Referring physicians' intention to use hospital report cards for hospital referral purposes in the presence or absence of patient-reported outcomes: a randomized trial.

PURPOSE: This study aims to determine the intention to use hospital report cards (HRCs) for hospital referral purposes in the presence or absence of patient-reported outcomes (PROs) as well as to explore the relevance of publicly available hospital performance information from the perspective of referring physicians. METHODS: We identified the most relevant information for hospital referral purposes based on a literature review and qualitative research. Primary survey data were collected (May-June 2021) on a sample of 591 referring orthopedists in Germany and analyzed using structural equation modeling. Participating orthopedists were recruited using a sequential mixed-mode strategy and randomly allocated to work with HRCs in the presence (intervention) or absence (control) of PROs. RESULTS: Overall, 420 orthopedists (mean age 53.48, SD 8.04) were included in the analysis. The presence of PROs on HRCs was not associated with an increased intention to use HRCs (p = 0.316). Performance expectancy was shown to be the most important determinant for using HRCs (path coefficient: 0.387, p < .001). However, referring physicians have doubts as to whether HRCs can help them. We identified "complication rate" and "the number of cases treated" as most important for the hospital referral decision making; PROs were rated slightly less important. CONCLUSIONS: This study underpins the purpose of HRCs, namely to support referring physicians in searching for a hospital. Nevertheless, only a minority would support the use of HRCs for the next hospital search in its current form. We showed that presenting relevant information on HRCs did not increase their use intention.

The elicitation of patient and physician preferences for calculating consumer-based composite measures on hospital report cards: results of two discrete choice experiments.

PURPOSE: The calculation of aggregated composite measures is a widely used strategy to reduce the amount of data on hospital report cards. Therefore, this study aims to elicit and compare preferences of both patients as well as referring physicians regarding publicly available hospital quality information METHODS: Based on systematic literature reviews as well as qualitative analysis, two discrete choice experiments (DCEs) were applied to elicit patients' and referring physicians' preferences. The DCEs were conducted using a fractional factorial design. Statistical data analysis was performed using multinomial logit models RESULTS: Apart from five identical attributes, one specific attribute was identified for each study group, respectively. Overall, 322 patients (mean age 68.99) and 187 referring physicians (mean age 53.60) were included. Our models displayed significant coefficients for all attributes (p < 0.001 each). Among patients, "Postoperative complication rate" (20.6%; level range of 1.164) was rated highest, followed by "Mobility at hospital discharge" (19.9%; level range of 1.127), and ''The number of cases treated" (18.5%; level range of 1.045). In contrast, referring physicians valued most the ''One-year revision surgery rate'' (30.4%; level range of 1.989), followed by "The number of cases treated" (21.0%; level range of 1.372), and "Postoperative complication rate" (17.2%; level range of 1.123) CONCLUSION: We determined considerable differences between both study groups when calculating the relative value of publicly available hospital quality information. This may have an impact when calculating aggregated composite measures based on consumer-based weighting.

The use intention of hospital report cards among patients in the presence or absence of patient-reported outcomes.

BACKGROUND: So far, the adoption of hospital report cards (HRCs) falls short of expectations. One promising strategy is to modify the content of HRCs by presenting patient-reported outcomes (PROs). OBJECTIVE: To identify the key determinants influencing patients to use HRCs for hospital decision making and determine the effect of presenting PROs on HRCs on their use intention. METHODS: Primary survey data were collected (5/6-2021) on a sample of 2000 randomly selected insurees from a German statutory health insurance who have undergone elective hip arthroplasty surgery. RESULTS: Overall, 447 participants (mean age 66.56) completed the survey and were included in the analysis. Respondents rated "PROs" as most important for the hospital choice followed by "Mobility at hospital discharge" and "Confirmed diagnosis rate". Patients generally perceive HRCs to be a good idea that makes searching for a hospital more interesting. We identified attitude and social influence as the most important determinants for using HRCs (p<.001 each). The presence of PROs on HRCs was not associated with an increased intention to use HRCs neither in our descriptive analysis (p=.593), nor in our research model (p=.763). CONCLUSIONS: Patients value PROs to be an important information for choosing a hospital. Nevertheless, health policy makers should note that presenting PROs on HRCs as a single approach is not likely to increase the use of HRCs.

