Significant investments have been made in developing and disseminating health care provider cost and quality information on the Internet with the expectation that stronger consumer engagement will lead consumers to seek providers who deliver high-quality, low-cost care. However, prior research shows that the awareness and use of such information is low. This study investigates how the information search process may contribute to explaining this result. The analysis reveals that the Web sites most likely to be found by consumers are owned by private companies and provide information based on anecdotal patient experiences. Web sites less likely to be found have government or community-based ownership, are based on administrative data, and contain a mixture of quality, cost, and patient experience information. Searches for information on hospitals reveal more cost and quality information based on administrative data, whereas searches that focus on clinics or physicians are more likely to produce information based on patient narratives.
[Show abstract][Hide abstract] 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.
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.
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.
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.
BMC Health Services Research 08/2012; 12(1):272. DOI:10.1186/1472-6963-12-272 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Key challenges in benchmarking health service achievement of policy goals in areas such as chronic disease are: 1) developing indicators and understanding how policy goals might work as indicators of service performance; 2) developing methods for economically collecting and reporting stakeholder perceptions; 3) combining and sharing data about the performance of organizations; 4) interpreting outcome measures; 5) obtaining actionable benchmarking information. This study aimed to explore how a new Boolean-based small-N method from the social sciences—Qualitative Comparative Analysis or QCA—could contribute to meeting these internationally shared challenges.
A ‘multi-value QCA’ (MVQCA) analysis was conducted of data from 24 senior staff at 17 randomly selected services for chronic disease, who provided perceptions of 1) whether government health services were improving their achievement of a set of statewide policy goals for chronic disease and 2) the efficacy of state health office actions in influencing this improvement. The analysis produced summaries of configurations of perceived service improvements.
Most respondents observed improvements in most areas but uniformly good improvements across services were not perceived as happening (regardless of whether respondents identified a state health office contribution to that improvement). The sentinel policy goal of using evidence to develop service practice was not achieved at all in four services and appears to be reliant on other kinds of service improvements happening.
The QCA method suggested theoretically plausible findings and an approach that with further development could help meet the five benchmarking challenges. In particular, it suggests that achievement of one policy goal may be reliant on achievement of another goal in complex ways that the literature has not yet fully accommodated but which could help prioritize policy goals. The weaknesses of QCA can be found wherever traditional big-N statistical methods are needed and possible, and in its more complex and therefore difficult to empirically validate findings. It should be considered a potentially valuable adjunct method for benchmarking complex health policy goals such as those for chronic disease.
BMC Health Services Research 09/2012; 12(1):343. DOI:10.1186/1472-6963-12-343 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: : 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.
: 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.
: 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.
: A total of 555 US residents, aged 25-64, who had Internet access through computer were recruited from an existing online panel.
: 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.
: 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.
Medical care 11/2012; 50 Suppl(11):S56-64. DOI:10.1097/MLR.0b013e31826c84e1 · 3.23 Impact Factor
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