Effect of CAHPS performance information on health plan choices by Iowa Medicaid beneficiaries

This evaluation tested if Consumer Assessment of Health Plans Study (CAHPS) information on plan performance affected health plan choices by new beneficiaries in Iowa Medicaid. New cases entering Medicaid in selected counties during February through May 2000 were assigned randomly to experimental or control groups. The control group received standard Medicaid enrollment materials, and the experimental group received these materials plus a CAHPS report. We found that CAHPS information did not affect health plan choices by Iowa Medicaid beneficiaries, similar to previously reported findings for New Jersey Medicaid. However, it did affect plan choice in an earlier laboratory experiment. The value of this information may be limited to a subset of receptive consumers who actively study information received, even then only when (1) ratings of available plans differ greatly, (2) ratings differ from prior beliefs about plan quality, and (3) reports are easy to understand.

Consulting the Internet before visit to general practice. Patients' use of the Internet and other sources of health information

OBJECTIVES

To describe where patients in Danish general practice get information about health and disease, particularly how patients prepare for a visit to their GP, with special reference to use of the lnternet.

DESIGN

Structured interviews.

SETTING

Four Danish general

PATIENTS

93 consecutive patients after visiting their GP.

MAIN OUTCOME MEASURES

The patient's report about we of the Internet and different mass media in preparation for the consultation.

RESULTS

Only two patients never looked for health information. Of all patients, 20% had used the Internet to get health information, 8% because of the current visit, i.e. a third of all with Internet access had used it because of the current visit. Women used the sources of information more than men did. Personal contact with family, friends or neighbours was the most commonly used source.

CONCLUSION

The Internet is used in direct preparation for a visit to the general practitioner. The vast majority of patients use the mass media for information. In general practice, the main source of information on a health-related subject is personal contact with family and friends.

Sociodemographic differences in exposure to health information

OBJECTIVE

Baseline data from the Heart Attack REACT Study provided the opportunity to explore population subgroup differences in exposure to health information in an ethnically diverse sample from 5 regions across the United States.

METHODS

During the 4-month baseline period of the REACT study, some 1,200 residents from the 20 study communities were surveyed using random digit dial telephone methods. Respondents were asked to recall health messages seen and/or heard recently, and the sources of these messages. Comparisons were made between sociodemographic subgroups defined by age, sex, race/ethnicity, education, income, work status, and geographic location.

RESULTS

Except for education level differences, the amount of exposure to health information did not vary significantly by sociodemographics; however, significant variation among subgroups in the types of messages cited and the sources of these messages was observed. Minority and low-income groups were found to have less exposure to chronic disease prevention information, eg, on nutrition, exercise, and heart disease. Additionally, the sources of health information most popular among sociodemographic subgroups appeared to be a determining factor in the types of messages received.

CONCLUSIONS

The results of these analyses support previous findings, adding to the sparse body of information on the best channels for reaching under-served populations.

Internet-based search tools can help reduce bad debt

The healthcare industry wrote off more than $20 billion in bad debt in 1999 alone, according to one estimate. Bills frequently do not reach patients because healthcare organizations do not have accurate patient contact and billing information. Incorrect billing information can be easily and inexpensively corrected by using Internet-based search tools. Healthcare accounts receivable staffs are using these tools to improve the patient experience and the bottom line with no capital outlay, minimal staff training or workflow change requirements, and low cost.

Product-related emphasis of skin disease information online

BACKGROUND

In 2000, 41 million people searched for medical information online. The quality of that information is unregulated, variable, and not well studied.

OBJECTIVE

To quantify and compare the numbers and types of Internet sites matched for 10 diverse skin conditions through different search systems.

DESIGN

Search strategies were performed at 6-month intervals via Netscape Navigator, using 3 search engines and 1 directory. Ten skin conditions were chosen to represent common (psoriasis and eczema), cosmetic (wrinkles and cellulite), difficult-to-treat (alopecia, mastocytosis, granuloma annulare, and xanthoma), and uncommon (dermatitis herpetiformis and epidermolysis bullosa) problems. Search strings were designed to generate lists of Web sites that provide educational or product-related information. Results were compared.

SETTING

The Saint Louis University information technology server, July 9, 1999, December 16, 1999, and February 5, 2000.

MAIN OUTCOME MEASURES

Comparisons of the total number, top 10 ranking, and type (educational vs product-related) of sites that matched through different search systems at 6-month intervals.

