The elicitation of patient and physician preferences for calculating consumer-based composite measures on hospital report cards: results of two discrete choice experiments

PURPOSE

The calculation of aggregated composite measures is a widely used strategy to reduce the amount of data on hospital report cards. Therefore, this study aims to elicit and compare preferences of both patients as well as referring physicians regarding publicly available hospital quality information METHODS: Based on systematic literature reviews as well as qualitative analysis, two discrete choice experiments (DCEs) were applied to elicit patients' and referring physicians' preferences. The DCEs were conducted using a fractional factorial design. Statistical data analysis was performed using multinomial logit models RESULTS: Apart from five identical attributes, one specific attribute was identified for each study group, respectively. Overall, 322 patients (mean age 68.99) and 187 referring physicians (mean age 53.60) were included. Our models displayed significant coefficients for all attributes (p < 0.001 each). Among patients, "Postoperative complication rate" (20.6%; level range of 1.164) was rated highest, followed by "Mobility at hospital discharge" (19.9%; level range of 1.127), and ''The number of cases treated" (18.5%; level range of 1.045). In contrast, referring physicians valued most the ''One-year revision surgery rate'' (30.4%; level range of 1.989), followed by "The number of cases treated" (21.0%; level range of 1.372), and "Postoperative complication rate" (17.2%; level range of 1.123) CONCLUSION: We determined considerable differences between both study groups when calculating the relative value of publicly available hospital quality information. This may have an impact when calculating aggregated composite measures based on consumer-based weighting.

Validity evaluation of the Health Information Preferences Questionnaire among college students

Objective

This study aims to explore the association between health information preferences and specific health behaviors and outcomes, such as preventive measures and chronic disease management among college students. It assesses how different levels of health information preference influence individuals' utilization, perception, and self-efficacy within healthcare and health information contexts. Given the rising prevalence of non-communicable chronic diseases among younger populations in China, this research seeks to understand how tailored health information preferences can support effective health education and behavioral interventions. The development of the Health Information Preference Questionnaire (HIPQ) aims to bridge the existing gap in tools for assessing health information preferences among Chinese college students, with a focus on collecting validity evidence to confirm the HIPQ's applicability in this group.

Methods

The study employed a mixed-methods approach, beginning with an initial item pool derived from a comprehensive review of existing research tools, literature, and expert inputs. An expert review panel conducted item evaluations, leading to item reduction for clarity and relevance. The validation process utilized two independent samples of college students, detailing the sample size (n = 446 for preliminary testing, n = 1,593 for validation) and characteristics (age, major, urban vs. rural background) to enhance the understanding of the study's generalizability.

Results

The HIPQ, comprising 25 items across five dimensions-prevention-oriented approaches, relationship with healthcare providers, self-efficacy in obtaining health information, perception of the importance of health information, and health information behavior-demonstrated excellent content validity (ICVI ranged from 0.72 to 0.86). Factor analysis confirmed significant loadings for each item across the anticipated factors, with fit indices (RMSEA = 0.065, CFI = 0.942) supporting good model fit. The HIPQ's reliability was underscored by Cronbach's alpha coefficients (>0.8) for each subscale, with significant correlations across all subscales, indicating strong internal consistency and construct validity.

Conclusion

The HIPQ proves to be a reliable and valid instrument for assessing health information preferences among Chinese college students, highlighting its potential for broader application in health education and intervention strategies. Recognizing the study's focus on a specific demographic, future research should investigate the HIPQ's adaptability and utility in broader populations and different cultural settings. The study's limitations, including its concentrated demographic and context, invite further exploration into the HIPQ's applicability across diverse groups. Additionally, potential future research directions could include longitudinal studies to assess the impact of tailored health information on actual health outcomes and behaviors.

The effect of hospital discharge price increases on publicly reported measures of quality

OBJECTIVE

To determine if increases in hospital discharge prices are associated with improvements in clinical quality or patient experience.

DATA SOURCES

This study used Medicare cost report data and publicly available Medicare.gov Care Compare quality measures for approximately 3000 short-term care general hospitals between 2011 and 2018.

