How Patient Comments Affect Consumers' Use of Physician Performance Measures

Published in: Medical Care, 2015

Posted on RAND.org on November 18, 2015

by David E. Kanouse, Mark Schlesinger, Dale Shaller, Steven Martino, Lise Rybowski

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Research Question

  1. How does adding comments from patients to websites that include standardized performance information about doctors and health facilities affect user engagement with the website, their consumption of the performance information, and their choice of doctor?

BACKGROUND: Patients' comments about doctors are increasingly available on the internet. The effects of these anecdotal accounts on consumers' engagement with reports on doctor quality, use of more statistically reliable performance measures, and ability to choose doctors wisely are unknown. OBJECTIVE: To examine the effects of providing patient comments along with standardized performance information in a web-based public report. DESIGN: Participants were randomly assigned to view 1 of 6 versions of a website presenting comparative performance information on fictitious primary care doctors. Versions varied by the combination of information types [Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS), and patient comments] and number of doctors. PARTICIPANTS: A random sample of working-age adults (N=848) from an online panel representing the noninstitutionalized population of the United States. MAIN MEASURES: Time spent and actions taken on the website, probing of standardized measures, and decision quality (chosen doctor rated highest on quantifiable metrics, chosen doctor not dominated by another choice). Secondary outcomes were perceived usefulness and trustworthiness of performance metrics and evaluations of the website. KEY RESULTS: Inclusion of patient comments increased time spent on the website by 35%-42% and actions taken (clicks) by 106%-117% compared with versions presenting only CAHPS and HEDIS measures (P<0.01). It also reduced participants' attention to standardized measures (eg, percentage of time probing HEDIS measures dropped by 67%, P<0.01). When patient comments were present, fewer participants chose the doctor scoring highest on standardized metrics (44%-49% vs. 61%-62%, P<0.01). CONCLUSIONS: Including patient comments in physician performance reports enhances consumers' engagement but reduces their attention to standardized measures and substantially increases suboptimal choices. More research is needed to explore whether integrated reporting strategies could leverage the positive effects of patient comments on consumer engagement without undermining consumers' use of other important metrics for informing choice among doctors.

Key Findings

  • Including patient comments on a website improved consumer engagement. Visitors spent at least a third more time on the website and took twice as many actions compared with a site that presented only standardized performance measures.
  • Visitors who were able to view patient comments spent significantly less time examining the details of standardized measures.
  • When patient comments were present, fewer participants chose the doctor with the highest average score on the standardized measures. In fact, the percentage of participants making a suboptimal choice more than doubled.
  • Including comments did not significantly alter people's perceptions of the overall usefulness of the website, their satisfaction with the choices they had among clinicians, or the usefulness or trustworthiness of the standardized measures.

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