Do Content and Format Affect Older Consumers’ Use of Comparative Information in a Medicare Health Plan Choice? Results from a Controlled Experiment

Comparing Medicare plan selection among beneficiaries with and without a history of cancer

Individuals aging into Medicare must choose among plans that vary in their scope of benefits, access to health care providers, and exposure to out-of-pocket expenses. When faced with complex coverage decisions, it is unclear whether older adults consider their experiences with prior serious illness or current medical conditions. We estimated the association between a self-reported history of cancer and initial plan selection among 3811 Health and Retirement Study participants aging into Medicare between 2008 and 2020. The proportion of individuals with and without a history of cancer who chose Medicare Advantage was similar; however, the probability of selecting traditional Medicare plus supplemental coverage was 8.03 percentage points (95% confidence interval, 2.99-13.07) higher for respondents with a history of cancer compared with those without a history of cancer. Individuals with a history of cancer may have accounted for their previous experiences with high-cost health care services and prioritized plans with robust benefits (eg, greater financial protections). Raising awareness of and enhancing educational resources could ensure that older adults select plans that meet their current and evolving health care needs.

Effects of public reporting of prescription indicators on patient choices: evidence from propensity scores matching

Background: Public reporting on health providers' performance (PRHPP) is increasingly used for empowering patients. This study aimed to test the effect of PRHPP using the theory of the consumer choice model. Methods: The study was conducted in 10 primary care institutions in Hubei province, China. Information related to the percentage of prescriptions requiring antibiotics, the percentage of prescriptions requiring injections, and average costs per prescription for each prescriber was calculated, ranked and displayed in a public place on a monthly basis. A questionnaire survey was undertaken on 302 patients 10 months after the initiation of the PRHPP, tapping into patient awareness, understanding, perceived value and use of the information in line with the theory of the consumer choice model. The fitness of data with the model was tested using structural equation modelling. The patients who were aware of the PRHPP were compared with those who were unaware of the PRHPP. The propensity score method (considering differences between the two groups of patients in age, gender, education, health and income) was used for estimating the effects of the PRHPP. Results: About 22% of respondents were aware of the PRHPP. Overall, the patients showed limited understanding, perceived value and use of the disclosed information. The data fit well into the consumer choice model. Awareness of the PRHPP was found to be associated with increased understanding of the antibiotic (p = 0.028) and injection prescribing indictors (p = 0.030). However, no significant differences in perceived value and use of the information (p > 0.097) were found between those who were aware and those who were unaware of the PRHPP. Conclusion: Although PRHPP may improve patient understanding of the prescribing performance indicators, its impacts on patient choices are limited due to low levels of perceived value and use of information from patients. Additional support is needed to enable patients to make informed choices using the PRHPP.

Impact of an educational program and decision tool on choice of maternity hospital: the delivery decisions randomized clinical trial

Background

Reducing cesarean rates is a public health priority. To help pregnant people select hospitals with lower cesarean rates, numerous organizations publish publically hospital cesarean rate data. Few pregnant people use these data when deciding where to deliver. We sought to determine whether making cesarean rate data more accessible and understandable increases the likelihood of pregnant people selecting low-cesarean rate hospitals.

Methods

We conducted a 1:1 randomized controlled trial in 2019–2021 among users of a fertility and pregnancy mobile application. Eligible participants were trying to conceive for fewer than five months or were 28–104 days into their pregnancies. Of 189,456 participants approached and enrolled, 120,621 participants met entry criteria and were included in analyses. The intervention group was offered an educational program explaining the importance of hospital cesarean rates and an interactive tool presenting hospital cesarean rates as 1-to-5-star ratings. Control group users were offered an educational program about hospital choice and a hospital choice tool without cesarean rate data. The primary outcome was the star rating of the hospital selected by each patient during pregnancy. Secondary outcomes were the importance of cesarean rates in choosing a hospital and delivery method (post-hoc secondary outcome).

Results

Of 120,621 participants (mean [SD] age, 27.8 [7.9]), 12,284 (10.2%) reported their choice of hospital during pregnancy, with similar reporting rates in the intervention and control groups. Intervention group participants selected hospitals with higher star ratings (2.52 vs 2.16; difference, 0.37 [95% CI, 0.32 to 0.43] p < 0.001) and were more likely to believe that the hospitals they chose would impact their chances of having cesarean deliveries (38.5% vs 33.1%, p < 0.001) but did not assign higher priority to cesarean delivery rates when choosing their hospitals (76.2% vs 74.3%, p = 0.05). There was no difference in self-reported cesarean rates between the intervention and control groups (31.4% vs 31.4%, p = 0.98).