STUDY DESIGN

We separately regressed quality measure scores on a lag of case mix adjusted discharge price, hospital fixed effects, and year indicators. Clinical quality measures included 30-day readmission rates for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, hip and knee replacement, and pneumonia; risk-adjusted 30-day mortality rates for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, and stroke; and 90-day complication rate for hip and knee replacement. Patient experience measures included the summary star rating and 10 domain measures reported through the Hospital Consumer Assessment of Healthcare Providers and Systems survey. We tested for heterogeneous effects by hospital ownership, number of beds, the commercial share of overall discharges, and market concentration.

DATA COLLECTION/EXTRACTION METHODS

We linked hospitals identified in Medicare cost reports to Medicare.gov Care Compare quality measures. We excluded hospitals for which we could not identify a discharge price or that had an unrealistic price.

PRINCIPAL FINDINGS

There was no positive association between lagged discharge price and any clinical quality measure. For patient experience measures, a 2% increase in discharge price was not associated with overall patient satisfaction but was associated with small, statistically significant increases ranging from 0.01% to 0.02% (relative to mean scores) for seven of ten domain measures. There was a positive association for five of ten patient experience measures in competitive markets and one measure in both moderately concentrated and heavily concentrated markets.

CONCLUSIONS

We found no evidence that hospitals use higher prices to make investments in clinical quality; patient experience improved, but only negligibly.

Promoting Quality of Life and Safety in Assisted Living: A Survey of State Monitoring and Enforcement Agents

Our goal was to learn about monitoring and enforcement of state assisted living (AL) regulations. Using survey responses provided in 2019 from administrative agents across 48 states, we described state agency structures, accounted for operational processes concerning monitoring and enforcement, and documented data collecting and public reporting efforts. In half of the states, oversight of AL was dispersed across three or more agencies, and administrative support varied in terms of staffing and budget allocations. Operations also varied. While most agents could deploy a range of monitoring and enforcement tools, less than half compiled data concerning inspections, violations, and penalties. Less than 10 states shared such information in a manner that was easily accessible to the public. Future research should determine how these varied administrative structures and processes deter or contribute to AL communities' efforts to implement regulations designed to promote quality of life and provide for the safety of residents.

Accuracy and Completeness of Intermediate-Level Nursery Descriptions on Hospital Websites

IMPORTANCE

Birth at hospitals with an appropriate level of neonatal intensive care units is associated with better neonatal outcomes. The primary sources for information about hospital neonatal unit levels for prospective parents, referring physicians, and the public are hospital websites, but the accuracy of neonatal unit capacity is unclear.

OBJECTIVE

To determine if hospital websites accurately report the capabilities of intermediate (ie, level II) units, which are intended for care of newborns with low to moderate illness levels or the stabilization of newborns prior to transfer.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study compared descriptions of level II unit capabilities on hospital web pages in 10 large states with their respective state-level designation. Analyzed units were located in the 10 states with the highest number of live births in 2019 (excluding states with no level II regulations) and had active websites as of May 2021.

MAIN OUTCOMES AND MEASURES

Hospital websites were assessed for whether there was any mention of the unit, the description of the unit was provided, the unit was identified as a level III or both levels II and III, the terms "neonatal intensive care unit" or "NICU" were used without indicating limits in care available or newborn acuity, or the unit was claimed to provide the most advanced level of care.

RESULTS

A total 28 states had no regulation of nursery unit levels; in the 10 large, regulated states, web descriptions of level II units were incomplete for 39.2% of hospitals (95% CI, 33.3%-45.3%) and inaccurate for 24.6% (95% CI, 19.6%-30.2%). Within incomplete descriptions, 2.6% (95% CI, 1.1%-5.3%) of hospitals did not mention an advanced care unit and 22.0% (95% CI, 17.2%-27.5%) identified a level II unit without providing further description. Within inaccurate descriptions, 25.4% (95% CI, 20.3%-31.0%) of hospitals described the unit as a "neonatal intensive care unit" or "NICU" without any qualification and 9.3% (95% CI, 6.3%-13.5%) claimed that the unit provided the most advanced neonatal care or care to the sickest newborns; 3.0% of hospitals (95% CI, 1.3%-6.0%) stated that their unit was level III and 1.5% (95% CI, 0.4%-3.8%) as level II and III. Across states there was substantial variation in rates of incompleteness and inaccuracy.

CONCLUSIONS AND RELEVANCE

Incomplete and inaccurate hospital web descriptions of intermediate newborn care units are common. These deficits can mislead parents, clinicians, and the public about the appropriateness of a hospital for sick newborns, which raises important ethical questions.