RESULTS

The total number of matched sites for different skin conditions varied up to 100-fold. This number increased by 30% to 316% between July and December 1999. The largest number of Web sites related to wrinkles, followed by Web sites related to common conditions. Product-related sites outnumbered educational sites, especially for common and cosmetic conditions. Although there were differences in the total number of sites found through different search engines, the ratios of product-related to educational sites were similar. Different search engines yielded different top 10 match lists for the same condition. The top 10 lists included higher proportions of educational sites than the total match lists for all conditions except cellulite. Within the top 10 lists, the rank order of well respected sites varied by search engine used and changed over time.

CONCLUSIONS

Patients are increasingly accessing the growing body of data available through the Internet. Most Web sites contain information related to products. Until standards are enacted to govern the distribution of online medical information, consumers are at risk for obtaining misinformation and buying ineffective products. To better guide patients, physicians must become familiar with this ever-changing information.

Understanding the needs of people using a cancer information service in Northern Ireland

A retrospective analysis of first-time enquirers using a cancer information service in Belfast, Northern Ireland, is presented. Our results show that women are three times more likely to use the service than men, with relatives and friends more likely to seek information on behalf of cancer patients than patients themselves. Unlike patients with cancer at other sites, the number of enquiries from breast cancer patients [standard incidence rate (SIR) = 1.5] was greater than incidence figures for the general population would suggest. Individuals without a cancer diagnosis but with potentially cancer-related symptoms accounted for 30% of all enquiries. Breast changes accounted for 49% of calls, testicular abnormalities 19% and concerns about cervical smear test results 13%; prostate problems (12%) and changes in skin pigmentation were the other main sources of caller concern. Our results also demonstrate that cancer patients often have a poor understanding of commonly used medical terms. This analysis shows that individuals using a cancer information service are not representative of the population that develops the disease, highlights how media campaigns can encourage the awareness and reporting of new and pre-existing symptoms, and exposes some of the confusion and misconceptions about cancer that are experienced by sections of the Irish population.

Disease-related difficulties and satisfaction with level of knowledge in adults with mild or complex congenital heart disease

OBJECTIVES

To evaluate difficulties in daily life, and satisfaction with level of knowledge about their disease, in patients with congenital cardiac disease in order to improve counselling.

METHODS

A self-administered questionnaire was completed by 80 patients with mild, and 76 with complex, congenital cardiac disease. They were aged from 17 to 32 years.

RESULTS

Even patients with only mild malformations experienced difficulties related to their disease, but being found in only 11%, these were significantly less than those uncovered in 87% of those with complex disease (p < 0.001). Those patients with complex malformations frequently felt restricted in choices because of their disease in areas such as sport (59%), employment (51%), and education (34%). Other difficulties reported were: paying a higher premium for life insurance (29%), having to give up on a sport (28%), and being excluded from a job (18%). Depending on the item, between one-fifth and two-thirds of participants reported gaps in knowledge, most frequently for "causes of congenital cardiac disease", "future consequences", and "family planning". For 53% of those with mild anomalies, and 93% of severely affected patients, the cardiologist is the most important source of information.

CONCLUSIONS

A minority of adults with mild, and a majority of those with complex congenital cardiac disease report difficulties in daily life. A substantial number of these patients feel that they have an inadequate level of knowledge about their disease. Our results suggest the need for a specific programme of counselling.

Use and barriers to use of laboratory data by clinical dietitians

The results of this study reveal two general areas of concern for clinical dietitians in the use of laboratory data--their lack of confidence in their own interpretive skills and the perceived resistance of physicians. Although clinical dietitians receive theoretical and applied training on the use of laboratory values in their undergraduate education and dietetic internship, clinical managers should be aware that they need support and continuing education to use their laboratory assessment skills to the fullest. Also, dietitians should demonstrate more clearly to physicians their knowledge, skill, and needs in this area. They should initiate and continue dialogue about the importance of laboratory analysis to nutrition care and improved patient outcome. Evidence-based data and clear documentation of improved medical outcomes should help overcome barriers to use of laboratory data by clinical dietitians.

