Objective. Public reporting on the quality of provider care has the potential to empower patients to make evidence-based decisions. Yet patients seldom consult resources such as provider report cards in part because they perceive the information as irrelevant. To inform more effective public reporting, we investigated patients’ information priorities when selecting a hospital for cancer treatment. We hypothesized that patients would be most interested in data on clinical outcomes. Methods. An experienced moderator led a series of focus groups using a semistructured discussion guide. Separate sessions were held with patients aged 18 to 54 years and those older than 54 years in Philadelphia, Pennsylvania; Phoenix, Arizona; and Indianapolis, Indiana, in 2017. All 38 participants had received treatment for cancer within the past 2 years and had a choice of hospitals. Results. In selecting hospitals for cancer treatment, many participants reported that they considered factors such as reputation, quality of the facilities, and experiences of other patients. For most, however, decisions were guided by trusted advisors, with the majority agreeing that a physician’s opinion would sway them to disregard objective data about hospital quality. Nonetheless, nearly all expressed interest in having comparative data. Participants varied in selecting from a hypothetical list, “the top 3 things you would want to know when choosing a hospital for cancer care.” The most commonly preferred items were overall care quality, timeliness, and patient satisfaction. Contrary to our hypothesis, many preferred to avoid viewing comparative clinical outcomes, particularly survival. Conclusions. Patients’ information preferences are diverse. Fear or other emotional responses might deter patients from viewing outcomes data such as survival. Additional research should explore optimal ways to help patients incorporate comparative data on the components of quality they value into decision making.
U.S. Institute of Medicine Roundtable on Value & Science-Driven Health Care; YongPLSaundersRSOlsenL, eds. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: National Academies Press; 2010.
2.
FaberMBoschMWollersheimHLeathermanSGrolR. Public reporting in health care: how do consumers use quality-of-care information? A systematic review. Med Care. 2009;47(1):1–8. Epub 2008/12/25. doi: 10.1097/MLR.0b013e3181808bb5.PubMed PMID: 19106724.
3.
HafnerJMWilliamsSCKossRGTschurtzBASchmaltzSPLoebJM. The perceived impact of public reporting hospital performance data: interviews with hospital staff. Int J Qual Health Care. 2011;23(6):697–704. doi: 10.1093/intqhc/mzr056.
4.
HibbardJHJewettJJ. Will quality report cards help consumers?Health Affairs. 1997;16(3):218–28. doi: 10.1377/hlthaff.16.3.218.
5.
HibbardJHStockardJTuslerM. Hospital performance reports: impact on quality, market share, and reputation. Health Aff (Millwood). 2005;24(4):1150–60. doi: 10.1377/hlthaff.24.4.1150.
6.
LindenauerPKRemusDRomanS, et al. Public reporting and pay for performance in hospital quality improvement. N Engl J Med. 2007;356(5):486–96. doi: 10.1056/NEJMsa064964.
7.
Institute of Medicine. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington, DC: National Academies Press; 2013.
Agency for Healthcare Research and Quality. Public Reporting as a Quality Improvement Strategy. Rockville, MD: Agency for Healthcare Research and Quality; 2012.
10.
HibbardJHJewettJJ. What type of quality information do consumers want in a health care report card?Med Care Res Rev. 1996;53(1):28–47.
11.
SofaerSCroftonCGoldsteinEHoyECrabbJ. What do consumers want to know about the quality of care in hospitals?Health Serv Res. 2005;40(6 Pt 2):2018–36. doi: 10.1111/j.1475-6773.2005.00473.x.
12.
LongoDR. Health care consumer reports: an evaluation of employer perspectives. J Health Care Finance. 2004;30(3):85–92.
13.
RichardSARawalSMartinDK. Patients’ views about cardiac report cards: a qualitative study. Can J Cardiol. 2005;21(11):943–7.
14.
MarshallMNShekellePGLeathermanSBrookRH. The public release of performance data: what do we expect to gain? A review of the evidence. JAMA. 2000;283(14):1866–74.
15.
YangAChimonasSBachPBTaylorDJLipitz-SnydermanA. Critical choices: what information do patients want when selecting a hospital for cancer surgery?J Oncol Pract. 2018;14(8):e505–e512.
SchneiderECEpsteinAM. Use of public performance reports: a survey of patients undergoing cardiac surgery. JAMA. 1998;279(20):1638–42.
20.
JewettJJHibbardJH. Comprehension of quality care indicators: differences among privately insured, publicly insured, and uninsured. Health Care Financ Rev. 1996;18(1):75–94. PubMed PMID: 10165038; PubMed Central PMCID: PMC4193616.
