Choosing a Hospital for Surgery: The Importance of Information on Quality of Care

Dijs-Elsinga, J.; Otten, W.; Versluijs, Martine M.; Smeets, H.J.; Kievit, J.; Vree, R.; Made, Wendeline J. van der; Mheen, Perla J Marang-van de

doi:10.1177/0272989x09357474

Cited by 109 publications

(147 citation statements)

References 12 publications

(14 reference statements)

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“…Where aggregated scores result in one estimate of hospital performance, our approach generates five, potentially divergent, answers. In a recent study, Dijs-Elsinga et al 65 have shown that a large group of patients favour simple data presentation and prefer one overall measure of hospital quality; however, many patients intend to use more detailed quality information when making decisions about where to seek care in the future. 65 The question then arises of how much information should be provided for the different objectives for which performance information can be used (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study, Dijs-Elsinga et al 65 have shown that a large group of patients favour simple data presentation and prefer one overall measure of hospital quality; however, many patients intend to use more detailed quality information when making decisions about where to seek care in the future. 65 The question then arises of how much information should be provided for the different objectives for which performance information can be used (i.e. patient choice, accountability, identification of best practice) and who decides the relative weighting of each component and objective.…”

Section: Discussionmentioning

confidence: 99%

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Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data

Street

Gutacker

Bojke

et al. 2014

Health Services and Delivery Research

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BackgroundIt is important that NHS resources are used to their full extent, but efforts to reduce costs may have an adverse effect on patient outcomes. Our research is designed to provide a better understanding of the inter-relationship between costs and health outcomes among NHS providers (hospitals) for common surgical procedures.ObjectivesIn England, patient-reported outcomes measures (PROMs) are collected from patients undergoing one of four elective procedures: unilateral hip replacement, unilateral knee replacement, groin hernia repair and varicose vein surgery. We identify variation in patient-reported outcomes (PROs) across hospitals, assess the relationship between the cost and outcomes among NHS hospitals for these procedures, and determine the extent to which variations in outcomes and costs are due to differences in hospital performance.Data sourcesWe link Hospital Episode Statistics (HES) data with reference cost data and PROM data for patients having the four treatments between April 2009 and March 2010.MethodsThe first part of the empirical analysis focuses on variation in different dimensions of self-reported health status. We argue that each of the EuroQol-5D questionnaire (EQ-5D; European Quality of Life-5 Dimensions) dimensions should be assessed separately. Our graphical summary of the differential impact that hospitals have on PROs indicates the probability of reporting a given health outcome and shows how these probabilities vary across EQ–5D dimensions and hospitals. The second part of the empirical analysis focuses on the performance of hospitals and the inter-relationship between PROs and resource use.ResultsWe find that poorer post-treatment health status is associated with lower initial health status, higher weighted Charlson score, more diagnoses and lower socioeconomic status. We find significantly unexplained variation among hospitals in outcomes for patients undergoing hip replacement, knee replacement or varicose vein surgery, but not for hernia patients. For all four treatments we find significant unexplained variation in resource use among hospitals, whether measured by cost of treatment or length of stay. This suggests that hospitals can improve their utilisation of resources.LimitationsOur analyses are based on the HES. If data are missing from the medical record, or extracted and coded inaccurately, HES will contain errors. Hospitals should minimise these errors. Our study suffers from a large number of missing data, mainly because some hospitals were better than others at administering the baseline survey.ConclusionsThere is no general evidence that hospitals with lower resource use have worse health outcomes. There is a significant positive correlation for varicose veins, but this is sensitive to the choice of resource use and PRO measures. For hip and knee replacement the correlation is either insignificant or negative (depending on the resource use and PRO measures), implying that promoting health outcomes and controlling costs are not contradictory objectives. Indeed, we are able to identify hospitals with better than expected outcomes where resource use is below average. Future research should address how to handle missing data, evaluate hospital performance within the broader health economy, communicate PROMs to prospective patients, evaluate the impact of PROMs on patient choice and provider behaviour and evaluate PROMs for people with chronic conditions.FundingThe National Institute for Health Research Health Service and Delivery Research programme.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data

Street

Gutacker

Bojke

et al. 2014

Health Services and Delivery Research

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“…A study of the use of decision aids indicates that further work is needed to support decision-making processes. 15 Our study of the choice of hospitals for surgical treatment 16 indicates that most patients prefer a summary measure about care quality to more detailed measures, but they seem to value a hospital's good reputation even more.…”

Section: Studymentioning

confidence: 94%

E-health Applications and Services for Patient Empowerment: Directions for Best Practices in The Netherlands

Alpay¹,

Henkemans²,

Otten³

et al. 2010

Telemedicine and e-Health

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Objective: E-health may enable the empowerment process for patients, particularly the chronically ill. However, e-health is not always designed with the requirements of patient empowerment in mind. Drawing on evidence-based e-health studies, we propose directions for best practices to develop e-health that promotes patient empowerment. Methods: The concept of patient empowerment in the Dutch setting is discussed first. The prerequisites for patient empowerment are then described and translated into empowerment areas relevant to e-health. Materials: We reviewed Dutch e-health studies that provide insights into what works, and what does not, in e-health. Results: On the basis of the lessons learned from the studies, we propose directions for best practices to develop e-health that promotes patient empowerment. These directions cover various aspects, such as the design and implementation of e-health, its information content and usability, awareness, and acceptance. The studies also indicate the difficulty of establishing that e-health is really dedicated to patient empowerment. Conclusions: Despite the body of knowledge about patient empowerment, as well as the technological visibility of e-health, evidence for best practices in general and for patient empowerment in particular is scarce. We call for a more systematic evaluation of e-health for patient empowerment and more reliable evidence. Beyond the organizational and technical issues involved in e-health, there is also a need to demonstrate its practical benefits to patients. The Netherlands is active in developing sustainable e-health. National initiatives are now in place to support the processes with the aim of establishing the required evidence-based best practices.

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“…79 However, several studies found that patients formed opinions about these factors not through consulting hospital performance data but through their own experiences, the experiences of friends and family, word of mouth and, to a lesser extent, the media. 79,210,211 While GPs were a source of advice about the choice of hospital, they were much less cited as a source of information of hospital performance. 79 In line with this finding, GPs themselves tended to provide advice to patients based on their own relationships with and experience of a provider, rather than on the basis of performance information.…”

Section: Theorymentioning

confidence: 99%

“…Respondents to the survey, reported by Dijs-Elsinga et al, 211 who had recently undergone one of six surgical procedures, were asked if they were willing to be contacted again to take part in a further study; 665 out of 1329 patients agreed to be contacted, and 559 of these responded to an invitation to participate in the study. Of these, 369 agreed to take part in the study and were sent a questionnaire, and 308 returned a questionnaire.…”

mentioning

confidence: 99%

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

170

263

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BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Choosing a Hospital for Surgery: The Importance of Information on Quality of Care

Cited by 109 publications

References 12 publications

Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data

Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data

E-health Applications and Services for Patient Empowerment: Directions for Best Practices in The Netherlands

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

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