[Satisfaction of Rehabilitation Patients on Social Media Websites and Online Rating Portals]. / Rehabilitandenzufriedenheit in den sozialen Medien und auf Online-Bewertungsportalen.

PURPOSE: Patients increasingly express themselves about their medical rehabilitation stay, evaluate health service providers with star ratings, and write reviews on the internet. So far, no results are available regarding online patient satisfaction for inpatient medical rehabilitation in Germany. For the first time, this study conducted a systematic analysis of rehabilitation patient satisfaction on social media websites and hospital rating portals. METHODS: We collected reviews of medical rehabilitation on the portal Klinikbewertungen.de and the social network Facebook for 8 indication groups (orthopedics, psychosomatics/psychotherapy, oncology, cardiology, neurology, internal medicine, pulmonology/dermatology, gastroenterology) with a full data extraction over 3 survey years (October 2014-September 2017) and for rehabilitation clinics with main bed occupancy of retirement insurance (N=497). The star ratings, aggregated according to indication groups, were evaluated to determine patient satisfaction (Pearson's chi-square test, Fisher's exact test, Phi coefficient). RESULTS: A total of 97.2% of the rehabilitation clinics were represented, with 24,806 ratings on Klinikbewertungen.de. The most frequently evaluated indication groups were orthopedics (38.5%) and psychosomatics/psychotherapy (27.1%). Facebook ratings (N=4,127) were collected for rehabilitation clinics with one department (38.6%) in order to ensure an indication group assignment. Almost the same number of ratings were determined on official (48.7%) and unofficial Facebook pages (51.3%), with no significant correlation between website management and overall satisfaction (p>0.05). On the Facebook pages of the rehabilitation clinics, 49.1% of the ratings were written by women (38.5% by men; 12.4% not assignable). Sociodemographic information on Klinikbewertungen.de was based solely on the status of the insured (89.1% of those with statutory insurance). Overall, 95.4% of the reviews were written by patients and 4.0% by relatives, with 77.5% of patients recommending the clinic to other users (relatives: 37.2%). Most patient ratings were positive. However, there were differences in overall satisfaction between the indication groups. Patients in oncology (77.9%) were more satisfied than those in neurology (59.0%). CONCLUSIONS: Online ratings of inpatient medical rehabilitation were collected to a considerable extent. These were mostly positive. The results are comparable to standardized surveys. Despite restrictions in the use of social media data, the results indicated that the publicly available real-time online feedback from patients can provide useful information for the quality management of clinics as well as for patients in exercising their right to choose a rehabilitation clinic.

[User Satisfaction in Social Media: How do Patients Rate their Hospital Stay Online?] / Nutzerzufriedenheit in den sozialen Medien. Wie beurteilen Patienten ihren Krankenhausaufenthalt online?

BACKGROUND: Patients are increasingly using social media and review sites to get information on hospitals, to rate them or to write a review about their own experiences during hospital stay. Hospitals have the opportunity to use these patient reviews for internal quality assurance as well as online reputation marketing. OBJECTIVE: The objective is to analyze the satisfaction ratings of previous hospitals stays by social media users on platforms such as "Google", as well as reviews from the German site "Klinikbewertungen.de", and to compare them. METHODS: User reviews (n=16,691) for all hospitals (n=180) in the federal state of Lower Saxony (complete survey) for 2013-2018 were extracted from the platforms Google and the German Klinikbewertungen.de. Subsequently, a descriptive and inductive analysis (Chi²-test) of the user reviews and a comparison specific for the platforms were completed. RESULTS: Most users are satisfied with their hospital stay, whereby users of the platform Google ratd their hospital stay worse (n=6,181; 57.6% satisfied) than users of the platform Klinikbewertungen.de (n=10,509; 65.4% satisfied). Features of the hospital (number of beds, specialist departments) and features of the users (author, type of insurance) were significantly associated with the rating for the hospital stay (star review). (Google: number of beds p<0.001; Klinikbewertungen.de: number of beds p<0.001, author p<0.001, specialist departments p<0.001, type of insurance p<0.001). CONCLUSION: The online review of a hospital stay is associated with the number of beds, the specialist departments of hospitals, whether the author is the patient or a relative, and the type of health insurance they have, namely private or statutory. Online reviews and ratings for hospitals may be used for internal quality assurance or improvements of company online reputation.

