Key PointsQuestionHow often are cost considerations documented in narrative clinical notes, and do those considerations influence treatment decisions?FindingsIn an in silico cohort study of narrative clinical notes from 46 146 index admissions to the intensive care unit at a large academic medical center, 4% had at least 1 note reflecting financial considerations during the intensive care unit stay.MeaningEven in the intensive care unit setting, financial considerations are addressed and may be associated with adjustments to treatment decisions.
Key Points Question How often are cost considerations documented in narrative clinical notes in a primary care setting? Findings In this cohort study of a data set including 222 457 outpatient primary care notes for 46 244 patients at a large academic medical center, 13.1% of patients had at least 1 note indicating a financial conversation with their physician. Specific socioeconomic features were associated with the presence of documented cost considerations. Meaning Although the literature suggests that patients desire to discuss health costs with their physicians, these conversations remain infrequent.
Background Although some health care market reforms seek to better engage consumers in purchasing health care services, health consumer behavior remains poorly understood. Objective This study aimed to characterize the behaviors and sentiment of consumers who attempt to shop for health care services. Methods We used a semistructured interview guide based on grounded theory and standard qualitative research methods to examine components of a typical shopping process in a sample size of 54 insured adults. All interviews were systematically coded to capture consumer behaviors, barriers to shopping behavior, and sentiments associated with these experiences. Results Participants most commonly described determining and evaluating options, seeking value, and assessing or evaluating value. In total, 83% (45/54) of participants described engaging in negotiations regarding health care purchasing. The degree of positive sentiment expressed in the interview was positively correlated with identifying and determining the health plan, provider, or treatment options; making the decision to purchase; and evaluating the decision to purchase. Conversely, negative sentiment was correlated with seeking value and making the decision to buy. Conclusions Consumer shopping behaviors are prevalent in health care purchasing and can be mapped to established consumer behavior models.
BACKGROUND Although some health care market reforms seek to better engage consumers in purchasing health care services, health consumer behavior remains poorly understood. OBJECTIVE This study aimed to characterize the behaviors and sentiment of consumers who attempt to shop for health care services. METHODS We used a semistructured interview guide based on grounded theory and standard qualitative research methods to examine components of a typical shopping process in a sample size of 54 insured adults. All interviews were systematically coded to capture consumer behaviors, barriers to shopping behavior, and sentiments associated with these experiences. RESULTS Participants most commonly described determining and evaluating options, seeking value, and assessing or evaluating value. In total, 83% (45/54) of participants described engaging in negotiations regarding health care purchasing. The degree of positive sentiment expressed in the interview was positively correlated with identifying and determining the health plan, provider, or treatment options; making the decision to purchase; and evaluating the decision to purchase. Conversely, negative sentiment was correlated with seeking value and making the decision to buy. CONCLUSIONS Consumer shopping behaviors are prevalent in health care purchasing and can be mapped to established consumer behavior models.
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