[Inequities in access to information and inequities in health]

This piece presents evidence that inequities in information are an important determinant of health inequities and that eliminating these inequities in access to information, especially by using new information and communication technologies (ICTs), could represent a significant advance in terms of guaranteeing the right to health for all. The piece reviews the most important international scientific research findings on the determinants of the health of populations, emphasizing the role of socioeconomic inequities and of deteriorating social capital as factors that worsen health conditions. It is noteworthy that Latin America has both socioeconomic inequities and major sectors of the population living in poverty. Among the fundamental strategies for overcoming the inequalities and the poverty are greater participation by the poor in civic life and the strengthening of social capital. The contribution that the new ICTs could make to these strategies is analyzed, and the Virtual Health Library (VHL) is discussed. Coordinated by the Latin American and Caribbean Center on Health Sciences Information (BIREME), the VHL is a contribution by the Pan American Health Organization that takes advantage of the potential of ICTs to democratize information and knowledge and consequently promote equity in health. The "digital gap" is discussed as something that can produce inequity itself and also increase other inequities, including ones in health. Prospects are discussed for overcoming this gap, emphasizing the role that governments and international organizations should play in order to expand access to the global public good that information for social development is.

Factors influencing medical information seeking among African American cancer patients

Qualitative research methods were used to explore factors that may affect medical information seeking, treatment engagement, and emotional adjustment among African American cancer patients. Focus group findings suggest that an array of cultural and socioeconomic factors plays important roles in the behavior of African American cancer patients. Participants described a number of important barriers and facilitators of medical information seeking and treatment participation. Factors linked to the health care-related behaviors and adjustment of African American cancer patients included limited knowledge and misinformation about cancer, mistrust of the medical community, concerns about privacy, lack of insurance, religious beliefs, and emotional issues such as fear and stigma associated with seeking emotional support. Recommendations are made that may assist mental and physical health providers in improving patient information and mental and physical health outcomes of African American cancer patients.

Use of internet medical websites and NHS direct by neurology outpatients before consultation

With increasing personal access to the internet, and the mass of medical information available in cyberspace, many patients may access information before an outpatient consultation. Since this information may shape individual health beliefs and expectations, yet is acknowledged to be of very variable quality, it may be important for practitioners to know about their patients' self-directed findings. Medical information may also be gained from the NHS Direct telephone helpline. This study measured the frequency of use of the internet and of NHS Direct by questioning consecutive new referrals attending general neurology outpatient clinics over a three-month period. A comparison was made between patients' searches and their final diagnosis. Patients' views on the use of the information received were sought.

Similarities and differences in choosing health plans

BACKGROUND

Increasingly, consumers have multiple health insurance options. New information is being developed to help consumers with these choices.

OBJECTIVES

To study similarities and differences in how the publicly and privately insured choose health plans. To explore the effect of traditional enrollment materials and reports developed by the Consumer Assessment of Health Plans Study (CAHPS) on consumers' perceptions and decision-making.

RESEARCH DESIGN

Using data from eight CAHPS demonstrations, we tested for significant differences across consumers with employer-sponsored insurance, Medicaid, and Medicare.

SUBJECTS

Approximately 10,000 consumers with employer-sponsored, Medicaid, and Medicare health plans.

MEASURES

Perceptions of the health plan selection process, use of information sources, and reactions to and use of traditional enrollment materials and CAHPS reports.

RESULTS

Most consumers with all types of insurance thought that choosing a health plan was important and obtained information from multiple sources. Choosing a plan was more difficult for Medicare and Medicaid recipients than for the privately insured. When choosing a plan, Medicaid recipients cared most about convenience and access, whereas the privately insured emphasized providers and costs. The percentage of consumers who looked at and remembered the CAHPS report varied widely from 24% to 77%. In all but one of the demonstration sites, most consumers spent less than 30 minutes looking at the CAHPS report.

CONCLUSIONS

Group sponsors and the developers of information interventions such as CAHPS may need to invest in developing and testing different reporting approaches for Medicare, Medicaid, and privately insured consumers.

How does the purchasing staff of an accident insurance organization seek information about treatment effectiveness?

OBJECTIVES

The objective is to study how the staff who purchase health care services for a large national government accident-compensation system seek information on treatment effectiveness, how they assess the quality of that information, whether they question the information sources they choose, and how familiar they are with the key concepts of evidence-based health care (EBHC).

METHOD

Staff (22 out of 34) of the health purchasing division of the New Zealand Accident Compensation Corporation (NZ ACC) were interviewed using eight preformatted questions to which they could provide open and multiple answers. Responses were subsequently codified into typologies for quantitative analysis.

RESULTS

Most respondents report that they assess the effectiveness of a treatment by accessing published information (nonhuman sources), by consulting others (human sources), or by both means. They assess the quality of information mostly by consulting others, and the second-highest proportion of responses state that they do not know how to evaluate the quality of information. No clear preference emerges with respect to the types of information needed to determine the effectiveness of treatments. The majority of the staff believes they can access information needed to determine treatment effectiveness through the Internet or information databases such as MEDLINE. Although most said they understand the key concepts of EBHC, only five out of twenty-two were able to accurately describe them.

