Strategies for reporting health plan performance information to consumers: evidence from controlled studies

OBJECTIVE: To assess whether presentation approaches designed to be more meaningful result in greater weighting of quality information in decisions. An emerging body of research indicates that the way information is presented affects how it is interpreted and how it is weighted in decisions. Comparative health plan performance reports are not being used by consumers possibly because the information presented is difficult to use. The next generation of these reports should be designed to support decision making. DESIGN AND STUDY PARTICIPANTS: The study uses a controlled experimental design. Participants (n = 162) were randomly assigned to different conditions and asked to complete tasks related to using quality information and making health plan selections. Dependent variables included the amount of weight given to quality information in choices and decision accuracy. RESULTS: Some presentation approaches make it easier for users to process and integrate quality data into their choices. However, other presentation formats influence consumers' decisions in ways that undermine their self-interest. CONCLUSIONS: Findings indicate that presenting quality data in a more evaluable format increases the weight it carries in consumer decisions. Every change made in the presentation of comparative data has the potential to influence decisions. Those who disseminate information have a responsibility to be aware of how they use that influence and to direct it in productive and defensible ways. The alternative is to manipulate people in ways that are unknown, are not thought out, or are not defensible, but are no less manipulative.     

The use of evidence by health care user organizations

Objectives To explore the use of research evidence by consumer and patient organizations and the extent to which their goals and activities are consistent with evidence-based health care and patient-centred care.
Design A mailed survey, telephone and face-to-face interviews of leaders of organizations representing health care users.
Setting Norway.
Participants Sixty-nine of 109 questionnaires that were mailed were included in our analysis and approximately 20 interviews were conducted with representatives of general consumer and patient advocacy groups and interest groups that focus on particular diseases or disabilities.
Measurements Information was collected on the goals of the organizations, the nature of their everyday work, the extent to which research information is required in this work and how research information is accessed and appraised.
Results An important focus of many user groups is peer support. They tend to emphasize experience-based knowledge. A total of 82% of the respondents said that they often or sometimes had use for research results in their work. Research-based information is most often obtained indirectly through physicians or researchers.
Conclusions Norwegian health care user organizations do not appear to promote evidence-based health care. To the extent that they help to disseminate scientific information, they appear to do so uncritically, relying on few sources and traditional authorities.     

Selection Criteria for Choosing Mental Health Service Providers: A Pilot Study

Although there is an established literature concerned with the manner in which consumers select providers of general health care, far less attention has been given to the nature of the process used by consumers to select providers of mental health services. The present study provides further insight into this process by identifying dimensions used by consumers to differentiate among potential providers. A sample of 153 undergraduate college students was asked to read a scenario describing a situation in which they had decided that they were in need of mental health services and then to complete a questionnaire pertaining to the importance of a therapist possessing various characteristics. The results indicated that whereas demographic characteristics of potential providers were not heavily weighted as selection criteria, credentials, specific expertise, as well as personal characteristics of the therapist were of considerable importance.     

Misconceptions about efficacy of mammography screening: a public health dilemma

OBJECTIVE: This study assessed accuracy of women's opinions about reduction in mortality from breast cancer attributable to mammography screening. DESIGN: Cross sectional survey. SETTING: General population of Geneva, Switzerland. PARTICIPANTS: 895 randomly selected women aged 40 to 80 years, free of breast cancer. RESULTS: Women estimated the proportion of deaths from breast cancer that regular mammography screening prevents in women over age 50. Only 19.3% of the respondents assessed screening efficacy realistically (that is, reduction by about one fourth); 52.0% overestimated efficacy; 26.0% "didn't know", and 2.6% stated that screening prevents no death. Women who believed mammography screening to be effective had more positive attitudes toward screening (higher scores of pros and lower scores of cons) and were more likely to plan to have a mammogram (both p<0.001). Lack of opinion about the benefit of mammography screening was more common among women who had not consulted a gynaecologist recently (p=0.02) nor had had a mammogram during the past two years (p=0.009), who had no opinion about their risk of breast cancer (p<0.001), and who were 70 to 80 years old (p=0.04). Compared with women who provided realistic estimates of screening efficacy, those who overestimated efficacy believed to be at higher risk of breast cancer than other women (p=0.04) and were more likely to be Swiss nationals (p=0.001). CONCLUSIONS: Most women overestimated and many were uninformed about the efficacy of mammography screening. Therefore, few women were able to take truly informed decisions about screening mammography.     

