AHRQ Grant HS021858: Related Publication Summaries

Eliciting Patient Experiences to Augment Public Reports on Health Care Quality

1. "Consumer response to patient experience measures in complex information environments."

Schlesinger M, Kanouse DE, Rybowski L, Martino SC, Shaller D.
Medical Care 2012 Nov; 50 Suppl S56-S64.
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The researchers sought to assess the effects of report complexity on consumers' understanding and use of patient experience measures derived from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey. Participants were randomly assigned to choice sets of varied complexity (CAHPS alone vs. CAHPS with other measures). They found that consumers presented with both CAHPS and other performance measures relied less on CAHPS than did those presented with CAHPS information alone. This study highlights the difficulty of creating simple, usable reports for consumers without losing important variations and nuances between providers.

2. "Complexity, public reporting, and choice of doctors: A look inside the blackest box of consumer behavior."

Schlesinger M, Kanouse DE, Martino SC, Shaller D, Rybowski L.
Medical Care Research Review 2014 Oct; 71(5 Suppl): S38-S64.
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This article presents the first in-depth exploration of how the complexity of public reports might impair consumer choices among health care providers. The researchers provide a synthesis of ways in which complex choice sets can affect deicisonmaking. Consumers with certain decision styles and lower decision skills are particularly likely to make questionable choices when faced with an abundance of quality information. They find that after accounting for consumers' skills and decisionmaking style, complexity undermines the quality of decisionmaking in ways that cannot be fully explained.

3. "Context-based strategies for engaging consumers with public reports about health care providers."

Shaller D, Kanouse DE, Schlesinger M.
Medical Care Research Review 2014 Oct; 71(5 Suppl):S17-S37.
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The authors examine four specific decision contexts that are likely to trigger a consumer’s search for health care quality information: "shoppable" conditions such as joint replacement, encountering an external disruption such as moving or getting a new job, developing a serious chronic health condition, or experiencing problems with a current provider. The authors discuss how consumer engagement and receptivity to information in each situation are likely to be affected by the following factors common to all health care choices: an individual's emotional state in the choice situation, capacity to interpret multiple measures of performance, and need to trust sources of support to help interpret complex information. The authors recommend several strategies for improving engagement based on these factors: identify a target audience for decisionmaking, use emotional cues and content to engage consumers, provide content that is relevant to the choice situation, integrate and summarize information, and provide personal navigation and support.

4. "Taking patients' narratives about clinicians from anecdote to science."

Schlesinger M, Grob R, Shaller D, Martino SC, Parker AM, Finucane ML, Cerully  JL, Rybowski L.
New England Journal of Medicine 2015 Aug 13;373(7):675-9.
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This editorial notes the value of incorporating open-ended patient narrative feedback into evaluation of clinician performance in order to better capture the full range of patient experience and to better engage other consumers in public reports. However, the authors caution that patients’ narrative data must be held to the same standard of scientific rigor that is already applied to conventional patient experience surveys. The representativeness of the patient experience narratives might best be achieved by integrating open-ended questions into existing standardized surveys, such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) instruments.

5. "Breaking narrative ground: innovative methods for rigorously eliciting and assessing patient narratives."

Grob R, Schlesinger M, Parker AM, Shaller D, Barre LR, Martino SC, Finucane ML, Rybowski L, Cerully JL.
Health Services Research 2016 Jun;51 Suppl 2:1248-72.
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The researchers sought to design a methodology for rigorously eliciting narratives about patients' experiences with clinical care that are potentially useful for public reporting and quality improvement. They demonstrated that a five-question protocol that has been tested and refined yields three- to six-fold increases in completeness and four- to tenfold increases in meaningfulness compared to a single open-ended question. The new protocol performs equally well for healthy and sick patients.

6. "CAHPS and comments: how closed-ended survey questions and narrative accounts interact in the assessment of patient experience."

Martino SC, Shaller D, Schlesinger M, Parker AM, Rybowski L, Grob R, Cerully JL, Finucane ML.
Journal of Patient Experience 2017 Mar;4(1):37-45.
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The authors investigated whether content from patient narratives explains variation in patients' primary care provider (PCP) ratings beyond information from the closed-ended questions of the CAHPS Clinician and Group Survey and whether the relative placement of closed- and open-ended survey questions affects either the content of the narratives or the CAHPS composite scores. They found that incorporating a protocol for eliciting narratives into a patient experience survey resulted in minimal distortion of patient feedback, and narratives from sicker patients helped explain variation in provider ratings.

7. "Using patient reported information to improve clinical practice."

Schlesinger M, Grob R, Shaller D.
Health Services Research 2015 Dec;50 Suppl 2:2116-54.

The purposes of this study were to assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. It concluded that unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value.

Page last reviewed May 2018
Page originally created January 2016
Internet Citation: AHRQ Grant HS021858: Related Publication Summaries. Content last reviewed May 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/sciencepubreport/hs-021858.html