Conclusion

People offered an educational program and interactive tool to compare hospital cesarean rates were more likely to use cesarean data in selecting a hospital and selected hospitals with lower cesarean rates but were not less likely to have a cesarean.

Clinical Trial Registration

Registered December 9, 2016 at clinicaltrials.gov, First enrollment November 2019. ID NCT02987803, https://clinicaltrials.gov/ct2/show/NCT02987803

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05087-y.

Implementation of a Medicare Plan Selection Assistance Program Through a Community Partnership

Objective. To describe the implementation and outcomes of a sustainable Medicare Plan Selection Assistance Program conducted through a partnership between Auburn University Harrison School of Pharmacy (AU) and the Alabama State Health Insurance and Assistance Program (SHIP) since 2013. Methods. The program's goal is to assist Medicare beneficiaries in Medicare Part D plan selection. Reported outcomes included Medicare beneficiaries' plan cost savings and satisfaction, and pharmacy students' self-reported changes in knowledge and attitudes. Results. Each year, more than 80 pharmacy students assist more than 120 beneficiaries; at least 10 events are held covering 6-10 Alabama counties. On average, Medicare beneficiaries had a projected savings of $278.71 (2013), $1,081.66 (2014), $842.84 (2015), and $1,382.90 (2016) after enrolling in a new plan, and most students reported perceived increased ability to help beneficiaries select the most appropriate Medicare Part D plan. Conclusion. The program produced positive outcomes for both beneficiaries and students. Other pharmacy schools may consider partnering with their State Health Insurance and Assistance Program to deliver a similar program to benefit their students and Medicare beneficiaries.

The effect of public reporting presentation on patients' decision making: An experimental survey in Yunan Province, China

Public reporting of comparative performance information (PRCPI) influence patients' decision making and optimal presentation of PRCPI is urgently required for successful patients' engagement and quality improvement. This study was to explore the presentation of PRCPI impacting on consumers' decision making.This research applied a controlled design, with participants allocated randomly to 6 groups, and a total of 515 participants were recruited in Yunnan province. Five aspects of PRCPI presentations were evaluated, including display (star rating vs numeric information), and whether information was simplified, interpreted, overload, or ranked. Participants were stimulated to identify the best or worst physicians with a hypothetical scenario. Main outcome measures were correct choices rate of best/worst physicians, indicating participants fully understood and correctly used PRCPI. χ test and logistic regression were applied to assess the effect between different presentations on consumers' decision making.The correct choices rate is only 48.93%. Compared with star rating, numerical information helped participants differentiate low-performance physicians (OR = 2.573, P = .029), including low-performance physicians in antibiotics (OR = 2.974, P = .031) and low-performance physicians in injections (OR = 2.369, P = .035). Disordered information impeded participants to fully understand and correctly use PRCPI (OR = 0.519, P = .041). The effect was mainly reflected on participants differentiating low-performance physicians (OR = 0.491, P = .039) and low-performance physicians in injections (OR = 0.440, P = .016). Other aspects of PRCPI showed nonsignificant impacts on consumers' decision making.Presentation, including information display and ranking, can influence patients' correct usage of PRCPI and the effect was mainly observed when the patients were identifying poorly performing physicians. The present study demonstrated that numerical and ranked PRCPI, combined with sufficient patient education, could be most effective to facilitate patient use.

Can a More User-Friendly Medicare Plan Finder Improve Consumers' Selection of Medicare Plans?

OBJECTIVE

To evaluate the efficacy for consumers of two potential enhancements to the Medicare Plan Finder (MPF)-a simplified data display and a "quick links" home page designed to match the specific tasks that users seek to accomplish on the MPF.

DATA SOURCES/STUDY SETTING

Participants (N = 641) were seniors and adult caregivers of seniors who were recruited from a national online panel. Participants browsed a simulated version of the MPF, made a hypothetical plan choice, and reported on their experience.

STUDY DESIGN

Participants were randomly assigned to one of eight conditions in a fully factorial design: 2 home pages (quick links, current MPF home page) × 2 data displays (simplified, current MPF display) × 2 plan types (stand-alone prescription drug plan [PDP], Medicare Advantage plan with prescription drug coverage [MA-PD]).