21.
DammanOCHendriksMRademakersJDelnoijDMGroenewegenPP. How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews. BMC public health. 2009;9:423. doi: 10.1186/1471-2458-9-423.
22.
ChristiansonJBVolmarKMAlexanderJScanlonDP. A report card on provider report cards: current status of the health care transparency movement. J Gen Intern Med. 2010;25(11):1235–41. doi: 10.1007/s11606-010-1438-2.
23.
SinaikoADEastmanDRosenthalMB. How report cards on physicians, physician groups, and hospitals can have greater impact on consumer choices. Health Aff (Millwood). 2012;31(3):602–11. doi: 10.1377/hlthaff.2011.1197.
24.
BrookRHMcGlynnEAShekellePG, et al. Report Cards for Health Care: Is Anyone Checking Them?Santa Monica, CA: RAND Corporation; 2002.
SpinksTEWaltersRFeeleyTW, et al. Improving cancer care through public reporting of meaningful quality measures. Health Aff (Millwood). 2011;30(4):664–72. doi: 10.1377/hlthaff.2011.0089.
27.
BachPBCramerLDSchragDDowneyRJGelfandSEBeggCB. The influence of hospital volume on survival after resection for lung cancer. N Engl J Med. 2001;345(3):181–8. doi: 10.1056/NEJM200107193450306.
28.
SmithTJPenberthyLDeschCE, et al. Differences in initial treatment patterns and outcomes of lung cancer in the elderly. Lung Cancer. 1995;13(3):235–52.
29.
GhaferiAABirkmeyerJDDimickJB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361(14):1368–75. doi: 10.1056/NEJMsa0903048.
30.
MakarovDSenSSoulosP, et al. Regional-level inappropriate imaging rates for prostate and breast cancers are correlated: potential lessons for the Choosing Wisely campaign. J Urol. 2014;191(4):E97–E.
31.
TarimanJDDoorenbosAScheppKGSinghalSBerryDL. Information needs priorities in patients diagnosed with cancer: a systematic review. J Adv Pract Oncol. 2014;2014(5):115–22.
32.
TongASainsburyPCraigJ. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. doi: 10.1093/intqhc/mzm042.
33.
MorganDL. Focus Groups as Qualitative Research. 2nd ed.Thousand Oaks, CA: Sage; 1997. p 42–3.
34.
U.S.Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
35.
SprancaMKanouseDEElliottMShortPFFarleyDOHaysRD. Do consumer reports of health plan quality affect health plan selection?Health Serv Res. 2000;35(5 Pt 1):933–47.
36.
GreeneJHibbardJHSacksRM. Summarized costs, placement of quality stars, and other online displays can help consumers select high-value health plans. Health Aff (Millwood). 2016;35(4):671–9. doi: 10.1377/hlthaff.2015.1367.
37.
KruegerRA. Focus Groups: A Practical Guide for Applied Research. 2nd ed.Thousand Oaks, CA: Sage; 1994.
38.
SandelowskiM. Theoretical saturation. In: GivenLM, ed. The Sage Encyclopedia of Qualitative Methods. Thousand Oaks, CA: Sage; 2008. p 875–6.
39.
SaumureKGivenLM. Data saturation. In: GivenLM, ed. The Sage Encyclopedia of Qualitative Methods. Thousand Oaks, CA: Sage; 2008. p 195–6.
de GrootIBOttenWDijs-ElsingaJ, et al. Choosing between hospitals: the influence of the experiences of other patients. Med Decis Making. 2012;32(6):764–78. doi: 10.1177/0272989X12443416.
42.
Dijs-ElsingaJOttenWVersluijsMM, et al. Choosing a hospital for surgery: the importance of information on quality of care. Med Decis Making. 2010;30(5):544–55. doi: 10.1177/0272989X09357474.
43.
Marang-van de MheenPJDijs-ElsingaJOttenW, et al. The relative importance of quality of care information when choosing a hospital for surgical treatment: a hospital choice experiment. Med Decis Making. 2011;31(6):816–27. doi: 10.1177/0272989X11386799.
44.
DammanOCSpreeuwenbergPRademakersJHendriksM. Creating compact comparative health care information: what are the key quality attributes to present for cataract and total hip or knee replacement surgery?Med Decis Making. 2012;32(2):287–300. doi: 10.1177/0272989x11415115.
45.
