Engaged Patients Will Need Comparative Physician-Level Quality Data And Information About Their Out-Of-Pocket Costs
ABSTRACT For patients to be engaged, they will need meaningful and comparable information about the quality and cost of health care. We conducted a literature review and key-informant interviews, reviewed selected online reporting tools, and found that quality and cost reporting fell into two categories. One emphasizes public reporting of information, supported by philanthropic or government institutions that aim to improve provider quality and efficiency. The other is characterized by proprietary websites that aim to provide personalized, integrated information on cost and quality to support consumers' decision making on providers and services. What consumers seem to want is quality data at the physician level and cost data that reflect their personal out-of-pocket exposure. These needs will be acute under the coverage expansions inherent in the Affordable Care Act. State and federal policy thus should support all-payer claims databases, standards for electronic health records to facilitate sharing of quality data, and a unified approach to presenting information that prioritizes consumers' needs.
Conference Paper: THE PRESENTATION OF COST-RELATED INFORMATION IN PATIENT DECISION AIDS[Show abstract] [Hide abstract]
ABSTRACT: Purpose: To determine the frequency of cost-related information included in patient decision aids (PtDAs) and identify the common modes of presenting cost-related information. Method: We analyzed published PtDAs found in the Decision Aid Library Inventory (DALI) system, maintained by the Ottawa Hospital Research Institute (N=290). We recorded whether cost was mentioned, how many times, and how it was mentioned and performed descriptive statistical analysis on these data. Result: A total of 290 PtDAs were anlayzed. A majority of them (n = 161, 55%) mentioned cost in some way, but only 37 (13%) mentioned cost directly by giving a specific price or range of prices. In addition to the provision of a specific price, cost was mentioned in 8 additional ways: as a benefit (e.g., “[the treatment] is low in cost”), a risk (e.g., “medicines cost a lot”), a “depends on insurance” clause, a statement of predication about insurance (e.g. “insurance usually covers this”), a comparison of costs (e.g., one option is cheaper than another), value and importance of cost (e.g., scale of worry or importance of cost), a suggestion to discuss costs with someone (e.g., physician, social worker, insurance provider), and a suggestion to [vaguely] "consider" cost. The most common way to mention cost was as a benefit (n = 73, 45%), followed by a risk (n = 54, 34%), depends on insurance (n = 54, 34%), and value and importance to you (n = 48, 30%). 23 of the decision aids that mentioned cost (14%) suggested talking to someone about the costs; of those, 14 suggested a doctor, 3 an insurance provider, and 9 either multiple sources or other. Decisions about medication option(s) were the type of decision where cost was most likely to be mentioned, with 73% of the decision aids about medication (n = 49) discussing cost in some way. Conclusion: Whether costs are dicussed in PtDAs is highly variable, as is how they are discussed when they are. Best pracitces are needed for the presentation of cost information. The International Pateint Decision Aid Standards (IPDAS) Collaboration may consider taking on this issue.The 36th Annual Meeting of the Society for Medical Decision Making; 10/2014
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ABSTRACT: Costs are an important component of patients' decision making, but a comparatively underemphasized aspect of formal shared decision making. We hypothesized that decision aids also avoid discussion of costs, despite their being tools designed to facilitate shared decision making about patient-centered outcomes. We sought to define the frequency of cost-related information and identify the common modes of presenting cost and cost-related information in the 290 decision aids catalogued in the Ottawa Hospital Research Institute's Decision Aid Library Inventory (DALI) system. We found that 56% (n = 161) of the decision aids mentioned cost in some way, but only 13% (n = 37) gave a specific price or range of prices. We identified 9 different ways in which cost was mentioned. The most common approach was as a "pro" of one of the treatment options (e.g., "you avoid the cost of medication"). Of the 37 decision aids that gave specific prices or ranges of prices for treatment options, only 2 were about surgery decisions despite the fact that surgery decision aids were the most common. Our findings suggest that presentation of cost information in decision aids is highly variable. Evidence-based guidelines should be developed by the International Patient Decision Aid Standards (IPDAS) Collaboration. © The Author(s) 2015.Medical Decision Making 01/2015; DOI:10.1177/0272989X14564433 · 2.27 Impact Factor
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ABSTRACT: There is significant interest in building the next generation of public reporting tools that will more effectively engage consumers and better enable them to make use of comparative performance information when selecting a provider. Demand for public reporting tools that make health care cost and quality information transparent is fueled by a variety of market forces underway. A host of public reporting efforts and studies have identified a number of challenges, highlighting that, we still do not understand how best to design public reports to meet the needs of the consumer. We identify five areas for additional research that, if addressed, could foster better design and delivery of quality and cost information to consumers.Medical Care Research and Review 05/2014; 71(5). DOI:10.1177/1077558714535982 · 2.57 Impact Factor