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Journal of General Internal Medicine

, Volume 34, Issue 2, pp 243–249 | Cite as

Improving Patients’ Choice of Clinician by Including Roll-up Measures in Public Healthcare Quality Reports: an Online Experiment

  • Jennifer L. CerullyEmail author
  • Andrew M. Parker
  • Lise Rybowski
  • Mark Schlesinger
  • Dale Shaller
  • Rachel Grob
  • Melissa L. Finucane
  • Steven C. Martino
Original Research

Abstract

Background

Public reports on healthcare quality typically include complex data. To lower the cognitive burden of interpreting these data, some report designers create summary, or roll-up, measures combining multiple indicators of quality into one score. Little is known about how the availability of roll-ups affects clinician choice.

Objective

To determine how presenting quality scores at different levels of aggregation affects patients’ clinician choices.

Design

We conducted a simulated clinician-choice experiment, randomizing participants to three versions of a public reporting website and comparing their clinician choices. One version aggregated all clinician-level quality measures into roll-ups, the second provided disaggregated (drill-down) scores only, and the third offered both roll-ups and drill-downs.

Participants

Five hundred fifty panelists drawn from a probability-based Internet panel.

Main Measures

We assessed the amount of effort participants exerted by tracking the length of time spent on the website and the number of concrete actions taken on the website (e.g., clicking items). We evaluated decision quality by measuring whether participants selected a clinician who performed more poorly than others and incongruence between participants’ stated preferences for dimensions of quality and their chosen clinician’s performance on those dimensions.

Key Results

Participants seeing drill-downs alone (mean = 14.9) or with roll-ups (mean = 19.2) took more actions than those who saw roll-ups alone (mean = 10.5) (ps < 0.05). However, participants seeing only drill-downs made poorer choices than those who saw roll-ups alone or with drill-downs. More participants seeing drill-downs chose a clinician who was outperformed (36.3% versus 23.4% [roll-up] and 25.6% [drill-down + roll-up], ps < 0.05) and made choices incongruent with stated preferences (51.2% versus 45.6% [roll-up] and 47.5% [drill-down + roll-up], ps < 0.05). The distinction between roll-up and drill-down was somewhat stronger for sicker participants.

Conclusions

Our results suggest that roll-ups in healthcare quality reports, alone or as a complement to drill-downs, can help patients make better decisions for themselves.

KEY WORDS

healthcare quality patient experience patient satisfaction composite measure summary score 

Notes

Funding

This paper was supported by two cooperative agreements (2U18HS016980 and 1U18HS016978) from AHRQ to RAND Corporation and Yale University, respectively.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Prior Presentations

This research has not been presented previously.

Supplementary material

11606_2018_4725_MOESM1_ESM.docx (567 kb)
ESM 1 (DOCX 567 kb)

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Jennifer L. Cerully
    • 1
    Email author
  • Andrew M. Parker
    • 1
  • Lise Rybowski
    • 2
  • Mark Schlesinger
    • 3
  • Dale Shaller
    • 4
  • Rachel Grob
    • 5
  • Melissa L. Finucane
    • 1
  • Steven C. Martino
    • 1
  1. 1.RAND CorporationPittsburghUSA
  2. 2.Severyn GroupAshburnUSA
  3. 3.Yale UniversityNew HavenUSA
  4. 4.Shaller Consulting GroupChesterfieldUSA
  5. 5.University of Wisconsin–MadisonMadisonUSA

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