Patients' & Consumers' Use Of Evidence: Health Affairs' April Issue
Bethesda, MD -- The April issue of Health Affairs examines patients' and consumers' use of evidence to inform health care decisions. The issue includes studies about the role of evidence in health care decisions, the barriers associated with collecting and using data, and opportunities to engage with patients as consumers.
A DataGraphic (excerpted below) offers a pictorial view of the use of evidence in making health care decisions.
Content on patient use of evidence in the April issue of Health Affairs was supported by the Patient-Centered Outcomes Research Institute (PCORI). The issue contains articles about the potential transformative impact of engaging patients and other stakeholders in health research. One, by Steven Woolf, of Virginia Commonwealth University, and coauthors, lays out a road map, with examples, for how to better connect patients with researchers. "Authentic engagement encompasses ... involving stakeholders as full partners in all phases of research," writes Woolf. "Such engagement, although challenging, can enhance the quality and impact of studies on many levels, from ensuring that data are relevant to users' needs to elevating the moral plane of research by showing respect to patients and vulnerable populations."
Whether consumers choose high-quality health plans may depend on how data are presented.
An online experimental survey conducted by Jessica Greene, of George Washington University, and coauthors tested various methods of presenting cost and quality data to determine what displays effectively encourage consumers to take quality, as well as cost, into account when selecting a health plan. The researchers found that consumers were much more likely to select a high-value plan when: 1) cost information was summarized instead of detailed, 2) quality stars were displayed adjacent to cost information, 3) consumers understood that stars signified the quality of medical care, and 4) when high-value plans were highlighted with a check mark or blue ribbon. The researchers report that these findings are particularly timely given that starting in 2017, all state and federal health insurance exchanges will be required to present quality data on all health plans, in addition to the cost information currently provided.
A related study on how consumers make health plan choices:
Majority of Americans do not see a link between health care cost and quality.
Amid efforts to boost price transparency in health care, some experts have expressed concern that consumers may avoid low-cost care if they perceive cost to be associated with quality. However, most Americans do not think health care cost and quality are associated, according to a nationally representative survey of over 2,000 adults conducted by Public Agenda with funding from the Robert Wood Johnson Foundation. An analysis of the data conducted by Kathryn A. Phillips, of the University of California, San Francisco, and coauthors found that a majority of Americans (58-71 percent, depending on how the survey questions were framed) do not think health care cost and quality are associated (depicted below). Less than one-quarter (21-24 percent) perceive an association, while 8-16 percent are unsure. The researchers found that Americans are more likely to say there is no association between high price and high quality, but are more likely to be unsure whether there is an association between low price and low quality.
What can Yelp teach us about measuring hospital quality?
Patients and caregivers have posted thousands of reviews of hospitals on online platforms, such as Yelp, that allow consumers to rate businesses. Benjamin L. Ranard, of the University of Pennsylvania, and coauthors characterized the content of approximately 17,000 Yelp reviews of 1,352 US hospitals and compared the major themes to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the federal government's survey of inpatient hospital experience. According to the authors, "reviews on social media sites" such as Yelp "are organic, largely unstructured, and essentially uncurated;" however, patients and caregivers likely write about aspects of care most important to them. The investigators' analysis shows that while Yelp reviews correlate with overall hospital ratings, HCAHPS may be missing major drivers of patients' experience of hospitalized care. These important drivers of patient experience include how caring and comforting the physicians, nurses, and staff are, as well as experiences with hospital billing. The researchers conclude that Yelp reviews could be used to both supplement and guide government reporting and contribute to the understanding and assessment of hospital quality by patients, providers, and policy makers.
A related study on how consumers rate health care quality:
Connecticut health plan increased targeted services use and Rx adherence, reducing ER visits.
Faced with rising health care expenditures and looming budget shortfalls, Connecticut created a new health plan option for its employees using the principles of a value-based insurance design (VBID). This approach, while voluntary, requires employees to participate to avoid a premium surcharge. It encourages consumers to use high-value, evidence-based medical services by aligning their out-of-pocket costs with the determined clinical value of the service. To assess whether this plan could be a successful, replicable model, Richard Hirth, of the University of Michigan, and coauthors examined claims data to see whether the program was having the intended effects. Their analysis showed that during the first two years of the program, medication adherence improved, use of targeted service increased, and the number of emergency room visits decreased, relative to the comparison group. The authors conclude that, while initially promising, more study is needed to determine whether the plan is controlling costs.