How do pregnant women use quality measures when choosing their obstetric provider?

Abstract

BackgroundGiven increased public reporting of the wide variation in hospital obstetric quality, we sought to understand how women incorporate quality measures into their selection of an obstetric hospital.MethodsWe surveyed 6141 women through Ovia Pregnancy, an application used by women to track their pregnancy. We used t tests and chi‐square tests to compare response patterns by age, parity, and risk status.ResultsMost respondents (73.2%) emphasized their choice of obstetrician/midwife over their choice of hospital. Over half of respondents (55.1%) did not believe that their choice of hospital would affect their likelihood of having a cesarean delivery. While most respondents (74.9%) understood that quality of care varied across hospitals, few prioritized reported hospital quality metrics. Younger women and nulliparous women were more likely to be unfamiliar with quality metrics. When offered a choice, only 43.6% of respondents reported that they would be willing to travel 20 additional miles farther from their home to deliver at a hospital with a 20 percentage point lower cesarean delivery rate.DiscussionWomen's lack of interest in available quality metrics is driven by differences in how women and clinicians/researchers conceptualize obstetric quality. Quality metrics are reported at the hospital level, but women care more about their choice of obstetrician and the quality of their outpatient prenatal care. Additionally, many women do not believe that a hospital's quality score influences the care they will receive. Presentations of hospital quality data should more clearly convey how hospital‐level characteristics can affect women's experiences, including the fact that their chosen obstetrician/midwife may not deliver their baby.

Patterns of Use of a Price Transparency Tool for Childbirth Among Pregnant Individuals With Commercial Insurance

“…Studies of clinician selection among pregnant individuals have reported that most of these individuals select their clinician, obstetrician, or midwife and then deliver at whichever hospital or birthing center the clinician has admitting privileges. 24 …”

Neighborhoods, networks, and delivery methods

“…As reported by Declercq et al (2007), the informal channel constituted by friends and relatives is particularly relevant for first-birth mothers. Similarly, both Gourevitch et al (2017) and Gourevitch et al (2019) confirm the weak role played by standard hospital-based quality measures in affecting mothers' preferences. They do observe a strong self-reported interest of mothers in the health of their baby and the quality of the obstetric care they receive, but this is mainly informed through the opinions of peers or relatives.…”

Neighborhoods, Networks, and Delivery Methods

“…As reported by Declercq et al (2007), the informal channel constituted by friends and relatives is particularly relevant for first-birth mothers. Similarly, both Gourevitch et al (2017) and Gourevitch et al (2019) confirm the weak role played by standard hospital-based quality measures in affecting mothers' preferences. They do observe a strong self-reported interest of mothers in the health of their baby and the quality of the obstetric care they receive, but this is mainly informed through the opinions of peers or relatives.…”