PRINCIPAL FINDINGS

The quick links page resulted in more favorable perceptions of the MPF, improved users' understanding of the information, and increased the probability of choosing the objectively best plan. The simplified data display resulted in a more favorable evaluation of the website, better comprehension of the displayed information, and, among those choosing a PDP only, an increased probability of choosing the best plan.

CONCLUSIONS

Design enhancements could markedly improve average website users' understanding, ability to use, and experience of using the MPF.

Does the Medicare Part D Decision-Making Experience Differ by Rural/Urban Location?

PURPOSE

Although much has been written about Medicare Part D enrollment, much less is known about beneficiaries' personal experiences with choosing a Part D plan, especially among rural residents. This study sought to address this gap by examining geographic differences in Part D enrollees' perceptions of the plan decision-making process, including their confidence in their choice, their knowledge about the program, and their satisfaction with available information.

METHODS

We used data from the 2012 Medicare Current Beneficiary Survey and included adults ages 65 and older who were enrolled in Part D at the time of the survey (n = 3,706). We used ordered logistic regression to model 4 outcomes based on beneficiaries' perceptions of the Part D decision-making and enrollment process, first accounting only for differences by rurality, then adjusting for sociodemographic, health, and coverage characteristics.

FINDINGS

Overall, half of all beneficiaries were not very confident in their Part D knowledge. Rural beneficiaries had lower odds of being confident in the plan they chose and in being satisfied with the amount of information available to them during the decision-making process. After adjusting for all covariates, micropolitan residents continued to have lower odds of being confident in the plan that they chose.

CONCLUSIONS

Policy-makers should pay particular attention to making information about Part D easily accessible for all beneficiaries and to addressing unique barriers that rural residents have in accessing information while making decisions, such as reduced Internet availability. Furthermore, confidence in the decision-making process may be improved by simplifying the Part D program.

Effective presentation of health care performance information for consumer decision making: A systematic review

OBJECTIVE

This systematic review synthesizes what is known about the effective presentation of health care performance information for consumer decision making.

METHODS

Six databases were searched for articles published in English between September 2003 and April 2014. Experimental studies comparing consumers' responses to performance information when one or more presentation feature was altered were included. A thematic analysis was performed and practical guidelines derived.

RESULTS

All 31 articles retained, the majority which tested responses to various presentations of health care cost and/or quality information, found that consumers better understand and make more informed choices when the information display is less complex. Simplification can be achieved by reducing the quantity of choices, displaying results in a positive direction, using non-technical language and evaluative elements, and situating results in common contexts.

CONCLUSION

While findings do not offer a prescriptive design, this synthesis informs approaches to enhancing the presentation of health care performance information and areas that merit additional research.

PRACTICE IMPLICATIONS

Guidelines derived from these results can be used to enhance health care performance reports for consumer decision making including using recognizable, evaluative graphics and customizable formats, limiting the amount of information presented, and testing presentation formats prior to use.

Information presentation features and comprehensibility of hospital report cards: design analysis and online survey among users

Background

Improving the transparency of information about the quality of health care providers is one way to improve health care quality. It is assumed that Internet information steers patients toward better-performing health care providers and will motivate providers to improve quality. However, the effect of public reporting on hospital quality is still small. One of the reasons is that users find it difficult to understand the formats in which information is presented.

Objective

We analyzed the presentation of risk-adjusted mortality rate (RAMR) for coronary angiography in the 10 most commonly used German public report cards to analyze the impact of information presentation features on their comprehensibility. We wanted to determine which information presentation features were utilized, were preferred by users, led to better comprehension, and had similar effects to those reported in evidence-based recommendations described in the literature.

Methods

The study consisted of 5 steps: (1) identification of best-practice evidence about the presentation of information on hospital report cards; (2) selection of a single risk-adjusted quality indicator; (3) selection of a sample of designs adopted by German public report cards; (4) identification of the information presentation elements used in public reporting initiatives in Germany; and (5) an online panel completed an online questionnaire that was conducted to determine if respondents were able to identify the hospital with the lowest RAMR and if respondents’ hospital choices were associated with particular information design elements.

