting Legislation of Nurse Staffing: A Trend Analysis

Public reporting is a tactic that hospitals and other health care facilities use to provide data such as outcomes to clinicians, patients, and payers. Although inadequate registered nurse (RN) staffing has been linked to poor patient outcomes, only eight states in the United States publicly report staffing ratios-five mandated by legislation and the other three electively. We examine nurse staffing trends after the New Jersey (NJ) legislature and governor enacted P.L.1971, c.136 (C.26:2 H-13) on January 24, 2005, mandating that all health care facilities compile, post, and report staffing information. We conduct a secondary analysis of reported data from the State of NJ Department of Health on 73 hospitals in 2008 to 2009 and 72 hospitals in 2010 to 2015. The first aim was to determine if NJ hospitals complied with legislation, and the second was to identify staffing trends postlegislation. On the reports, staffing was operationalized as the number of patients per RN per quarters. We obtained 30 quarterly reports for 2008 through 2015 and cross-checked these reports for data accuracy on the NJ Department of Health website. From these data, we created a longitudinal data set of 13 inpatient units for each hospital (14,158 observations) and merged these data with American Hospital Association Annual Survey data. The number of patients per RN decreased for 10 specialties, and the American Hospital Association data demonstrate a similar trend. Although the number of patients does not account for patient acuity, the decrease in the patients per RN over 7 years indicated the importance of public reporting in improving patient safety.

Patient preferences for objective quality metrics during community pharmacy selection: A discrete choice experiment

BACKGROUND

Patients select healthcare providers and facilities based on a complex array of factors. Pharmacy-level quality metrics have been discussed as a way to help direct patients towards high-quality pharmacies. Limited research has been conducted on the potential impact of quality metrics on the pharmacy selection process.

OBJECTIVES

This study aimed to measure the relative strength of patient preferences for community pharmacy attributes and to describe associations between patient sociodemographic and health characteristics and pharmacy preferences.

METHODS

This study elicited preferences for pharmacy attributes using a discrete choice experiment presenting a scenario in which participants had moved to a new location and needed to select a pharmacy. Six attributes were selected based on published literature, expert opinion, and pilot testing feedback. Attributes were relationship-based (hours of operation, staff friendliness/courtesy, pharmacist communication, pharmacist willingness to establish a personal relationship) or competence-based (overall quality and a drug-drug interaction (DDI) specific quality metric). Participants responded to blocks of 10 random and 2 fixed choice tasks assigned by Sawtooth v9.2. Data were analyzed using conditional logit, and Hierarchical Bayes estimates of individual-level utilities were used to compare preferences across demographic subgroups.

RESULTS

Study participants expressed the strongest preferences for competence-based pharmacy attributes, including DDI-specific and overall quality measures (Attribute Importance Values: 40.3% and 31.3%, respectively). Women ascribed higher utility to 5-star DDI and overall quality ratings than men. Rural respondents and those with inadequate health literacy expressed stronger preferences for patient-pharmacist relationships than those in suburban areas and with adequate health literacy, respectively.

CONCLUSIONS

Respondents exhibited strong preferences for pharmacies with higher competence-based quality ratings, suggesting that they may perceive medication safety to be a key role of community pharmacists. Future research on patient expectations of and preferences for community pharmacies can inform ways to effectively encourage patient engagement with pharmacists to improve health outcomes.

Increasing the Use of Comparative Quality Information in Maternity Care: Results From a Randomized Controlled Trial

This randomized controlled trial tested an intervention to increase uptake of hospital-level maternity care quality reports among 245 pregnant women in North Carolina (123 treatment; 122 control). The intervention included three enhancements to the quality report offered to the control: (a) biweekly text messages or e-mails directing women to the website, (b) videos and materials describing the relevance of quality measures to pregnant women's interests, and (c) tools to support discussions with clinicians. Compared with controls, intervention participants were significantly more likely to visit the website and report adopting behaviors to inform care, such as thinking through preferences, talking with their doctor, or creating a birth plan. Reports designed to put quality information into the larger context of what consumers want and need to know, along with targeted and timely communications, can increase consumer use of quality information and prompt them to talk with providers about care preferences and evidence-based practices.

Comparative performance information plays no role in the referral behaviour of GPs

Background

Comparative performance information (CPI) about the quality of hospital care is information used to identify high-quality hospitals and providers. As the gatekeeper to secondary care, the general practitioner (GP) can use CPI to reflect on the pros and cons of the available options with the patient and choose a provider best fitted to the patient’s needs. We investigated how GPs view their role in using CPI to choose providers and support patients.

Method

We used a mixed-method, sequential, exploratory design to conduct explorative interviews with 15 GPs about their referral routines, methods of referral consideration, patient involvement, and the role of CPI. Then we quantified the qualitative results by sending a survey questionnaire to 81 GPs affiliated with a representative national research network.

Results

Seventy GPs (86% response rate) filled out the questionnaire. Most GPs did not know where to find CPI (87%) and had never searched for it (94%). The GPs reported that they were not motivated to use CPI due to doubts about its role as support information, uncertainty about the effect of using CPI, lack of faith in better outcomes, and uncertainty about CPI content and validity. Nonetheless, most GPs believed that patients would like to be informed about quality-of-care differences (62%), and about half the GPs discussed quality-of-care differences with their patients (46%), though these discussions were not based on CPI.

Conclusion

Decisions about referrals to hospital care are not based on CPI exchanges during GP consultations. As a gatekeeper, the GP is in a good position to guide patients through the enormous amount of quality information that is available. Nevertheless, it is unclear how and whether the GP’s role in using information about quality of care in the referral process can grow, as patients hardly ever initiate a discussion based on CPI, though they seem to be increasingly more critical about differences in quality of care. Future research should address the conditions needed to support GPs’ ability and willingness to use CPI to guide their patients in the referral process.

