Provider PerspectivesCommunicating quality of care information to physicians: A study of eight presentation formats
Introduction
Public reporting of provider quality of care aims to support patients in their health care choices, to stimulate improvement efforts among providers, and to increase accountability of health care providers [1], [2]. Public reporting fits into the concept of consumer-directed or demand-driven health care which is emphasized in health care reforms of many industrialized countries today [3]. Accordingly, an increasing number of websites provide public reports about health care [4]. However, the expansion in public reporting has occurred despite a lack of convincing evidence that patients use public reports for decision-making or that public reporting has had much of an impact on the quality of care [5], [6], and despite concerns that public reporting may unintentionally harm quality of care [7], [8], [9].
Explanations for the lack of use of public reports consider that consumers are not aware of the reports, mainly ignore them or do not use them for decision-making [10], [11], [12], [13], [14], [15] because published reports are usually internet-based and may be missed by parts of the target population, lack clarity, and are overloaded with information that is only partly understood and inaccurately presented [16], [17], [18], [19], [20].
Another line of argument questions whether consumers or patients should represent the principal target audience for public reports of provider quality [3], [21], [22]. When choosing a hospital most patients rely on recommendations by their referring doctor. combined with their own hospital experiences, opinions of friends and family members, and traveling distance [23], [24], [25], [26], [27], [28]. Hence the influence of public reports on choice decisions may be increased by aiming performance data directly at referring physicians, asking them to use public reports in counseling patients, and enhancing the actual report usage by designing the reports’ information presentation according to physicians’ preferences [3], [29], [30].
However, present research on designing public report cards focused on consumers and patients but not physicians. This research suggests that presentation approaches should aim to reduce the cognitive burden by structuring the information according to its importance, highlighting important information and omitting unnecessary information [20], [31], [32], [33], [34]. Following these strategies, consumers, especially those with low numerical skills, showed improved comprehension of the data presented and were found to preferentially choose high quality providers [34]. However, contemporary graphical display formats such as star ratings or bar graphs used in presenting comparative performance data on health care providers do not necessarily improve comprehension. In comparison to numeric tables and bar graphs, evaluative tables were found to be easier to understand and preferred by consumers when asked to choose a nursing home by comparing CMS reported quality measures [30].
Since it is not clear which formats for presenting quality of care data non-hospital based physicians prefer to support their counseling of patients in need of hospital care, we tested different presentation formats and measured physicians’ ratings of information content, comprehensibility, clarity, acceptance, preference and comprehension of the formats.
Section snippets
Study setting and recruitment of participants
We chose non-hospital based physicians as target population. Physicians working in outpatient care in Germany provide primary care or specialized services and usually do not have hospital privileges. Non-hospital based physicians refer their patients in need of inpatient services to hospitals. In case of elective admissions patients need a referral form where the doctor names the two closest and appropriate hospitals providing the services the doctor's patient needs. The decision which hospital
Participants
662 randomly chosen physicians had to be contacted by mail and phone to fill the predefined strata – 20 participants per specialty and region, together 300 physicians. 218 out of 518 physicians meeting the inclusion criteria (non-hospital based without hospital privileges, contact successful) refused to participate. The overall response rate of 58% (300/518) resulted from response rates within the five chosen specialties as follows: surgeons 65%, primary care physicians 63%, internists 58%,
Discussion
The findings indicate that when choosing hospitals on the basis of comparative performance data, physicians prefer presentation formats that combine individual indicator values with evaluative features such as rankings or traffic light symbols. Presentation formats displaying just aggregated indicator information such as tables showing indicator data only as traffic light symbols, stars or comparative terms, or simple star ratings of hospitals are not accepted as a means to support physicians
Competing interests
The authors declare that they have no conflict of interest.
Authors’ contributions
MG conceived and designed the study, supervised data analysis and drafted the manuscript. PH collected data, performed data analysis, helped draft the manuscript and revised the manuscript critically for important intellectual content. WC supervised data analysis and revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.
Acknowledgements
Financial support for this study was provided by a grant from Germany's Federal Chamber of Physicians (07-003). We thank all participants for their contributions and Christina Wagner and Michael Bauer for their linguistic support.
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