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

Abstract

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...

Public release of hospital quality data for referral practices in Germany: results from a cluster-randomised controlled trial

“…Previous evidence has demonstrated that less complex information displays should be favored to increase the comprehensibility and usage of performance report cards among patients and other consumers [ 17 , 23 ]. We initially hypothesized that this might not be true for referring physicians who are more likely to be interested in detailed hospital quality information.…”

“…Currently, the assurance system comprises 400 quality indicators within 30 different clinical areas [ 24 ]. Besides other objectives, these data can be used for public reporting purposes [ 19 , 23 , 25 ]; [For the special purpose of the NHQRS, all available publicly reported quality indicators with a defined reference range were used.] (2) Insurance claims data (Allgemeine Ortskrankenkasse): these data allow for an assessment of hospital quality based on routine data which enable a long-term perspective after hospital discharge (e.g., up to 365 days in prostate cancer treatment) [ 26 ].…”

“…Based on this, we investigate whether an increased level of awareness will also result in a greater willingness to use the NHQRS for referring patients to hospitals. Finally, studies have shown that less complex information displays should be employed to increase the comprehensibility and usage of report cards [ 17 , 23 ]. So far, most research has focused on patients as the target group of report cards.…”

The effect of public reporting presentation on patients’ decision making

“…[ 14 – 16 ] The most frequently discussed barrier is that consumers do not understand the formats in which the information is presented. [ 17 ] The 2011 National Summit on public reporting, sponsored by the Agency for Health care Research and Quality (AHRQ), concluded that changes in the presentation of future PRCPI is vital and urgent, and the optimal content, structure, and communication vehicle of PRCPI for successful patients’ engagement is still veiled. [ 18 ] To bridge the gap between PRCPI presentation and consumers’ usage, there is increasing research focusing on design of PRCPI that optimize consumers’ use of performance information these years [ 12 ] and the essential requirement for effective PRCPI is to present the information less complicatedly.…”

Increasing Consumer Engagement by Tailoring a Public Reporting Website on the Quality of Diabetes Care: A Qualitative Study

“…Yet, studies suggest that consumers do not seek out this information, understand it, trust it, or know how to use it [7,8]. Promising strategies to increase consumer engagement in public reports are to improve the design [9,10], include patient narrative [11-14], and to tailor metrics to reflect the concerns and preferences of individual consumers [15]. It has been shown that the absence of tailoring in public reports makes them unlikely to succeed [16,17] and that consumers are deterred by the content and design of current reports that lack tailoring to their individual needs [18].…”