Complexity, Public Reporting, and Choice of Doctors

Schlesinger, Mark; Kanouse, David E.; Martino, Steven C.; Shaller, Dale; Rybowski, Lise

doi:10.1177/1077558713496321

Cited by 58 publications

(30 citation statements)

References 31 publications

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“…They presented PRWs featuring quality of care data in combination with written reviews. However, the combined format did not yield better physician selection results, especially if choices grew more complex with larger choice sets and more indicators and information present [55]. Hence, finding PRW formats in which health care consumers can voice their opinion on aspects that are deemed assessable, while condensing and summarizing technical quality of care information in a format that is understandable by health care consumers (as suggested by Hibbard et al [54]) should be the subject for further research.…”

Section: Discussionmentioning

confidence: 99%

“…This finding is alarming as lower educational levels have been associated with low health literacy [57], more difficulty in processing quality of care information, and less optimal health care choices [55,58,59]. These findings suggest that individuals who are most in need for tools that guide them toward a better search and assessment of Web-based information [60], attribute themselves higher expertise than they probably have from an objective point of view.…”

Section: Discussionmentioning

confidence: 99%

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Physician Rating Websites: What Aspects Are Important to Identify a Good Doctor, and Are Patients Capable of Assessing Them? A Mixed-Methods Approach Including Physicians’ and Health Care Consumers’ Perspectives

Rothenfluh

Schulz

2017

J Med Internet Res

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BackgroundPhysician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians’ professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers’ evaluation of physicians’ performance.ObjectiveTo identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects.MethodsIn a first step, a Delphi study with physicians from 4 specializations was conducted, testing various indicators to identify a good physician. These indicators were theoretically derived from Donabedian, who classifies quality in health care into pillars of structure, process, and outcome. In a second step, a cross-sectional survey with health care consumers in Switzerland (N=211) was launched based on the indicators developed in the Delphi study. Participants were asked to rate the importance of these indicators to identify a good physician and whether they would feel capable to evaluate those aspects after the first visit to a physician. All indicators were ordered into a 4×4 grid based on evaluation and importance, as judged by the physicians and health care consumers. Agreement between the physicians and health care consumers was calculated applying Holsti’s method.ResultsIn the majority of aspects, physicians and health care consumers agreed on what facets of care were important and not important to identify a good physician and whether patients were able to evaluate them, yielding a level of agreement of 74.3%. The two parties agreed that the infrastructure, staff, organization, and interpersonal skills are both important for a good physician and can be evaluated by health care consumers. Technical skills of a doctor and outcomes of care were also judged to be very important, but both parties agreed that they would not be evaluable by health care consumers.ConclusionsHealth care consumers in Switzerland show a high appraisal of the importance of physician-approved criteria for assessing health care performance and a moderate self-perception of how capable they are of assessing the quality and performance of a physician. This study supports that health care consumers are differentiating between aspects they perceive they would be able to evaluate after a visit to a physician (such as attributes of structure and the interpersonal skills of a doctor), and others that lay beyond their ability to make an accurate judgment about (such as technical skills of a physician and outcome of care).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Physician Rating Websites: What Aspects Are Important to Identify a Good Doctor, and Are Patients Capable of Assessing Them? A Mixed-Methods Approach Including Physicians’ and Health Care Consumers’ Perspectives

Rothenfluh

Schulz

2017

J Med Internet Res

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“…Prior studies suggest that maximizing the pertinence of publicly reported quality data for patients is likely to increase use of these data. 31,32 Narrative reviews are one mechanism for increasing both the pertinence and the ability to participate in assessing quality. Designing reporting systems that enable consumers to easily choose what data they view may increase utility and use of publicly reported quality data.…”

Section: Discussionmentioning

confidence: 99%

Factors That Matter to Low-Income and Racial/Ethnic Minority Mothers When Choosing a Pediatric Practice: a Mixed Methods Analysis