[Positive association between successful rehabilitation and patient hospital ratings: Experience reports of patients in rehabilitation on a hospital rating and review site]. / Klinik-Weiterempfehlung bei Reha-Erfolg: Erfahrungsberichte von Rehabilitanden auf einer Klinik-Bewertungsplattform.

INTRODUCTION: Feedback from patients about aspects of rehabilitation services is increasingly provided online, for example, on specialized hospital comparison websites. Therefore, we examined which kind of online statements from rehabilitation patients published on the leading hospital comparison website "Klinikbewertungen.de" (KB) is associated with a positive recommendation of a rehabilitation clinic and which negative aspects are associated with a non-recommendation. METHODS: For eight indication groups stratified online statements of rehabilitants at KB were evaluated qualitatively using content analysis. The relationship between positive (negative) statements and the (non-) recommendation was examined. RESULTS: Content analysis of 911 experience reports revealed 20 categories. Most often, it was the "rehabilitation success" perceived by rehabilitation patients that was significantly associated with a recommendation or a non-recommendation of a hospital, and in five quality assurance (QA) comparison groups the category "catering" was associated with a positive or negative recommendation. In all QS comparison groups, there was an association with at least one of the following process-oriented rehabilitation categories: "rehabilitation measures", "rehabilitation plan and rehabilitation goals" and / or "diagnosis to discharge". DISCUSSION AND CONCLUSION: Patient experiences with the perceived "rehabilitation success" and with the central processes of rehabilitation are particularly important for the recommendation or non-recommendation of a hospital for patients in all eight indication groups. On the basis of these results, rehabilitation hospitals can specifically identify the aspects of care that are important when patients recommend a hospital for rehabilitation. Online narratives of patients provide additional insights into the reasons for patients' satisfaction or dissatisfaction with their rehabilitation. These narratives are available to potential rehabilitation patients as a low-threshold source of information and decision-making aid.

[Group Discussions in Health Services Research - Part 2: Reflections on The Concept of Group, Moderation and Analysis of Group Discussions as well as Online Group Discussion]. / Gruppendiskussionen in der Versorgungsforschung ­ Teil 2: Überlegungen zum Begriff der Gruppe, zur Moderation und Auswertung von Gruppendiskussionen sowie zur Methode der Online-Gruppendiskussion.

This article is the second of 2 articles on group discussions in health services research, written by the Qualitative Methods Working Group of the German Network for Health Care Research (DNVF). It starts with theoretical considerations on the concept of groups, and provides specific knowledge about groups in general and the behaviour of individual group members in particular, which is relevant for the design and interpretation of interaction processes in the group context. The following sections deal with the processuality of group discussions, moderation styles and techniques as well as reflections on possible subjects and methods of analysis. Presentation of results and text passages which unveil the interaction structure of several discussion participants are also discussed here. Finally, insights into the special features, potentials and challenges of group discussions via online platforms are provided. Together, the two articles provide an overview of the most important aspects of the application of group discussions in the field of health services research.

Do German public reporting websites provide information that office-based physicians consider before referring patients to hospital? A four-step analysis.

