Provider Perspectives
Communicating quality of care information to physicians: A study of eight presentation formats

https://doi.org/10.1016/j.pec.2011.11.005Get rights and content

Abstract

Objective

Non-hospital based physicians usually counsel their patients which hospital to choose. Our aim was to determine which formats for presenting quality of care data are preferred by physicians.

Methods

300 randomly recruited non-hospital based physicians participated in a survey. We created eight presentation formats which varied in terms of information aggregation and usage of evaluative cues. Participants rated clarity, comprehensibility, information content, acceptance, and preference of the presentation formats. Additionally, we tested physicians’ comprehension of the formats.

Results

Physicians’ ratings of the formats differed significantly (p < 0.001). Formats combining numeric information and evaluative cues performed best in terms of information content, comprehensibility and preference. Comprehension of presentation formats also differed (p < 0.001). Even though physicians’ accuracy of interpreting “Simple Star Rating” was best a majority of participants accepted only formats that contained detailed numerical information (p < 0.001).

Conclusion

In order to support physicians’ use of quality of care information in counseling patients, report cards should depict indicator values in a format that combines actual indicator values with evaluative cues.

Practice implications

If authors of comparative hospital quality reports apply the results of our study in designing reports, the results may increase physicians’ use of comparative performance reports in their counseling of patients.

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.

References (36)

  • J.H. Hibbard et al.

    Making health care quality reports easier to use

    Jt Comm J Qual Improv

    (2001)
  • B. Fasolo et al.

    Helping patients choose: how to improve the design of comparative scorecards of hospital quality

    Patient Educ Couns

    (2010)
  • S.T. Hawley et al.

    The impact of the format of graphical presentation on health-related knowledge and treatment choices

    Patient Educ Couns

    (2008)
  • M. Marshall et al.

    The public release of performance data – what do we expect to gain?

    J Am Med Assoc

    (2000)
  • A.H. Rosenstein

    Hospital report cards: intent, impact, and illusion

    Am J Med Qual

    (2004)
  • C.J. Lako et al.

    Demand-driven care and hospital choice. Dutch health policy toward demand-driven care: results from a survey into hospital choice

    Health Care Anal

    (2009)
  • O.C. Damman et al.

    An international comparison of web-based reporting about health care quality: content analysis

    J Med Internet Res

    (2010)
  • C.H. Fung et al.

    Systematic review: the evidence that publishing patient care performance data improves the quality of care

    Ann Intern Med

    (2008)
  • D.L. Robinowitz et al.

    Public reporting of provider performance: can its impact be made greater?

    Annu Rev Publ Health

    (2006)
  • R. Werner et al.

    The unintended consequences of publicly reporting quality information

    J Am Med Assoc

    (2005)
  • P. Smith

    On the unintended consequences of publishing performance data in the public sector

    Int J Publ Admin

    (1995)
  • C.R. Narins et al.

    The influence of public reporting of outcome data on medical decision making by physicians

    Arch Intern Med

    (2005)
  • S. Sofaer et al.

    What do consumers want to know about the quality of care in hospitals?

    Health Serv Res

    (2005)
  • M.N. Marshall et al.

    How do we maximize the impact of the public reporting of quality of care?

    Int J Qual Health Care

    (2004)
  • M. Hochhauser

    Lousy report card? Most consumers don’t pay attention

    Manag Care Q

    (2003)
  • H.H. Schauffler et al.

    Consumer reports in health care: do they make a difference?

    Annu Rev Publ Health

    (2001)
  • E. Schneider et al.

    Use of public performance reports – a survey of patients undergoing cardiac surgery

    J Am Med Assoc

    (1998)
  • M. Faber et al.

    Public reporting in health care: how do consumers use quality-of-care information? A systematic review

    Med Care

    (2009)
  • Cited by (14)

    • The communication of uncertainty in health: A scoping review

      2021, Patient Education and Counseling
      Citation Excerpt :

      We also excluded studies that did not pertain to humans and those that asked participants to recall or reflect on previous messages of uncertainty due to the potential for recall bias [21]. Lastly, articles were excluded that did not test a specific message or examine a conversation, or measured only participant preference since few studies support an association between participant preference and comprehension [22]. The first and second authors screened the articles for inclusion in multiple steps and calculated intercoder reliability using Krippendorff’s alpha at each step.

    • Do German public reporting websites provide information that office-based physicians consider before referring patients to hospital? A four-step analysis

      2018, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen
      Citation Excerpt :

      However, based on the finding that the importance of criteria varies across physician specialties and medical procedures, the formats and content of quality information should correspond at least to these requirements (physicians’ specialty and medical procedure). This has also been postulated in the literature and by the European Observatory on Health Systems and Policies [5,29,35]. The last step of our investigation comprised the examination of the availability of the high-, medium-, and low-priority criteria.

    • What factors determine the intention to use hospital report cards? The perspectives of users and non-users

      2017, Patient Education and Counseling
      Citation Excerpt :

      Again, this is in line with the results of related research studies, which apply the UTAUT model in other healthcare settings [26,27,44,46,48]. This finding indicates that the ease of using HRC does not seem to be a concern among patients, which is somewhat surprising given the results from experimental research suggesting that individuals tend to struggle with processing comparative quality information on report cards [15,16,32,51,53–58]. Two potential explanations for this finding are: First, patients may be used to working with rating websites from other areas, such as for travel (e.g., TripAdvisor, HRS), shopping (e.g., Amazon), or restaurants (e.g., Zagat).

    • Do German hospital report cards have the potential to improve the quality of care?

      2014, Health Policy
      Citation Excerpt :

      Geraedts et al. tested the comprehension of 300 non-hospital based physicians using eight presentation formats. Here, the comprehension ranged from 55% to 94% indicating a higher comprehension; however, a group having higher health literacy skills was surveyed [46]. However, there are also some studies available showing similar results to ours.

    • Public reporting on health and social care services

      2021, Research Anthology on Public Health Services, Policies, and Education
    View all citing articles on Scopus
    View full text