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

Geraedts, Max; Hermeling, Peter; Cruppé, Werner de

doi:10.1016/j.pec.2011.11.005

Cited by 15 publications

(10 citation statements)

References 29 publications

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“…Similar to Damman et al [ 32 ], we found that bar charts were used quite often and, like Gerteis et al [ 29 ], we found that graphical formats (standard bar chart without symbols) were not liked by respondents. However, we did not confirm the findings of Geraedts et al, who presented the formats of presentations to physicians, that bar charts without symbols did not assist the comprehension of data on hospital quality [ 30 ] or were the format least well understood by participants [ 29 ]. In our sample, more respondents who used a bar chart without symbols (64.47%) chose the hospital with the lowest mortality rate than respondents who did not (60.33%).…”

Section: Discussioncontrasting

confidence: 98%

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Information Presentation Features and Comprehensibility of Hospital Report Cards: Design Analysis and Online Survey Among Users

Sander¹,

Emmert²,

Dickel³

et al. 2015

J Med Internet Res

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BackgroundImproving the transparency of information about the quality of health care providers is one way to improve health care quality. It is assumed that Internet information steers patients toward better-performing health care providers and will motivate providers to improve quality. However, the effect of public reporting on hospital quality is still small. One of the reasons is that users find it difficult to understand the formats in which information is presented.ObjectiveWe analyzed the presentation of risk-adjusted mortality rate (RAMR) for coronary angiography in the 10 most commonly used German public report cards to analyze the impact of information presentation features on their comprehensibility. We wanted to determine which information presentation features were utilized, were preferred by users, led to better comprehension, and had similar effects to those reported in evidence-based recommendations described in the literature.MethodsThe study consisted of 5 steps: (1) identification of best-practice evidence about the presentation of information on hospital report cards; (2) selection of a single risk-adjusted quality indicator; (3) selection of a sample of designs adopted by German public report cards; (4) identification of the information presentation elements used in public reporting initiatives in Germany; and (5) an online panel completed an online questionnaire that was conducted to determine if respondents were able to identify the hospital with the lowest RAMR and if respondents’ hospital choices were associated with particular information design elements.ResultsEvidence-based recommendations were made relating to the following information presentation features relevant to report cards: evaluative table with symbols, tables without symbols, bar charts, bar charts without symbols, bar charts with symbols, symbols, evaluative word labels, highlighting, order of providers, high values to indicate good performance, explicit statements of whether high or low values indicate good performance, and incomplete data (“N/A” as a value). When investigating the RAMR in a sample of 10 hospitals’ report cards, 7 of these information presentation features were identified. Of these, 5 information presentation features improved comprehensibility in a manner reported previously in literature.ConclusionsTo our knowledge, this is the first study to systematically analyze the most commonly used public reporting card designs used in Germany. Best-practice evidence identified in international literature was in agreement with 5 findings about German report card designs: (1) avoid tables without symbols, (2) include bar charts with symbols, (3) state explicitly whether high or low values indicate good performance or provide a “good quality” range, (4) avoid incomplete data (N/A given as a value), and (5) rank hospitals by performance. However, these findings are preliminary and should be subject of further evaluation. The implementation of 4 of these recommendations should not present insurmountable obstacles. How...

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Section: Discussioncontrasting

confidence: 98%

“…Similar to Geraedts et al [ 30 ], we observed that the hospital with the lowest mortality was chosen more often when tables with symbols were used than when tables without symbols were used. In our survey, tables with symbols were rated better for comprehension (mean 3.58, SD 1.84) than bar charts without symbols (mean 2.99, SD 1.84).…”

Section: Discussionsupporting

confidence: 68%

Information Presentation Features and Comprehensibility of Hospital Report Cards: Design Analysis and Online Survey Among Users

Sander¹,

Emmert²,

Dickel³

et al. 2015

J Med Internet Res

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“…Additionally, the results of the physician ratings for all mandatory and optional questions were included. The mandatory physician rating system on jameda consists of 5 questions, rated according to the grading system in German schools on a 1-6 scale (1=very good; 2=good; 3=satisfactory; 4 =fair; 5=deficient; and 6=insufficient) [35]. These relate to (Q1) satisfaction with the treatment offered by the physician, (Q2) education about the illness and treatment, (Q3) the relationship of trust with the physician, (Q4) the time the physician spent on the patient´s concerns, and (Q5) the friendliness of the physician.…”

Section: Methodsmentioning

confidence: 99%

An Analysis of Online Evaluations on a Physician Rating Website: Evidence From a German Public Reporting Instrument

Emmert¹,

Meier²

2013

J Med Internet Res

111

108

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BackgroundPhysician rating websites (PRW) have been gaining in popularity among patients who are seeking a physician. However, little evidence is available on the number, distribution, or trend of evaluations on PRWs. Furthermore, there is no published evidence available that analyzes the characteristics of the patients who provide ratings on PRWs.ObjectiveThe objective of the study was to analyze all physician evaluations that were posted on the German PRW, jameda, in 2012.MethodsData from the German PRW, jameda, from 2012 were analyzed and contained 127,192 ratings of 53,585 physicians from 107,148 patients. Information included medical specialty and gender of the physician, age, gender, and health insurance status of the patient, as well as the results of the physician ratings. Statistical analysis was carried out using the median test and Kendall Tau-b test.ResultsThirty-seven percent of all German physicians were rated on jameda in 2012. Nearly half of those physicians were rated once, and less than 2% were rated more than ten times (mean number of ratings 2.37, SD 3.17). About one third of all rated physicians were female. Rating patients were mostly female (60%), between 30-50 years (51%) and covered by Statutory Health Insurance (83%). A mean of 1.19 evaluations per patient could be calculated (SD 0.778). Most of the rated medical specialties were orthopedists, dermatologists, and gynecologists. Two thirds of all ratings could be assigned to the best category, “very good”. Female physicians had significantly better ratings than did their male colleagues (P<.001). Additionally, significant rating differences existed between medical specialties (P<.001). It could further be shown that older patients gave better ratings than did their younger counterparts (P<.001). The same was true for patients covered by private health insurance; they gave more favorable evaluations than did patients covered by statutory health insurance (P<.001). No significant rating differences could be detected between female and male patients (P=.505). The likelihood of a good rating was shown to increase with a rising number of both physician and patient ratings.ConclusionsOur findings are mostly in line with those published for PRWs from the United States. It could be shown that most of the ratings were positive, and differences existed regarding sociodemographic characteristics of both physicians and patients. An increase in the usage of PRWs might contribute to reducing the lack of publicly available information on physician quality. However, it remains unclear whether PRWs have the potential to reflect the quality of care offered by individual health care providers. Further research should assess in more detail the motivation of patients who rate their physicians online.

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“…Using a feedback loop of relevant data is an essential aspect of any QM strategy [20], but little is known about how the feedback loop should best be operationalized [21,22], particularly in low-income settings. One problem is that high-quality, timely data are frequently not available at the local level.…”

Section: Introductionmentioning

confidence: 99%

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda

et al. 2014

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BackgroundMaternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda.MethodsIn Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys.DiscussionEQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings.Trial registrationPACTR201311000681314

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

Cited by 15 publications

References 29 publications

Information Presentation Features and Comprehensibility of Hospital Report Cards: Design Analysis and Online Survey Among Users

Information Presentation Features and Comprehensibility of Hospital Report Cards: Design Analysis and Online Survey Among Users

An Analysis of Online Evaluations on a Physician Rating Website: Evidence From a German Public Reporting Instrument

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda

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