"Which Sacramento area hospitals have the lowest C-section rates?" At one, it's 1 in 5. At another, it's 1 in 12. "Which is which?"
That was one of many advertisements in a recent campaign launched by the nonprofit California Healthcare Foundation in an effort to test ways of getting more consumers to ask critical quality questions about their hospital providers. In that way, providers themselves will know they are being compared and will be even more incentivized to improve their image in the public eye.
The organization is trying to draw more traffic to the foundation site, www.CalHospitalCompare.org, which rates care of 241 hospitals in the state (86% of the state's admissions) in seven categories. The hospitals voluntarily participate in the project.
That ad, and many others, was deemed a success, says Marybeth Shannon, director of the market and policy monitor program for CHF.
The campaign achieved an 11-fold increase in traffic after online and targeted e-mails were placed in the Bay Area between June and December of 2008. A similar campaign in Sacramento and San Diego between March and August of 2009 had similar success.
The campaign was launched because of a concern that patients don't know what questions to ask about quality and don't know these comparison tools are available, Shannon said. "This is the first attempt to spread what we've learned."
Nationally, "more than 200 examples of health quality rating programs are listed in the Health Care Report Card Compendium, assembled by the Association for Healthcare Research and Quality," according to "From Here to Maternity: Birth of an Online Marketing Campaign," a policy brief by Jane Sarasohn-Kahn of THINK-Health, who wrote about the online marketing campaign for the foundation.
However, "research shows that few consumers make use of them. In 2007, only 23% of Californians said they were aware of rating information on hospitals," Sarasohn-Kahn said.
Worse, only 1% actually used such information and changed their hospital choice as a result.
The foundation conducted the experiment to see if consumers could be re-educated to not just select a hospital on the basis of hearsay. The campaign targeted maternity care, one of the seven categories of care on CalHospitalCompare.org, because "it is among the most ‘shoppable' of health conditions" in an effort to get parents-to-be to know what questions to ask, Sarasohn-Kahn wrote.
"Women often have several choices of providers, as well as the time and motivation to do research beforehand. As maternity is not often a high-risk condition, personal preferences frequently play into decisions," she said.
On www.CalHospitalCompare.org, consumers can compare five hospitals simultaneously, and see how well they do in nine maternity measurements, such as the intensive care unit mortality rate, quality of respirator complication prevention efforts, and whether the hospital frequently performs vaginal birth after the mother has already had a Cesarean. Maternity patient experience is also ranked.
The site lists hospitals as superior, above average, average, below average or poor.
C-section information "can be useful for an expecting mother or couple," the site advises, adding, "If you want to do everything possible to have a vaginal delivery, you may prefer to use a hospital with a low C-section rate. You should discuss this concern with your obstetrician."
Another ad that turned out not to be as successful as the C-section one said, "Picking the color of your baby's room can be tough. But picking a hospital to give birth just got easier."
The campaign used newspaper Web sites, such as the San Francisco Chronicle's, the nonprofit voiceofsandiego.org, and branded e-mails, which turned out to be more expensive on a cost-per-click basis, than using Google or Yahoo search engines.
With Yahoo's Right Media, the campaign used blinded placement to achieve a cost-per-click-through rate of $1.14, versus $17.70 per click-through for other, more direct approaches.
Shannon says the results of the campaign testing were so promising, the foundation is about to launch a similar type of comparison effort for long-term care, and many other projects are in the planning stages.
Shannon says that the goal of www.CalHospitalCompare.org is not to direct patients to any one hospital, but only to give them some tips about aspects of care that are better or worse.
Launched in 2007, CalHospitalCompare.org is funded by about $2 million a year, 20% of which comes from participating hospitals and 80% from health plans. In addition to maternity care, the Web site also ranks care for heart attack, heart bypass surgery, heart failure, pneumonia, as well as other conditions and surgeries.