RavenMCGillespieCCDiBennardoRVan BusumKElbelB. Vulnerable patients’ perceptions of health care quality and quality data. Med Decis Making. 2012;32(2):311–26. doi: 10.1177/0272989x11421414.
46.
HammondWP. Psychosocial correlates of medical mistrust among African American men. Am J Commun Psychol. 2010;45(1–2):87–106. doi: 10.1007/s10464-009-9280-6.
47.
LaVeistTANickersonKJBowieJV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57(Suppl 1):146–61. doi: 10.1177/1077558700057001s07.
48.
BoulwareLECooperLARatnerLELaVeistTAPoweNR. Race and trust in the health care system. Public Health Rep. 2003;118(4):358–65. doi: 10.1093/phr/118.4.358.
49.
LeventhalHPhillipsLABurnsE. The common-sense model of self-regulation (CSM): a dynamic framework for understanding illness self-management. J Behav Med. 2016;39(6):935–46. doi: 10.1007/s10865-016-9782-2.
50.
SlovicPPetersEFinucaneMLMacgregorDG. Affect, risk, and decision making. Health Psychol. 2005;24(4s):S35–40. doi: 10.1037/0278-6133.24.4.S35
51.
TurnerJKellyB. Emotional dimensions of chronic disease. West J Med. 2000;172(2):124–8.
52.
MoullecGNinotG. An integrated programme after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: effect on emotional and functional dimensions of quality of life. Clin Rehabil. 2010;24(2):122–36. doi: 10.1177/0269215509346088.
53.
RozanskiABlumenthalJAKaplanJ. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99(16):2192–217.
54.
CorriganPWWatsonAC. Understanding the impact of stigma on people with mental illness. World Psychiatry. 2002;1(1):16–20.
55.
AngelRThoitsP. The impact of culture on the cognitive structure of illness. Cult Med Psychiatry. 1987;11(4):465–94.
56.
FalvoDR. Medical and Psychosocial Aspects of Chronic Illness and Disability. 3rd ed.Sudbury, MA: Jones and Bartlett; 2005.
57.
BarrJKBernardSLSofaerSGiannottiTELenfesteyNFMirandaDJ. Physicians’ views on public reporting of hospital quality data. Med Care Res Rev. 2008;65(6):655–73. doi: 10.1177/1077558708319734.
58.
FreedmanRAKouriEMWestDWKeatingNL. Racial/ethnic differences in patients’ selection of surgeons and hospitals for breast cancer surgery. JAMA Oncol. 2015;1(2):222–30. doi: 10.1001/jamaoncol.2015.20.
59.
SchwartzLMWoloshinSBirkmeyerJD. How do elderly patients decide where to go for major surgery? Telephone interview survey. BMJ. 2005;331(7520):821. doi: 10.1136/bmj.38614.449016.DE.
60.
WilsonCTWoloshinSSchwartzLM. Choosing where to have major surgery: who makes the decision?Arch Surg. 2007;142(3):242–6. doi: 10.1001/archsurg.142.3.242.
61.
SpiegelD. Healing words: emotional expression and disease outcome. JAMA. 1999;281(14):1328–9.
62.
SchneiderECEpsteinAM. Influence of cardiac-surgery performance reports on referral practices and access to care: a survey of cardiovascular specialists. N Engl J Med. 1996;335(4):251–6. doi: 10.1056/NEJM199607253350406.
63.
HannanELStoneCCBiddleTLDeBuonoBA. Public release of cardiac surgery outcomes data in New York: what do New York state cardiologists think of it?Am Heart J. 1997;134(6):1120–8.
64.
MadrianBCSheaDF. The power of suggestion: inertia in 401(k) participation and savings behavior. Quarterly Journal of Economics. 2001;116(4):1149–87.
65.
ThalerRHSunsteinCR. Libertarian paternalism. Am Econ Rev. 2003;93(2):175–9.
66.
LernerJSLiYValdesoloPKassamKS. Emotion and decision making. Annu Rev Psychol. 2015;66:799–823. doi: 10.1146/annurev-psych-010213-115043.
67.
HibbardJHPetersE. Supporting informed consumer health care decisions: data presentation approaches that facilitate the use of information in choice. Annu Rev Public Health. 2003;24(1):413–33. doi: 10.1146/annurev.publhealth.24.100901.141005.
68.
HibbardJHSofaerS. Best Practices in Public Reporting No. 1: How to Effectively Present Health Care Performance Data to Consumers. Rockville, MD: Agency for Healthcare Research and Quality; 2010.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