Results

Evidence-based recommendations were made relating to the following information presentation features relevant to report cards: evaluative table with symbols, tables without symbols, bar charts, bar charts without symbols, bar charts with symbols, symbols, evaluative word labels, highlighting, order of providers, high values to indicate good performance, explicit statements of whether high or low values indicate good performance, and incomplete data (“N/A” as a value). When investigating the RAMR in a sample of 10 hospitals’ report cards, 7 of these information presentation features were identified. Of these, 5 information presentation features improved comprehensibility in a manner reported previously in literature.

Conclusions

To our knowledge, this is the first study to systematically analyze the most commonly used public reporting card designs used in Germany. Best-practice evidence identified in international literature was in agreement with 5 findings about German report card designs: (1) avoid tables without symbols, (2) include bar charts with symbols, (3) state explicitly whether high or low values indicate good performance or provide a “good quality” range, (4) avoid incomplete data (N/A given as a value), and (5) rank hospitals by performance. However, these findings are preliminary and should be subject of further evaluation. The implementation of 4 of these recommendations should not present insurmountable obstacles. However, ranking hospitals by performance may present substantial difficulties.

Clinicians' views of formats of performance comparisons

RATIONALE, AIMS AND OBJECTIVES

Comparisons of the performance of health care providers are increasingly being used. Despite one key audience being clinicians, there has been little research on the format and content of such comparisons. Our aim was to explore clinicians' comprehension and preferences of format and content in displaying provider outcomes using comparisons of patient reported outcome measures data.

METHOD

A qualitative study, based on seven meetings involving 107 clinicians (mostly consultant and junior doctors, and nurses), revealed their views on nine formats and five aspects of content.

RESULTS

Key findings were the desire for data in more than one format, explicit display of comparative performance (rank order) and the need for explanations (e.g. of unfamiliar formats and of statistical uncertainty).

CONCLUSIONS

Several themes were identified that shaped clinicians' views. Results were sufficiently clear to permit recommendations for the form and content of standard reports for the National Health Service.

Consumer response to patient experience measures in complex information environments

BACKGROUND

As indicators of clinician quality proliferate, public reports increasingly include multiple metrics. This approach provides more complete performance information than did earlier reports but may challenge consumers' ability to understand and use complicated reports.

OBJECTIVES

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.

RESEARCH DESIGN

In an Internet-based experiment, participants were asked to compare information on physician quality and choose a primary care doctor. Participants were randomly assigned to choice sets of varied complexity (CAHPS alone vs. CAHPS with other measures) and number of doctors. Participants completed surveys before and after this choice task.

SUBJECTS

A total of 555 US residents, aged 25-64, who had Internet access through computer were recruited from an existing online panel.

MEASURES

Recall seeing CAHPS measures; use of CAHPS measures for making choices; ratings of ease of use, usefulness and trustworthiness of CAHPS ratings; concerns about usefulness and trustworthiness.

RESULTS

Participants presented with CAHPS information and other performance indicators relied less on CAHPS than did those presented with CAHPS information only, although they considered CAHPS information as valuable as did other respondents. Participants presented with smaller choice sets also judged CAHPS information as less easy to use when accompanied by other metrics than when it was presented alone.

A field experiment on the impact of physician-level performance data on consumers' choice of physician

BACKGROUND

In 2008, HealthPlus of Michigan introduced an online primary care provider (PCP) report that displays clinical quality data and patients' ratings of their experiences with PCPs on a public web site.

DESIGN AND PROCEDURE

A randomized encouragement design was used to examine the impact of HealthPlus's online physician-quality report on new plan members' choice of a PCP. This study evaluated the impact of an added encouragement to utilize the report by randomizing half of new adult plan members in 2009-2010, who were required to select a PCP (N=1347), to receive a 1-page letter signed by the health plan's chief medical officer emphasizing the importance of the online report and a brief phone call reminder. We examined the use of the report and the quality of PCPs selected by participants.

RESULTS

Twenty-eight percent of participants in the encouragement condition versus 22% in the control condition looked at the online report before selecting a PCP. Although participants in the encouragement condition selected PCPs with higher patient experience ratings than did control participants, this difference was not explained by their increased likelihood of accessing the online report.

CONCLUSIONS

Health plan members can be encouraged successfully to access physician-level quality data using an inexpensive letter and automated phone call. However, a large proportion of missing data in HealthPlus's online report may have limited the influence of the physician-quality report on consumer choice.

