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9/2/2011

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The Context for Our Use of Public Reporting

September 20, 2011

Advances in health care promise better outcomes while demanding more from us

MY EFFORTS WERE CRITICAL TO THE SUCCESS OF MY CARE.

We must participate actively and knowledgeably in our care if we are to realize its benefits.

What does it take for people to find good health care and then make the most of it?

ENGAGEMENT BEHAVIORS

Actions individuals must take to obtain benefit of available services

ENGAGEMENT BEHAVIORS

= Actions individuals must take to obtain benefit of available services

Actions of professionals or policies of institutions

APPROACH1. 210 patient / caregiver interviews2. Review literatures:

a. advocacy / non-profitb. peer reviewedc. systematic reviews (Cochrane)

3. 57 key informant interviews: professionals, researchers, advocates

4. Draft EBF review by 30 stakeholders

1. Many people do not take many of these actions.

2. Not an indictment.

Rather, a description of specific behaviors linked directly to health care with implications for outcomes

3. No one has to do all these things today.

Everyone has to do most of these things eventually

4. Many of us need help to do these things.

All of us need to know that we are expected to do them.

• Find provider who fits personal criteria and accepts new patients with compatible health insurance plan

• Seek care from appropriate venue when needed

Elective use of services such as joint replacements, cosmetic surgery, and

maternity care

• Highly “shoppable” services: people can often plan in advance, choose providers

• May also face cost sharing incentives

• Targeted promotion of public reports has proven effective in some cases

Short-term treatment episodes

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External disruptions

Moving to a new area, changing jobs, changing to a health plan with a different

network, etc.

• Strong motivation to learn: you have to choose a new provider

• Potential for unsettled emotions and anxiety

• May have limited time to make a decision

• Need for timely, easy-to-use information from a trusted source

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Serious chronic conditions

A large and growing segment of the U.S. population: half of all adults have at least

one chronic illness

• Chronic disease creates a continuing need for monitoring and management

• Strong motivation to learn, especially after initial diagnosis

• Need to match content of public reports to nature of disease, and combine measures with management information.

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Problematic medical experiences

Almost 8% of Americans report switching doctors each year in response to some problem

• High motivation to learn since stakes are high

• Emotions run toward fear or anger– Anger may induce information seeking to minimize

future risk

– Intense fear may lead to information avoidance

• Effective engagement may require metrics highlighting negative scores, and help from patient advocates

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Suggest that:

Infinite variety of needs: data challenge

Some will never need; some will never use

Window of need narrow for choice: the right stuff at the right time

Bounded rationality implies education, not just information provision

Consumer Reports: Car Buying Guide eBayU.S. News & World Report: America’s Best CollegesFDA Nutrition Facts Panels

http://www.cfah.org/activities/tools.cfm

Margaret Holmes-RovnerDavid KanouseSteven ParenteDale ShallerShoshanna Sofaer

1. Tailored to consumers interests and needs

2. Target audience has clear, compelling need for external information

3. Institutional credibility and trust

4. Viable business model to generate revenue for ongoing production & promotion

5. Marketing, promotion, and dissemination to build awareness and establish trust