CONCLUSIONS

The findings suggest that there is a low level of awareness among the staff of the NZ ACC regarding the use of evidence and understanding of the key concepts of EBHC. Many surveyed staff members lack the skills or training to directly question information about effectiveness of a treatment. They have little idea of the information required to determine the effectiveness of a treatment, and the majority appears to lack the skills to evaluate the health care literature.

Prevalence of South Australia's online health seekers

OBJECTIVE

To determine the proportion of South Australians accessing online health care information, predictive characteristics of online health seekers, nature of the information sought and consumer behaviour.

METHODS

A probability-based survey of 3,027 South Australians, aged 15 years and older, as part of the Spring 2000 South Australian Health Omnibus.

RESULTS

Internet access decreases with age, while the prevalence of online health seekers is constant (26% to 28%) among people aged between 15 and 54 years. Predictive characteristics of online health seekers include gender, age, education and income. Most commonly sought information is the cause or description of disease (60%). Consumers use online health information as a second opinion (19%), discuss it with their doctor or pharmacist (16%), or change their health care management (11%).

CONCLUSIONS

The Australian prevalence of online health seekers is likely to be slightly higher than 21%.

IMPLICATIONS

The Intemet can deliver preventative and clinical health information to a critical mass of Australians, but poorer and older Australians may be unable to access it.

Breast cancer on the world wide web: cross sectional survey of quality of information and popularity of websites

OBJECTIVES

To determine the characteristics of popular breast cancer related websites and whether more popular sites are of higher quality.

DESIGN

The search engine Google was used to generate a list of websites about breast cancer. Google ranks search results by measures of link popularity---the number of links to a site from other sites. The top 200 sites returned in response to the query "breast cancer" were divided into "more popular" and "less popular" subgroups by three different measures of link popularity: Google rank and number of links reported independently by Google and by AltaVista (another search engine).

MAIN OUTCOME MEASURES

Type and quality of content.

RESULTS

More popular sites according to Google rank were more likely than less popular ones to contain information on ongoing clinical trials (27% v 12%, P=0.01 ), results of trials (12% v 3%, P=0.02), and opportunities for psychosocial adjustment (48% v 23%, P<0.01). These characteristics were also associated with higher number of links as reported by Google and AltaVista. More popular sites by number of linking sites were also more likely to provide updates on other breast cancer research, information on legislation and advocacy, and a message board service. Measures of quality such as display of authorship, attribution or references, currency of information, and disclosure did not differ between groups.

CONCLUSIONS

Popularity of websites is associated with type rather than quality of content. Sites that include content correlated with popularity may best meet the public's desire for information about breast cancer.

Do Internet interventions for consumers cause more harm than good? A systematic review

OBJECTIVE

To systematically review the effect of consumer use of online health information on decision-making, attitudes, knowledge, satisfaction and health outcomes and utilization.

SEARCH STRATEGY

Electronic databases searched included the Cochrane Controlled Trials Register, MEDLINE, PREMEDLINE (to 14 March 2001), CINAHL, Australian Medical Index, Health and Society, National Institutes of Health Clinical Trials Database and CenterWatch.

INCLUSION CRITERIA

All post-1995 comparative studies (including controlled studies, before and after studies, and interrupted time series analyses) of Internet users vs. non-Internet users and other communications mediums, and Internet characteristics such as e-mail vs. other communication mediums, were included. Outcomes included consumer decision-making, attitudes, knowledge, satisfaction and measurable changes in health status or health utilization.

DATA EXTRACTION AND SYNTHESIS

One reviewer screened all papers then two reviewers independently assessed studies against the selection criteria and any discrepancies were resolved by discussion with a third reviewer. No attempt was made to combine the data for further statistical analysis.

MAIN RESULTS

We identified 10 comparative studies. Studies evaluated the effectiveness of using the Internet to deliver a smoking cessation programme, cardiac and nutrition educational programmes, behavioural interventions for headache and weight loss, and pharmacy and augmentative services. All studies showed some positive effects on health outcomes, although the methodological quality of many studies was poor.

CONCLUSIONS

Despite widespread consumer Internet use to obtain health-care information, there is almost a complete lack of evidence of any effects this may have on health outcomes.