Communicating health rights to disadvantaged populations: challenges in developing a culture-centered approach for Ethiopian immigrants in Israel

Knowing about one's health rights can be critical for obtaining equitable and appropriate health care. A model drawing on a culture-centered approach was used to develop and present health rights information materials for a disadvantaged cultural minority-the Ethiopian immigrant community in Israel. The model is based on the supposition that the design of health rights information materials should address both concerns and barriers identified by members of the cultural community and illustrate specific means to address them. Stories of community members' actual experiences served as the basis for several types of narratives presented in video clips, a photonovella, and an illustrated booklet. More than 100 people participated in the study in five focus groups and 50 personal interviews. Findings indicate participants felt the materials developed using this approach were informative and represented their concerns and cultural barriers to realizing these rights from their perspective and would help motivate them to realize their health rights. The analytic process, which involved members from the cultural community, resulted in the identification of dilemmas associated with the development of solution-oriented materials that draw on the culture-centered approach. These dilemmas pose additional theoretical challenges to the culture-centered approach.

Making data more meaningful: patients' views of the format and content of quality indicators comparing health care providers

OBJECTIVE

Patient reported outcome measures (PROMs) are being used to inform national quality indicators for health care providers in England. Our objective was to explore patients' views of different formats and content of these data displays.

METHODS

Six focus groups (N = 45) considered different formats (tables, bar charts, caterpillar and funnel plots) and content (uncertainty displays, volume of outcomes, color, icons, and ordering). A thematic analysis was carried out based on transcripts.

RESULTS

Tables housing icons (star ratings) were the preferred display, having the most popular resonance and facilitating cognitive processing, appealing to most as the best format. Inferred meanings were overwhelmingly applied to unfamiliar formats (funnel plot) and content (uncertainty). Traffic light highlighting and using consistent and recognizable icons (five stars) helped understanding. Familiarity with the bar chart seemed to lend to false readings--error bars were not interpreted.

CONCLUSION

Aspects of familiarity, meaningfulness (whether and how displays resonated with participants), and cognitive or choice processes informed views of displays.

PRACTICE IMPLICATIONS

Tables with star ratings should be a primary display, ordered on statistical significance, including providers in the region plus England average. Caterpillar plots should be used to provide contextual information. More detailed numeric tables should also be accessible.

Impact of an elective course on pharmacy students' attitudes, beliefs, and competency regarding Medicare Part D

OBJECTIVE

To determine the impact of an elective course on pharmacy students' perceptions, knowledge, and confidence regarding Medicare Part D, medication therapy management (MTM), and immunizations.

DESIGN

Thirty-three pharmacy students were enrolled in a Medicare Part D elective course that included both classroom instruction and experiential training.

ASSESSMENT

Students' self-reported confidence in and knowledge of Part D significantly improved upon course completion. End-of-course student perceptions about the relative importance of various aspects of MTM interventions and their confidence in performing MTM services significantly improved from those at the beginning of the course. Students' confidence in performing immunizations also increased significantly from the start of the course.

CONCLUSION

A classroom course covering Medicare Part D with an experiential requirement serving beneficiaries can improve students' attitudes and knowledge about Medicare Part D and their confidence in providing related services to beneficiaries in the community.

New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly 'crisis care'

Health literacy is the capacity to understand basic health information and make appropriate health decisions. Tens of millions of Americans have limited health literacy--a fact that poses major challenges for the delivery of high-quality care. Despite its importance, health literacy has until recently been relegated to the sidelines of health care improvement efforts aimed at increasing access, improving quality, and better managing costs. Recent federal policy initiatives, including the Affordable Care Act of 2010, the Department of Health and Human Services' National Action Plan to Improve Health Literacy, and the Plain Writing Act of 2010, have brought health literacy to a tipping point-that is, poised to make the transition from the margins to the mainstream. If public and private organizations make it a priority to become health literate, the nation's health literacy can be advanced to the point at which it will play a major role in improving health care and health for all Americans.

Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations

BACKGROUND

It is becoming increasingly common to release information about the performance of hospitals, health professionals or providers, and healthcare organisations into the public domain. However, we do not know how this information is used and to what extent such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers and purchasers, or to what extent the performance of professionals and providers can be affected.

OBJECTIVES

To determine the effectiveness of the public release of performance data in changing the behaviour of healthcare consumers, professionals and organisations.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE Ovid (from 1966), EMBASE Ovid (from 1979), CINAHL, PsycINFO Ovid (from 1806) and DARE up to 2011.

