Hospital Advertising, Competition, and HCAHPS: Does It Pay to Advertise?

OBJECTIVE: To test whether hospital advertising expenditures predict HCAHPS global ratings. DATA SOURCES/STUDY SETTING: We examined media advertising expenditures by 2,142 acute care hospitals in 209 markets in the United States. Data on hospital characteristics, location, and revenue came from CMS reports; system ownership was obtained from the American Hospital Association. Advertising data came from Kantar Media. HCAHPS data were obtained from HospitalCompare. STUDY DESIGN: Regression models examined whether hospitals' advertising spending predicts HCAHPS global measures and whether market concentration moderated this association. DATA COLLECTION/EXTRACTION METHODS: Hospital advertising spending was calculated by adding each individual hospital's expenditures to the amount spent by its parent health system, proportionally allocated by hospital revenue. Health system market share was used to estimate market concentration. These data were compared to hospitals' HCAHPS measures. PRINCIPAL FINDINGS: In competitive markets (HHI below 1,000), hospital advertising predicted HCAHPS global measures. A 1-percent increase in advertising was associated with a 1.173-percent increase in patients rating the hospital a "9" or "10" on the HCAHPS survey and a 1.540-percent increase in patients who "definitely" would recommend the hospital. In concentrated markets, this association was not significant. CONCLUSIONS: In competitive markets, hospitals that spend more on advertising earn higher HCAHPS ratings on global measures.

When are support and opposition not opposites? Depth of processing as a moderator of the valence-framing effect.

Prior research has demonstrated the valence-framing effect, in which leading people to frame a preference negatively (e.g., 'I oppose Romney') yields stronger attitudes than does leading people to frame that same preference positively (e.g., 'I support Obama'). Three studies tested whether or not depth of processing (as operationalized by manipulations of motivation and ability to cognitively process) moderate the effect. The valence-framing effect was replicated, such that opposers manifested stronger attitudes than did supporters, but only when attitudes were relevant to the participants (Experiments 1 and 3), and when participants were not under cognitive load (Experiment 2). Our results thus identify depth of processing as an important moderator of the valence-framing effect and provide potential insight into the effect's mechanism.

The effects of immediate forewarning of test difficulty on test performance.

Whereas prior research has demonstrated that warning students of an exam's difficulty well in advance of the exam enhances performance, the current research demonstrated the effect of such forewarning immediately before examination administration. Moments before taking an examination in a laboratory environment, participants were either (a) informed that the examination would be difficult, (b) informed that the examination would be easy, or (c) not given any information about the exam's ostensible difficulty. Participants of low trait anxiety performed better when told the exam would be difficult than when told that the exam would be easy. Conversely, participants of high trait anxiety performed worse when told the exam would be difficult than they did when told the exam would be easy or when provided with no such information. Implications and directions for future research are discussed.

The impact of personality on cognitive, behavioral, and affective political processes: the effects of need to evaluate.

Need to evaluate (NE) is a personality trait that reflects a person's proclivity to create and hold attitudes; people high in NE are especially likely to form attitudes toward all sorts of objects. Using data from the 1998 National Election Survey Pilot and the 2000 National Election Survey, NE was shown to predict a variety of important attitude-relevant cognitive, behavioral, and affective political processes beyond simply holding attitudes: NE predicted how many evaluative beliefs about candidates a person held, the likelihood that a person would use party identification and issue stances to determine candidate preferences, the extent to which a person engaged in political activism, the likelihood that a person voted or intended to vote, the extent to which a person used the news media for gathering information, and the intensity of emotional reactions a person felt toward political candidates. Thus, NE appears to play a powerful role in shaping important political behavior, emotion, and cognition.