Few patients view hospital quality and cost data, and fewer still act upon it, but many still end up at higher quality hospitals. "There is something else going on, and it would be fascinating to see what it is," says one researcher.
Patients gravitate toward highly rated hospitals even though few report using public quality and cost data to get there.
Instead, researchers say, doctors, insurers, and word of mouth are more likely drivers of patient choice than quality scores generated by sources such as Medicare's Hospital Compare or U.S. News & World Report rankings.
A study in the March issue of Health Economics found that heart attack patients are more likely to choose hospitals with high scores on publicly reported performance measures. Those findings come as the Kaiser Family Foundation's (KFF) latest Health Tracking Poll found that only 13% of consumers view information on hospitals quality and 6% view information on costs. Even fewer report using the information.
The Health Economics study was designed to look at the impact of lean management practices and publically reported performance scores on admissions for acute myocardial infarction (AMI) patients. Researchers developed a survey to measure the implementation of 18 management practices. These included
- Standardization of the admissions process
- Evaluation of senior managers and
- Use of evidence in the adoption of new technologies
Researchers also looked for a relationship between choice of hospital, represented by admissions, and measures such as patient satisfaction, mortality, and readmissions. High scores on both counts were linked to higher admissions, but the correlation was stronger for the publically reported quality measures.
"Despite the KFF survey, the research found that better scores were associated with more admissions, after controlling for a large number of factors," lead author John McConnell wrote in an email exchange.
He noted, however, that "the jury is still out" on whether or not the publicly reported data influences patient choice.
"In terms of attracting patients, we think there are two venues," wrote McConnell, a health economist at Oregon Health & Science University in Portland. "One is reputational effects, unrelated to publicly reported data. The other is through improvements in the publicly reported metrics."
McConnell and his team looked at 126,566 admissions to cardiac care units. They qualify their findings by noting that half of all heart attack patients arrive at the hospital via ambulance and may "have little time to weigh the benefits of one hospital over another." So, they suggest that management practices and public data may "have an even stronger association with patient choice in service lines that provide a greater share of non-urgent or elective care."
The researchers note that the results of previous studies looking at the link between publicly reported quality measures and patient choice is "mixed." The Kaiser Family Foundation study found that only a fraction of patients report using the information. More than 30% of those surveyed reported seeing information comparing doctors, hospitals, and health insurance plans in the past year.
"However, when asked more specifically if they have seen information comparing prices or quality across plans and providers, fewer than one-in-five say they have seen these types of information," the survey says. Only 4% said they had acted on information about hospital quality, and 2% said they had acted on information about price.
Bianca DiJulio, KFF's associate director for survey research, said she wasn't surprised by the findings.
'Patient Activation'
"We keep coming back to the idea that a lot of factors play into these decisions," she says. "People are still likely using the reputation of the hospital in the community or the recommendations of family and friends."
In addition, some hospital choices are driven by the affiliation with a doctors or an insurance company, she says.
Jessica Greene is the associate dean for research and a professor at the George Washington University School of Nursing in Washington. DC. She studies patient "activation," which she defines as "having the motivation, knowledge, skills, and confidence to manage one's own health." Greene's March paper in Health Affairs found that higher patient activation was associated with better health outcomes and lower costs.
She says the McConnell study and the Kaiser findings raise "an incredibly interesting question: How are patients with heart attacks seeking out or getting higher quality or better managed healthcare?"
Greene says the data is clear that few patients are using quality and cost information to make decisions. If researchers can establish what factors go into patients' decisions about care, that information will help those working to improve the utility of publically reported quality and costs data.
"It may be working through word of mouth or through healthcare systems where people are being steered toward the higher quality providers," Greene says. "There is something else going on, and it would be fascinating to see what it is."