Section 5. Consumers' Feedback
Users of Public Reports of Hospital Quality: Who, What, Why, and How?
Understanding why visitors come to the sites enables report sponsors to better meet the needs of visitors. We report on consumers in this section and on health care professionals in Section 6.
Most consumers arrive at the Web sites to look at hospital quality information. Figure 3 shows that most consumers (56%) arrived at the sites either to choose or compare hospitals or to see how a hospital they were using was performing. Some consumers came for purposes such as getting practical information about the hospital (7%) or to prepare for a talk with their doctor (6%).
Consumers are interested in performance measures about heart disease care and surgery. Figure 4 shows the medical conditions or procedures of interest for consumer visitors.
Consumers are interested in many types of quality information. Figure 5 shows that consumers were interested in patient experience (26%), complication and error rates (21%), and rates of correct care (21%). Consumers reported less interest in survival rates (11%) than complication and error rates. This is surprising, since the literature suggests that complications and errors can increase mortality, and death is a severe negative consequence of an error. It may be that consumers do not realize that hospital mistakes can have an impact on mortality rates.
Consumers want more information about how well hospitals treat their conditions and information about hospital doctors. As Figure 6 shows, the top areas in which consumers would like more information are how well hospitals treat their specific condition (21%) or perform their specific surgery (18%) and data on individual doctors working in the hospital (20%). Respondents also expressed interest in patient comments (15%) and how much one would pay for care (12%).
Consumers had many suggestions for how to improve the Web sites. As Figure 7 shows, consumers wanted the sites to provide additional ways of sorting information (23%) and to make it easier to find the best hospital (19%). Specific comments indicated a desire to compare hospitals side by side on one page (some Web sites only present information on one hospital at a time). Consumers also wanted to be able to select only one or two hospitals to review at a time (some Web sites present information on a preset group of hospitals, often all the hospitals in the report at once).
- A substantial proportion of consumers were looking for information that was not present, such as information about how well hospitals treat their conditions and information about their individual doctors or inclusion of patient comments. Including this missing information, to the extent it is consistent with the Web site's overall mission, may prove to be an important strategy for consumer engagement.
- It is not clear whether Web sites could increase traffic by providing information on cost of care.
- Several categories of greatest interest to consumers (surgery, cancer, obstetric and gynecologic care, and heart disease care) involve conditions or procedures about which consumers would have time to think about their decision and use hospital quality data to make a choice. Elective procedures or care may be good areas of focus for enhancing report content and usability.
- To address consumers' perceptions that survival rates are unimportant, it may be helpful to restate the concept of "survival" as "avoidable deaths" or in some other way clarify that hospital quality can affect a patient's risk of mortality.
- Some consumers find it difficult to use the Web sites to find the best hospitals. Web sites could adopt some specific actionable recommendations consumers made, including allowing side-by-side comparisons of hospitals rather than showing information one hospital at a time. They also could allow selection of individual hospitals to review rather than showing all hospitals or a predetermined selection. Section 7 discusses Web site characteristics that may support consumer use of quality information.