Goff

Mazor

Guhn-Knight

et al. 2017

J. Racial and Ethnic Health Disparities

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Background Pediatric practices’ scores on health care quality measures are increasingly available to the public. However, patients from low-income and racial/ethnic minority populations rarely use these data. We sought to understand potential barriers to using quality data by assessing what factors mattered to women when choosing a pediatric practice. Methods As part of a randomized trial to overcome barriers to using quality data, we recruited women from a prenatal clinic serving an underserved population. Women reported how much 12 factors mattered when they chose a pediatric practice (5-point Likert scale), what other factors mattered to them, and which factors mattered the most. We assessed whether factor importance varied with selected participant characteristics and qualitatively analyzed the “other” factors named. Results Participants’ (n=367) median age was 23 years and they were largely Hispanic (60.4%), White (21.2%), or Black (16.9%). Insurance acceptance “mattered a lot” to the highest percentage of women (93.2%), while online information about what other parents think of a practice “mattered a lot” to the fewest (7.4%). Major themes from our qualitative analysis of “other” factors that mattered included Physicians’ Interpersonal Skills and Pediatrician-Specific Traits. Factors related to Access “mattered the most” to the majority of women. Conclusions Pediatrician characteristics and factors related to access to care may be more important to low-income and racial/ethnic minority women than more commonly reported quality metrics. Aligning both the content and delivery of publicly reported quality data with women’s interests may increase use of pediatric quality data. Clinical Trial Registration Clinicaltrials.gov NCT01784575

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“…This requires additional research on how patient comments are appropriately "curated" to present experiences in ways that other consumers can most easily interpret (Greaves, Millett, and Nuki 2014). Reporting practices most also be designed to better assist consumers when they strive to integrate comments with quantitative metrics (Schlesinger et al 2014). For example, comments could be "tagged" with subject matter labels that match ratings from conventional surveys, tagged with a patient's health conditions so that users could learn from patients who match their treatment needs, or tagged with ratings that allow sorting based on negativepositive valence.…”

Section: Targeting Investments In Research Relevant To Patient-reportmentioning

confidence: 99%

Using Patient‐Reported Information to Improve Clinical Practice

Schlesinger

Grob

Shaller³

2015

Health Services Research

Self Cite

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ObjectiveTo assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient‐valued outcomes in health systems with strong financial incentives.Data Sources/Study SettingExisting literature (gray and peer‐reviewed) on measuring patient experience and patient‐reported outcomes, identified from Medline and Cochrane databases; evaluations of pay‐for‐performance programs in the United States, Europe, and the Commonwealth countries.Study Design/Data CollectionWe analyzed (1) studies of pay‐for‐performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient‐reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians.Principal FindingsFirst, we identify four forms of “patient‐reported information” (PRI), each with distinctive roles shaping clinical practice: (1) patient‐reported outcomes measuring self‐assessed physical and mental well‐being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay‐for‐performance systems appears to threaten certain patient‐valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient‐reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the public and private sectors in financing PRI and orchestrating an appropriate balance among its four forms.ConclusionsUnless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value. Certain policy parameters are already clear, but additional research is required to clarify how best to collect patient narratives in varied settings, how to report narratives to consumers in conjunction with quantified metrics, and how to promote a “culture of learning” at the practice level that incorporates patient feedback.

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Complexity, Public Reporting, and Choice of Doctors

Cited by 58 publications

References 31 publications

Physician Rating Websites: What Aspects Are Important to Identify a Good Doctor, and Are Patients Capable of Assessing Them? A Mixed-Methods Approach Including Physicians’ and Health Care Consumers’ Perspectives

Physician Rating Websites: What Aspects Are Important to Identify a Good Doctor, and Are Patients Capable of Assessing Them? A Mixed-Methods Approach Including Physicians’ and Health Care Consumers’ Perspectives

Factors That Matter to Low-Income and Racial/Ethnic Minority Mothers When Choosing a Pediatric Practice: a Mixed Methods Analysis

Using Patient‐Reported Information to Improve Clinical Practice

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