Consumer Response to Patient Experience Measures in Complex Information Environments
: 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.
- [Show abstract] [Hide abstract] ABSTRACT: Efforts to engage consumers in the use of public reports on health care provider performance have met with limited success. Fostering greater engagement will require new approaches that provide consumers with relevant content at the time and in the context they need to make a decision of consequence. To this end, we identify three key factors influencing consumer engagement and show how they manifest in different ways and combinations for four particular choice contexts that appear to offer realistic opportunities for engagement. We analyze how these engagement factors play out differently in each choice context and suggest specific strategies that sponsors of public reports can use in each context. Cross-cutting lessons for report sponsors and policy makers include new media strategies such as a commitment to adaptive web-based reporting, new metrics with richer emotional content, and the use of navigators or advocates to assist consumers with interpreting reports.
- [Show abstract] [Hide abstract] ABSTRACT: Growing discussion on the use of whole-genome or exome sequencing (WG/ES) in newborn screening (NBS) has raised concerns regarding the generation of incidental information on millions of infants annually. It is unknown whether integrating WG/ES would alter public expectations regarding participation in universal NBS. We assessed public willingness to participate in NBS using WG/ES compared with current NBS. Our secondary objective was to assess the public's beliefs regarding a parental responsibility to participate in WG/ES-based NBS compared with current NBS. We examined self-reported attitudes regarding willingness to participate in NBS using a cross-sectional national survey of Canadian residents recruited through an internet panel, reflective of the Canadian population by age, gender and region. Our results showed that fewer respondents would be willing to participate in NBS using WG/ES compared with NBS using current technologies (80 vs 94%, P<0.001), or perceived a parental responsibility to participate in WG/ES-based NBS vs current NBS (30 vs 48%, P<0.001). Our findings suggest that integrating WG/ES into NBS might reduce participation, and challenge the moral authority that NBS programmes rely upon to ensure population benefits. These findings point to the need for caution in the untargeted use of WG/ES in public health contexts.European Journal of Human Genetics advance online publication, 19 February 2014; doi:10.1038/ejhg.2014.22.
- [Show abstract] [Hide abstract] ABSTRACT: The English National Health Service's public reporting website-known as NHS Choices-has been incorporating anecdotal comments from patients about primary and hospital care since 2007. Publicly reporting patients' narrative comments along with numerical ratings of their experience and clinical quality metrics presents opportunities as well as challenges for reporting systems. This article reviews the lessons learned in England that could be useful to other health systems that are considering a similar approach. We explore five key design considerations for publicly reporting anecdotal comments-including how to collect, moderate, and display comments and how to encourage the public and the health care providers use them. While anecdotal comments might represent an untapped seam of valuable information about service quality and a potential hook for engaging patients to use comparative performance data, the jury is still out on where narrative comments fit in the complex landscape of quality measurement and reporting.