SELECTION CRITERIA

We searched for randomised or quasi-randomised trials, interrupted time series and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or individuals. The papers had to report at least one main outcome related to selecting or changing care. Other outcome measures were awareness, attitude, views and knowledge of performance data and costs.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers and healthcare purchasers), performance data, main outcomes (choice of healthcare provider and improvement by means of changes in care) and other outcomes (awareness, attitude, views, knowledge of performance data and costs).

MAIN RESULTS

We included four studies containing more than 35,000 consumers, and 1560 hospitals. Three studies were conducted in the USA and examined consumer behaviour after the public release of performance data. Two studies found no effect of Consumer Assessment of Healthcare Providers and Systems information on health plan choice in a Medicaid population. One interrupted time series study found a small positive effect of the publishing of data on patient volumes for coronary bypass surgery and low-complication outliers for lumbar discectomy, but these effects did not persist longer than two months after each public release. No effects on patient volumes for acute myocardial infarction were found.One cluster-randomised controlled trial, conducted in Canada, studied improvement changes in care after the public release of performance data for patients with acute myocardial infarction and congestive heart failure. No effects for the composite process-of-care indicators for either condition were found, but there were some improvements in the individual process-of-care indicators. There was an effect on the mortality rates for acute myocardial infarction. More quality improvement activities were initiated in response to the publicly-released report cards. No secondary outcomes were reported.

AUTHORS' CONCLUSIONS

The small body of evidence available provides no consistent evidence that the public release of performance data changes consumer behaviour or improves care. Evidence that the public release of performance data may have an impact on the behaviour of healthcare professionals or organisations is lacking.

Complex Medicare advantage choices may overwhelm seniors--especially those with impaired decision making

The proliferation of Medicare Advantage plans has given Medicare enrollees more choices, but these could be overwhelming for some, especially for those with impaired decision-making capabilities. We analyzed national survey data and linked Medicare enrollment data for the period 2004-07 to examine the effects on enrollment of expanded choices and benefits in the Medicare Advantage program. The availability of more plan options was associated with increased enrollment in Medicare Advantage when elderly Medicare beneficiaries chose from a limited number of plans-for example, fewer than fifteen plans. Enrollment was unchanged or decreased in Medicare Advantage when beneficiaries chose from larger numbers of plans-for example, fifteen to thirty, or more than thirty. Elderly adults with low cognitive function were less responsive to the generosity of available benefits than those with high cognitive function when choosing between traditional Medicare and Medicare Advantage. Simplifying choices in Medicare Advantage could improve beneficiaries' enrollment decisions, strengthen value-based competition among plans, and extend the benefits of choice to seniors with impaired cognition. It could also lower their out-of-pocket costs.

Patient's decision making in selecting a hospital for elective orthopaedic surgery

RATIONALE, AIMS AND OBJECTIVES

The admission to a hospital for elective surgery, like arthroplasty, can be planned ahead. The elective nature of arthroplasty and the increasing stimulus of the public to critically select a hospital raise the issue of how patients actually take such decisions. The aim of this paper is to describe the decision-making process of selecting a hospital as experienced by people who underwent elective joint arthroplasty and to understand what factors influenced the decision-making process.

METHODS

Qualitative descriptive study with 18 participants who had a hip or knee replacement within the last 5 years. Data were gathered from eight individual interviews and four focus group interviews and analysed by content analysis.

RESULTS

Three categories that influenced the selection of a hospital were revealed: information sources, criteria in decision making and decision-making styles within the GP- patient relationship. Various contextual aspects influenced the decision-making process. Most participants gave higher priority to the selection of a medical specialist than to the selection of a hospital.

CONCLUSION

Selecting a hospital for arthroplasty is extremely complex. The decision-making process is a highly individualized process because patients have to consider and assimilate a diversity of aspects, which are relevant to their specific situation. Our findings support the model of shared decision making, which indicates that general practitioners should be attuned to the distinct needs of each patient at various moments during the decision making, taking into account personal, medical and contextual factors.

Themes affecting health-care consumers' choice of a hospital for elective surgery when receiving web-based comparative consumer information

OBJECTIVE

To get insights into the decision-making strategy of health-care consumers when confronted with comparative consumer information.

METHODS

Qualitative descriptive study among 18 consumers who had a hip or knee replacement no longer than five years ago. To study their decision-making strategies a paper draft for a website was used providing comparative consumer information. Data were collected by cognitive interviews and focus-group meetings and subjected to thematic analysis.