Testing the effects on information use by older versus younger women of modality and narration style in a hospital report card

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.

Choosing a Provider: What Factors Matter Most to Consumers and Patients?

Enhancing consumer and patient choice has been proposed as a means to improve care quality and reduce health-related costs. Choosing a medical provider is one of the most critical and often complex decisions patients make about their health care. We investigated the perceived importance of factors patients may consider when selecting a practitioner and if rated importance of the factors varies with their characteristics and prior experiences with different types of clinicians (physicians, physician assistants, and nurse practitioners). Participants most often identified medical license, certification, and whether the provider accepts the patients’ health insurance as important, while provider type, others’ recommendations, and online reviews were among the least important. We found wide-ranging differences based on patient characteristics. Prior experience with providers was also a strong determinant of patterns of factors patients considered valuable. Policy-makers, health systems, insurers, and providers need to take into account that patients rely on a range of factors that vary based on their distinct needs, backgrounds, and previous experiences—requiring tailored information to make more informed decisions.

Disparate Impacts of Two Public Reporting Initiatives on Clinical and Perceived Quality in Healthcare

Purpose

Transparency is increasingly viewed as a prerequisite for value-based health care that invites quality in the assessment of achieved value. However, nowadays the ability of transparency initiatives to enhance quality of care remains obscure, if not rejected. Thus, this study aims to investigate how transparency initiatives influence two types of quality of care: clinical and perceived quality.

Methods

First, factor analyses were conducted to construct three dependent variables: healthcare-associated infections (HAIs), 30-day readmission rates, and patient satisfaction. Then, the three quality models were compared by running ordinary least squares multiple regressions using STATA 14.1. The existence of heteroskedasticity was remedied by using robust standard errors.

Results

Examining general acute care hospitals in the US, the present study noted that the ability of public reporting to improve quality of care remains inconclusive and that the pursuit of transparency may lead to inadvertent results. The disclosure of all-payer claims data (APCD) was found to have the power to differentiate hospitals’ clinical and perceived quality, but it failed to reach the desired outcomes without market pressure. The impact of transparency on quality of care diverges depending on the unique characteristics of each transparency policy, even though they pursue the same ends through information dissemination. Furthermore, the same public policy showed starkly disparate impacts on clinical quality (eg, healthcare-associated infections (HAIs) and 30-day readmission rates) and perceived quality (eg, patient satisfaction).

Conclusion

Despite the theoretically acknowledged merits of transparency, the present study noted that its ability to enhance quality of care remains inconclusive, and the pursuit of transparency may even inadvertently harm quality of care. While hospitals may need to finetune their strategies for each quality measurement in order to cope with the new environmental pressure, it is health policymakers’ role to coordinate those quality metrics and improve the validity of patient experience measures and surveys.

Crowd-sourced hospital ratings are correlated with patient satisfaction but not surgical safety

BACKGROUND

Hospital reviews posted online by patients are unsolicited and less structured than Hospital Consumer Assessment of Healthcare Providers and Systems surveys. The differences between online review platforms and their degrees of correlation with validated satisfaction and safety measures are unknown.

METHODS

We identified 515 large acute care teaching hospitals in the United States. We collected patient satisfaction results and postsurgical patient safety indicators from Hospital Compare. We also collected hospital star ratings (1-5) from Facebook, Google, and Yelp. Mean ratings were compared with paired t tests. Concordance between ratings websites, Hospital Consumer Assessment of Healthcare Providers and Systems scores, and surgical safety indicators were assessed with Pearson's correlation coefficient.

RESULTS

Mean Facebook ratings (3.81, interquartile range 3.5-4.3) were more favorable than Google (3.26, interquartile range 2.8-3.6) or Yelp (2.59, interquartile range 2.3-2.9). Facebook ratings were least strongly correlated with the Hospital Consumer Assessment of Healthcare Providers and Systems recommended hospital score (ρ = 0.356). Google was modestly correlated (ρ = 0.479), and Yelp was most strongly correlated (ρ = 0.500). The negative correlation between crowdsourced rating and composite safety indicator was too small to be meaningful on any platform.