Information and decision support needs of parents considering amniocentesis: interviews with pregnant women and health professionals

Objective Our aim was to clarify and categorize information and decision support needs of pregnant women deciding about amniocentesis. Background Prenatal screening for Down’s syndrome (implemented in routine practice) generates a quantifiable risk of chromosome abnormality. To increase certainty, chromosomal material needs to be obtained through amniocentesis or other diagnostic test. Amniocentesis carries risks of pregnancy loss. Methods Semi‐structured interviews were conducted with health professionals and pregnant women who had considered amniocentesis. The data were qualitatively analysed using a two‐step thematic content analysis. Results A sample of 17 health professionals and 17 pregnant women were interviewed. Professionals demonstrated little consensus regarding the miscarriage rate, the potential consequences of amniocentesis testing and the uncertainty associated with the tests. Furthermore, methods employed to communicate risks varied between professionals. Pregnant women reported heightened stress and anxiety. Twelve out of 17 women described the decision as complex and difficult to make while five participants were satisfied with the information and support provided. Women would have liked more information about the risks involved, the results, the consequences of an amniocentesis and associated emotional difficulties. Women highlighted the need for personalized information, presented in multiple ways, while remaining simple and unbiased. Conclusions There is variation in the provision of information related to amniocentesis testing. The majority of pregnant women reported difficulties making a decision and identified dimensions of information and decision support where improvements were needed.     

Sexual abuse of adults with mental retardation by other consumers

All allegations of sexual abuse of adults with mental retardation by other adults with mental retardation over a five year period were examined. There were 72 cases substantiated with a total of 49 perpetrators. In all 72 cases, sexual abuse of one adult with mental retardation by another occurred; however, the perpetrator was deemed culpable in 31 cases, abuse and neglect were confirmed in six cases and facility neglect accounted for the remaining 35 cases. Victims were represented in all levels of mental retardation and had few secondary disabilities. Men were found to be at as much risk of sexual abuse as women. Ninety-four percent of the perpetrators were men and 81% had or still dolive in large congregate settings. Findings were congruent with the theories that perpetrators with mental retardation victimize men and women at similar rates, that living in congregate settings results in significant risks, and that men and women with mental retardation need to be provided with the skills necessary to identify what constitutes sexual abuse and what actions to take to prevent it.     

Conflicting health information: a critical research need

Conflicting health information is increasing in amount and visibility, as evidenced most recently by the controversy surrounding the risks and benefits of childhood vaccinations. The mechanisms through which conflicting information affects individuals are poorly understood; thus, we are unprepared to help people process conflicting information when making important health decisions. In this viewpoint article, we describe this problem, summarize insights from the existing literature on the prevalence and effects of conflicting health information, and identify important knowledge gaps. We propose a working definition of conflicting health information and describe a conceptual typology to guide future research in this area. The typology classifies conflicting information according to four fundamental dimensions: the substantive issue under conflict, the number of conflicting sources (multiplicity), the degree of evidence heterogeneity and the degree of temporal inconsistency.     

Delivering the unexpected—Information needs for PSA screening from Men's perspective: A qualitative study

BackgroundMaking decisions about PSA screening tests is challenging, as it requires both knowledge of the possible benefits and harms of screening and an individual assessment of the patient''s values. Our research explores how much and what information men perceive to be necessary with regard to screening for prostate cancer.ObjectiveTo explore men''s information and associated needs for decision making in PSA testing.DesignQualitative interview study.Setting and participantsWe interviewed 32 men (aged 55‐69) about their decision making on PSA screening following counselling with a Decision Aid at their GP’s or urologist''s practice in Germany.Main Outcome MeasuresMen''s expressed needs for decision making in PSA testing.MethodsAll interviews were transcribed verbatim and analysed by framework analysis.ResultsComprehensive pre‐screening counselling is needed. For the men in our study, information about test (in)accuracy, the benefit‐harm balance and consequences of the test were relevant and surprising. Additional needs were for interpretation support, a take‐home summary and time for deliberation. For several men, their physician''s attitude was of interest. After being well‐informed, most men felt empowered to make a preference‐based decision on their own.DiscussionMen were surprised by what they learned, especially regarding the accuracy and possible harms of screening. There is large variation in the breadth and depth of information needed, and some controversy regarding the consequences of testing.Conclusion and patient contributionA core set of information should be offered before men make their first PSA screening decision. Information about biopsy and associated side‐effects could follow in a short form, with details only on request. Knowledge about a high rate of false‐positive test results beforehand might help men handle a suspicious test result.     