RESULTS

Consumers were able to understand the presented information, but had problems to use it as a decision aid. They primarily relied on previous experiences. Four themes were revealed: decision making, perceived benefits, unmet information needs, and trustworthiness. Consumers used different decision strategies and showed unpredictable behavior when choosing a hospital.

CONCLUSION

Individual decision strategies, unsatisfied information needs, limited tenability and too coarse aggregation levels of quality scores are barriers for a proper use of comparative consumer information. Personal experience remains a valuable information source for hospital selection. We suggest that a website presenting comparative consumer information should be flexible in various ways and should include functionality to share personal experience.

Elderly patients' knowledge of drug benefit caps and communication with providers about exceeding caps

OBJECTIVES

Many elderly persons have drug benefits with coverage gaps, such as in Medicare Part D. Because beneficiaries who have such gaps must pay all drug costs, an accurate knowledge of gap thresholds and communication with providers about exceeding caps is important for elderly persons to manage out-of-pocket drug costs.

DESIGN

Cross-sectional survey.

SETTING

Health plan.

PARTICIPANTS

One thousand three hundred eight health plan members aged 65 and older. The study was a 2002 cross-sectional survey of elderly persons with capped drug benefits in a managed care plan in one state. Participants were sampled so that half reached coverage caps and half did not.

METHODS

Participants reported cap levels, communication with providers about exceeding caps, and decreased medication use due to cost.

RESULTS

Of the 1,308 participants (65.4%response rate), 68.6%did not know their correct cap level. Rates were similar in those who exceeded caps (66.2%), reported difficulty paying for medications (63.9%), or decreased medication use (66%). For participants who exceeded caps, 59.1% did not know beforehand that they were close to exceeding caps and 50.2% did not tell providers afterward. In multivariate analyses accounting for demographics and health, the oldest participants (> or =85 vs 65-74) were at greater risk for not knowing cap levels (odds ratio (OR)=2.0, 95% confidence interval (CI)=1.2-3.4) and not telling providers about exceeding caps (OR=2.2, 95% CI=1.1-4.5).

CONCLUSIONS

Elderly patients often did not know correct cap levels and did not tell providers about exceeding caps. Providers, plans, and policymakers should actively assess and improve Medicare beneficiaries' knowledge of Part D coverage gaps.

Problem-based learning using the online Medicare Part D Plan Finder tool

OBJECTIVES

To implement didactic and problem-based learning curricular innovations aimed at increasing students' knowledge of Medicare Part D, improving their ability to apply the online Medicare Prescription Drug Plan Finder tool to a patient case, and improving their attitudes toward patient advocacy for Medicare beneficiaries.

METHODS

A survey instrument and a case-based online Medicare Prescription Drug Plan Finder tool exercise were administered to a single group (n = 120) of second-year pharmacy graduate students prior to and following completion of a course on health policy. Three domains (knowledge, skill mastery and attitudes) were measured before and after two 90-minute lectures on Medicare Part D.

RESULTS

The online Medicare Prescription Drug Plan Finder exercise and Medicare Part D didactic lectures had positive effects on students' knowledge of Part D, attitudes toward patient advocacy, and ability to accurately use the Medicare Prescription Drug Plan Finder tool.

CONCLUSIONS

The success of these didactic and problem-based curricular innovations in improving pharmacy students' knowledge, skills, and attitudes regarding Part D warrants further evaluation to determine their portability to clinical settings and other pharmacy schools.

The "choose with care system" - development of education materials to support informed Medicare health plan choices

People aging into Medicare need to choose a health plan. Several challenges exist for consumers in choosing a Medicare health plan, including limited knowledge of Medicare, limited experience in using comparative health plan quality information, and limited experience and ability to pull together and use plan information from different sources like employers and the Medicare program. The Choose with Care System was developed to help consumers aging into Medicare make informed Medicare health plan choices. Choose with Care is an innovative decision support tool for employers to use to assist people approaching age 65 to learn about their Medicare health plan options and how to incorporate information on the quality of care and services offered by health plans into their choices. Employers are the targeted channel for distributing the Choose with Care materials because they are one of the most recognized and accessible formal intermediaries for information about health insurance. We used multiple methods to test the Choose with Care products. Product testing showed that the Choose with Care materials increase older consumers' knowledge of Medicare and how it relates to retiree health insurance and improves their comprehension and use of comparative quality information when choosing a health plan.