Power of information: closing the gap between research and policy

States play an increasing role in setting U.S. health policy. A survey of 292 state government policymakers finds that officials are overwhelmed by the volume of information they receive and have a strong preference for information that is concise and more relevant to current debates. Younger officials are more likely to use electronic information, while older policymakers prefer printed material. Organizations of government professionals are trusted sources of information, and state agencies are a key source of data and information. Policymakers expressed a strong desire for tools to help them identify research on specific topics.

Patients' use of the Internet for medical information

OBJECTIVES

To determine the percentage of patients enrolled in a primary care practice who use the Internet for health information, to describe the types of information sought, to evaluate patients' perceptions of the quality of this information, and to determine if patients who use the Internet for health information discuss this with their doctors.

DESIGN

Self-administered mailed survey.

SETTING

Patients from a primary care internal medicine private practice.

PARTICIPANTS

Randomly selected patients ( N=1,000) were mailed a confidential survey between December 1999 and March 2000. The response rate was 56.2%.

MEASUREMENTS AND MAIN RESULTS

Of the 512 patients who returned the survey, 53.5% (274) stated that they used the Internet for medical information. Those using the Internet for medical information were more educated ( P <.001) and had higher incomes ( P <.001). Respondents used the Internet for information on a broad range of medical topics. Sixty percent felt that the information on the Internet was the "same as" or "better than" information from their doctors. Of those using the Internet for health information, 59% did not discuss this information with their doctor. Neither gender, education level, nor age less than 60 years was associated with patients sharing their Web searches with their physicians. However, patients who discussed this information with their doctors rated the quality of information higher than those who did not share this information with their providers.

CONCLUSIONS

Primary care providers should recognize that patients are using the World Wide Web as a source of medical and health information and should be prepared to offer suggestions for Web-based health resources and to assist patients in evaluating the quality of medical information available on the Internet.

The impact of a CAHPS report on employee knowledge, beliefs, and decisions

As comparative health plan performance data become more available, large employers are increasingly interested in knowing about the value in providing this information to employees to help them choose a plan. The purpose of this study is to empirically examine some of the key assumptions about how disseminating Consumer Assessment of Health Plans Study (CAHPS) report cards may influence employee knowledge, attitudes, and choice. The study used a quasi-experimental design, with preintervention and postintervention interviews with 958 employees. The findings indicate that exposure to the reports is related to having more information on how well the different plans perform on the CAHPS reporting categories. Furthermore, those who saw the report perceive the reporting categories to be more important in health plan choice than those who did not. Finally, the findings show that those who saw the report are more influenced by information sent by their employer than those who did not see the report.

Internet use in families with children requiring cardiac surgery for congenital heart disease

OBJECTIVE

We sought to document the prevalence of Internet access and usage patterns among families who have children with congenital heart disease presenting for cardiac surgery.

DESIGN

A cross-sectional study was performed utilizing a questionnaire (10 questions) as the study tool. Statistical analysis was performed on all completed questionnaires. The chi(2) test was used to evaluate categorical variables and the t test to evaluate continuous variables.

RESULTS

Two hundred seventy-five questionnaires were completed and analyzed. Thirty-seven percent (102/275) of the children had a cyanotic congenital heart defect. There were 21 children with Trisomy 21. Fifty-eight percent (160/275) of families had access to the Internet. The most common locations for accessing the Internet were home (80%; 129/160) and work (51%; 82/160). There were no significant differences in Internet access with regards to underlying individual congenital heart defect, cyanotic versus acyanotic heart defects, or congenital heart defects with functional univentricular hearts versus biventricular hearts. Families with older children (12--24 years) were more likely to have Internet access. Families of children undergoing placement of a right ventricle to pulmonary artery conduit were more likely to have Internet access. Of the 160 families with Internet access, 58% (93/160) used the Internet to obtain information related to their child's cardiac diagnosis. Eighty-two percent (76/93) characterized locating cardiology-related information as easy. Six parents created interactive personal Web sites specifically related to their child's congenital heart defect. Although families with older patients (12--24 years) were more likely to have access to the Internet, this did not translate into greater use of the Internet to obtain cardiology-related information. Among families who accessed the Internet for cardiology-related information, 95% (88/93) of families characterized the information as helpful or very helpful in furthering the understanding of their child's heart defect.

CONCLUSION

Families are utilizing the Internet to educate themselves about congenital heart disease. Most parents consider the process easy and the information obtained helpful to the understanding of their child's congenital heart defect and surgery. Internet use in this patient population is expected to increase. Our vigilance in providing accurate Internet references, as well as in identifying inaccurate Internet information available to our patients and their parents, is of paramount importance.