CONCLUSION

There is variation between platforms in consumer ratings of hospitals. Ratings on Facebook are more favorable than Google or Yelp. These are independently correlated with Hospital Consumer Assessment of Healthcare Providers and Systems scores. These findings suggest that unstructured consumer reviews generally reflect similar directionality as Hospital Consumer Assessment of Healthcare Providers and Systems satisfaction scores. Users should be aware of the significant difference between platforms. Consumer ratings platforms are not consistently correlated with postsurgical patient safety indicators, so online ratings may not reflect the safety of surgical care received.

Mechanisms and impact of public reporting on physicians and hospitals' performance: A systematic review (2000-2020)

BACKGROUND

Public performance reporting (PPR) of physician and hospital data aims to improve health outcomes by promoting quality improvement and informing consumer choice. However, previous studies have demonstrated inconsistent effects of PPR, potentially due to the various PPR characteristics examined. The aim of this study was to undertake a systematic review of the impact and mechanisms (selection and change), by which PPR exerts its influence.

METHODS

Studies published between 2000 and 2020 were retrieved from five databases and eight reviews. Data extraction, quality assessment and synthesis were conducted. Studies were categorised into: user and provider responses to PPR and impact of PPR on quality of care.

RESULTS

Forty-five studies were identified: 24 on user and provider responses to PPR, 14 on impact of PPR on quality of care, and seven on both. Most of the studies reported positive effects of PPR on the selection of providers by patients, purchasers and providers, quality improvement activities in primary care clinics and hospitals, clinical outcomes and patient experiences.

CONCLUSIONS

The findings provide moderate level of evidence to support the role of PPR in stimulating quality improvement activities, informing consumer choice and improving clinical outcomes. There was some evidence to demonstrate a relationship between PPR and patient experience. The effects of PPR varied across clinical areas which may be related to the type of indicators, level of data reported and the mode of dissemination. It is important to ensure that the design and implementation of PPR considered the perspectives of different users and the health system in which PPR operates in. There is a need to account for factors such as the structural characteristics and culture of the hospitals that could influence the uptake of PPR.

Consumer Use of Provider Quality Report Cards: The Role of Dissemination and Media Coverage

OBJECTIVE

The objective of this study was to measure the dissemination of comparative provider quality information (CPQI) and evaluate its impact on consumers' awareness and use of CPQI.

DATA SOURCES

Two-period, random-digit-dial panel survey of chronically ill consumers residing in 14 regions of the United States; summaries of CPQI dissemination activities of regional multistakeholder alliances; and the LexisNexis Academic and Access World News databases.

STUDY DESIGN/METHODS

Fixed effects regression to isolate the effect of CPQI producers' dissemination activities and the print media's CPQI coverage on chronically ill consumers' self-reported awareness and use of CPQI.

PRINCIPAL FINDINGS

Direct CPQI dissemination had no overall effect on either awareness or use of CPQI. One unit increase in the media coverage of an Aligning Forces for Quality (AF4Q) multistakeholder alliance report increased consumer awareness and use of CPQI by 1.4 percentage points (P=0.049) and 1.1 percentage points (P=0.009), respectively. Similar increases for the Centers for Medicare and Medicaid Services (CMS) CPQI and for the nonalliance, non-CMS CPQI improved CPQI use by 1.6 percentage points (P<0.001) and 0.2 percentage points (P=0.041), respectively.

CONCLUSION

Even though CPQI producers' direct dissemination efforts had little impact, the small but significant consumer impacts of CPQI's limited press coverage suggests that limited use of media in the dissemination of report cards may be a significant factor behind low consumer awareness and use.

Americans' Growing Exposure To Clinician Quality Information: Insights And Implications

For two decades, various initiatives have encouraged Americans to consider quality when choosing clinicians, both to enhance informed choice and to reduce disparities in access to high-quality providers. The literature portrays these efforts as largely ineffective. But this depiction overlooks two factors: the dramatic expansion since 2010 in the availability of patients' narratives about care and the growth of information seeking among consumers. Using surveys fielded in 2010, 2014, and 2015, we assessed the impact of these changes on consumers' awareness of quality information and sociodemographic differences. Public exposure to any quality information doubled between 2010 and 2015, while exposure to patient narratives and experience surveys tripled. Reflecting a greater propensity to seek quality metrics, minority consumers remained better informed than whites over time, albeit with differences across subgroups in the types of information encountered. An education-related gradient in quality awareness also emerged over the past decade. Public policy should respond to emerging trends in information exposure, establish standards for rigorous elicitation of narratives, and assist consumers' learning from a combination of narratives and quantified metrics on clinician quality.