Public perspectives on acquired brain injury rehabilitation and components of care: A Citizens’ Jury

BackgroundBrain injury rehabilitation is an expensive and long‐term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked ‘What considerations are important to include in a model of care of brain injury rehabilitation?’MethodsQualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross‐examined by jurors over two days.ResultsKey themes related to the need for a model of rehabilitation to: be consumer‐focused and supporting the retention of hope; be long‐term; provide equitable access to services irrespective of funding source; be inclusive of family; provide advocacy; raise public awareness; and be delivered by experts in a suitable environment. A set of eight recommendations were made.ConclusionInstigating the recommendations made requires careful consideration of the need for new models of care with flexible services; family involvement; recruitment and retention of highly skilled staff; and providing consumer‐focused services that prepare individuals and their carers for the long term.Patient and public contributionAs jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations.     

数据挖掘可视化技术与医院管理

在医院现有信息管理系统基础上，建立数据仓库，利用数据挖掘可视化技术。对海量历史数据进行组织和管理，用来支持管理决策。     

Strength of accumulating evidence and data monitoring committee decision making

The data monitoring committee (DMC) is a vital component of a randomized clinical trial. Its responsibilities include stopping the trial early for extreme results. The decision to stop the trial must be based on a careful synthesis of statistical methodology and clinical judgment. It is critical to ensure the validity of this complex process. In this paper we present results of a survey of 21 DMC members conducted to investigate how they evaluate accumulating evidence. The results indicate that some DMC members may be over-interpreting developing trends in the data.     

Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values

Incorporation of patient values is a key element of patient-centered care, but consistent incorporation of patient values at the point of care is lacking. Shared decision making encourages incorporation of patient values in decision making, but associated tools often lack guidance on value assessment. In addition, focusing on patient values relating only to specific decisions misses an opportunity for a more holistic approach to value assessment that could impact other aspects of clinical encounters, including health care planning, communication, and stakeholder involvement. In this commentary, we propose a taxonomy of values underlying patient decision making and provide examples of how these impact provision of health care. The taxonomy describes four categories of patient values: global, decisional, situational, and external. Global values are personal values impacting decision making at a universal level and can include value traits and life priorities. Decisional values are the values traditionally conceptualized in decision making, including considerations such as efficacy, toxicity, quality of life, convenience, and cost. Situational values are values tied to a specific moment in time that modify patients’ existing global and decisional values. Finally, discussion of external values acknowledges that many patients consider values other than their own when making decisions. Recognizing the breadth of values impacting patient decision making has implications for both overall health care delivery and shared decision making because value assessments focusing only on decisional values may miss important patient considerations. This draft taxonomy highlights different values impacting decision making and facilitates a more complete value assessment at the point of care.     

Patient,consumer, client,or customer: what do people want to be called?

OBJECTIVE: To clarify preferred labels for people receiving health care. BACKGROUND: The proper label to describe people receiving care has evoked considerable debate among providers and bio-ethicists, but there is little evidence as to the preferences of the people involved. DESIGN: We analysed dictionary definitions as to the derivation and connotations of such potential labels as: patient, client, customer, consumer, partner and survivor. We then surveyed outpatients from four clinical populations in Ontario, Canada about their feelings about these labels. SETTING AND PARTICIPANTS: People from breast cancer (n = 202), prostate disease (n = 202) and fracture (n = 202) clinics in an urban Canadian teaching hospital (Sharpe study), and people with HIV/AIDS at 10 specialty care clinics and three primary care practices affiliated with the HIV Ontario Observational Database (n = 431). VARIABLES AND OUTCOME MEASURES: The survey instruments included questions about opinion of label, role in treatment decision-making (the Problem Solving Decision Making scale), trust, use of information and health status. RESULTS: Our respondents moderately liked the label 'patient'. The other alternatives evoked moderate to strong dislike. CONCLUSIONS: Many alternatives to 'patient' incorporate assumptions (e.g. a market relationship) which care recipients may also find objectionable. People who are receiving care find the label 'patient' much less objectionable than the alternatives that have been suggested.