R. J. Ellis1,2, D. B. Hewitt3, J. K. Johnson4, K. Y. Bilimoria1 1Northwestern University,Department Of Surgery, Surgical Outcomes And Quality Improvement Center,Chicago, IL, USA 2American College of Surgeons,Chicago, IL, USA 3Thomas Jefferson University,Department Of Surgery,Philadelphia, PA, USA 4Northwestern Feinberg School of Medicine,Center For Healthcare Studies In The Institute Of Public Health And Medicine,Chicago, IL, USA
Introduction: Patient utilization of healthcare quality reporting has been suboptimal despite attempts to encourage use of publicly available data. Lack of utilization may be due to discordance between reported quality metrics and what patients want to know when making healthcare choices. The objectives of this study were (1) to identify hospital- and physician-level measures of quality that patients would prefer presented in public reporting and (2) to explore the relative importance of these factors in how patients assess healthcare quality during decision making.
Methods: Interviews and focus groups were used to develop and refine a survey exploring the relative importance of healthcare quality measures. Measures were studied across all domains of healthcare quality, including hospital-level measures (e.g., location, accreditations, hospital-level outcomes) and physician-level measures (e.g., years of experience, training program, adherence to national guidelines). The survey was administered to online survey panels through SurveyGizmo to obtain a census balanced national sample. Likert scale responses were compared using non-parametric tests of central tendency. Rank order responses were compared using analysis of variance testing adjusted for multiple comparisons. Associations with binary outcomes were analyzed using multivariable logistic regression models.
Results: The survey was sent to 11,125 individuals with 4,672 responses (42.0% response rate). Census balancing yielded 2,004 surveys for analysis. Of those, 1,213 (60.5%) reported previously researching healthcare online. Measures identified as most important were hospital reputation (considered important by 61.9%), physician years of experience (51.5%), and primary care physician recommendations (43.2%). Relatively unimportant factors included adherence to national guidelines (17.6%), risk of requiring temporary nursing home care (17.5%), and hospital academic affiliation (13.3%, p<0.001 for all compared to most important factors). Outcome measures were not among the most important factors, with the risk of death considered important by only 35.1% of respondents. Patients were unlikely to rank outcome measures as the most important factors in choosing healthcare providers, irrespective of age, gender, educational status, or income.
Conclusion: In selecting providers, patients valued hospital reputation, physician experience, and primary care physician recommendations. Publicly reported metrics like guideline adherence and patient outcomes were considered less important, despite a national push to focus on outcomes in public reporting. Public quality reports contain information that patients perceive to be of relatively low value, which may contribute to low utilization of public healthcare quality information. Development of reporting systems focused on relevant, patient-centered information may improve patient utilization of publicly reported quality data.