What influences the awareness of physician quality information? Implications for Medicare

OBJECTIVE

Examine the factors that are associated with awareness of physician quality information (PQI) among older people with one or more chronic illnesses and the implications for Medicare.

DATA SOURCES/STUDY SETTING

Random digit-dial survey of adults with one or more chronic illnesses.

RESEARCH DESIGN

Structural equation modeling to examine factors related to awareness of PQI.

RESULTS

Awareness of PQI is low (13 percent), but comparable to findings in general population surveys. Age, race, education, and self-reported health status are associated with PQI awareness. Trust in the Internet as a source of health care information and not trusting one's physician as a source of information both are associated with a greater likelihood of being aware of PQI. Patients with high levels of activation have greater trust in physicians as information sources, but this is not associated with awareness, nor is degree of satisfaction with their care experience.

CONCLUSIONS

Awareness of PQI among older persons with chronic illnesses is relatively low across all socio-economic and demographic subgroups. Changes in population characteristics over time are unlikely to improve awareness in this population, nor are changes in patient activation or satisfaction with care. Medicare would need a broad-based effort if it wishes to raise PQI awareness among Medicare beneficiaries in the near term. Before undertaking resource-intensive efforts to increase awareness, Medicare may want to consider what level of awareness actually is needed to accomplish the overall objective for PQI transparency, which is raising the quality of care received by beneficiaries. It may be that relatively low levels of awareness are sufficient.

Why and How Six Aligning Forces for Quality Communities Have Focused on Reducing Disparities

Public reports on provider performance can help guide consumers’ health care decisions, yet consumer awareness and use of public reports is low and may be even lower among racial/ethnic minorities. In this qualitative research article, we describe activities implemented by multi-stakeholder alliances in six U.S. communities to increase minorities’ awareness of public reports. We also describe alliances’ motivation for deliberately targeting greater awareness among minorities. We found that alliances’ decision was influenced by the proportion of minorities and perceptions of race-based disparities in care in the community. To raise awareness, alliances collaborated with minority-serving organizations to (a) advertise their web-based public report using ethnic media outlets, (b) present their public reporting website during health education outreach events held in minority communities, and (c) translate their public report into multiple languages. We conclude that community partnerships are a promising mechanism for targeting efforts to increase awareness of public reports in minority communities.

Consumer response to patient experience measures in complex information environments

BACKGROUND

As indicators of clinician quality proliferate, public reports increasingly include multiple metrics. This approach provides more complete performance information than did earlier reports but may challenge consumers' ability to understand and use complicated reports.

OBJECTIVES

To assess the effects of report complexity on consumers' understanding and use of patient experience measures derived from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.

RESEARCH DESIGN

In an Internet-based experiment, participants were asked to compare information on physician quality and choose a primary care doctor. Participants were randomly assigned to choice sets of varied complexity (CAHPS alone vs. CAHPS with other measures) and number of doctors. Participants completed surveys before and after this choice task.

SUBJECTS

A total of 555 US residents, aged 25-64, who had Internet access through computer were recruited from an existing online panel.

MEASURES

Recall seeing CAHPS measures; use of CAHPS measures for making choices; ratings of ease of use, usefulness and trustworthiness of CAHPS ratings; concerns about usefulness and trustworthiness.

RESULTS

Participants presented with CAHPS information and other performance indicators relied less on CAHPS than did those presented with CAHPS information only, although they considered CAHPS information as valuable as did other respondents. Participants presented with smaller choice sets also judged CAHPS information as less easy to use when accompanied by other metrics than when it was presented alone.

Editors and researchers beware: calculating response rates in random digit dial health surveys

OBJECTIVE

To demonstrate that different approaches to handling cases of unknown eligibility in random digit dial health surveys can contribute to significant differences in response rates.

DATA SOURCE

Primary survey data of individuals with chronic disease.

STUDY DESIGN

We computed response rates using various approaches, each of which make different assumptions about the disposition of cases of unknown eligibility.

DATA COLLECTION

Data were collected via telephone interviews as part of the Aligning Forces for Quality (AF4Q) consumer survey, a representative survey of adults with chronic illnesses in 17 communities and nationally.

PRINCIPAL FINDINGS

We found that various approaches to estimating eligibility rates can lead to substantially different response rates.

CONCLUSIONS

Health services researchers must consider strategies to standardize response rate reporting, enter into a dialog related to why response rate reporting is important, and begin to utilize alternate methods for demonstrating that survey data are valid and reliable.

Use of care management practices in small- and medium-sized physician groups: do public reporting of physician quality and financial incentives matter?

OBJECTIVE

To examine the effect of public reporting (PR) and financial incentives tied to quality performance on the use of care management practices (CMPs) among small- and medium-sized physician groups.

DATA

Survey data from The National Study of Small and Medium-sized Physician Practices were used. Primary data collection was also conducted to assess community-level PR activities. The final sample included 643 practices engaged in quality reporting; about half of these practices were subject to PR.

STUDY DESIGN

We used a treatment effects model. The instrumental variables were the community-level variables that capture the level of PR activity in each community in which the practices operate.

FINDINGS

(1) PR is associated with increased use of CMPs, but the estimate is not statistically significant; (2) financial incentives are associated with greater use of CMPs; (3) practices' awareness/sensitivity to quality reports is positively related to their use of CMPs; and (4) combined PR and financial incentives jointly affect CMP use to a greater degree than either of these factors alone.

CONCLUSION

Small- to medium-sized practices appear to respond to PR and financial incentives by greater use of CMPs. Future research needs to investigate the appropriate mix and type of incentive arrangements and quality reporting.