BACKGROUND: In recent years, many different performance frameworks and quality assurance systems have been developed to measure health care quality. In Germany, an external quality assurance system for hospitals was introduced in 2005. The data of these systems are often reported by public reporting websites (PRWs) to inform patients and other stakeholders interested in health care systems about health care providers' quality. However, publication is obligatory (at least in Germany) for most of the existing quality assurance measures; some may be reported voluntarily. An important target group for this information is the group of all office-based physicians as they are crucial for patients' hospital choice. However, public reporting initiatives in Germany and other countries have not increased the use of quality reports for hospital choice. OBJECTIVES: (1) To summarize the criteria that office-based physicians consider to be of high, medium, and low importance for hospital selection when referring patients and (2) to examine whether German public reporting websites (PRWs) provide these hospital-related criteria. METHODS: The analysis comprised four steps: 1) Five databases were systematically searched for peer-reviewed English- and German-language literature. 2) The selection of articles was based on compliance with inclusion criteria, and all the criteria relevant to the referral of patients to hospital were extracted. 3) The criteria were then divided into five main categories: structural quality, process quality, outcome quality, patient experience, and referring physicians' experience. In addition, the criteria were classified into three importance categories (high-, medium-, and low-priority criteria) according to their relevance to the referral decision. 4) We investigated whether German PRWs publicly report high-priority criteria. RESULTS: A total of N=11 articles published in peer-reviewed journals met our inclusion criteria. The studies were published in Germany (n=4), the Netherlands (n=3), Denmark, France, Norway, and the USA (n=1 each). In total, N=86 criteria were identified, most of them relating to structural quality (n=43) and process quality (n=26). We found just n=3 outcome quality criteria, only one of which fell in the high-priority category (breast cancer indicators with clinically relevant differences). In total, n=25 low-, n=40 medium-, and n=34 high-priority criteria could be established, which is due to the fact that some criteria had been investigated in several studies evaluating the importance of some criteria differently. Most of the high-priority criteria were related to process quality. All the high-priority structural quality criteria and high-priority outcome quality criteria were available on German PRWs, whereas just 38.5 % of those relating to process quality could be identified on these portals. We also identified 66.7 % of the high-priority criteria regarding patient experience and 50.0 % concerning the referring physicians' experience. Overall, a larger amount of low- and medium-priority criteria are available on German PRWs than high-priority criteria. DISCUSSION: A substantial amount of hospital information regarding structural quality and outcome quality is available on German PRWs. However, the development of further process quality criteria (which are currently underrepresented) should be considered, for example whether hospital physicians continue the medication initiated by office-based doctors. Also, hospital quality reports should be tailored for specific user groups, for instance for referring gynecologists or referring general practitioners (GPs).

[Group Discussions in Health Services Research - Part 1: Introduction and Deliberations on Selection of Method and Planning]. / Gruppendiskussionen in der Versorgungsforschung ­ Teil 1: Einführung und Überlegungen zur Methodenwahl und Planung.

Health services researchers focus on the players, structures and impact of health care in "real life". They investigate how social aspects, financing, organizational structures, technologies and personal attitudes affect the process and outcomes of health care. Qualitative research methods are used here, which address how people act according to their unique living conditions (outside the context of experimental studies). Different methods of debriefing groups are essential for qualitative health services research. In 2 subsequent articles, we aim to outline the diverse facets and possible range of implementation of the above-mentioned methods, in order to highlight the potential of debriefing groups in health services research (focus groups or group discussions) using these methods. In the current article, we would like to encourage researchers to reflect on relevant topics such as the selection of an appropriate method, the planning and undertaking of investigations including sampling methods, and questions regarding ethics and privacy. A follow-up article (in preparation) will deal with theoretical considerations of the term "group", as well as with the process of moderating discussions, methods of analyzing data and (qualitative) online research.

[Do laymen understand information about hospital quality? An empirical verification using risk-adjusted mortality rates as an example]. / Verstehen Laien Informationen über die Krankenhausqualität? Eine empirische Überprüfung am Beispiel der risikoadjustierten Mortalität.

INTRODUCTION: The effect of public reporting to improve quality in healthcare is reduced by the limited intelligibility of information about the quality of healthcare providers. This may result in worse health-related choices especially for older people and those with lower levels of education. There is, as yet, little information as to whether laymen understand the concepts behind quality comparisons and if this comprehension is correlated with hospital choices. METHODS: An instrument with 20 items was developed to analyze the intelligibility of five technical terms which were used in German hospital report cards to explain risk-adjusted death rates. Two online presentations of risk-adjusted death rates for five hospitals in the style of hospital report cards were developed. An online survey of 353 volunteers tested the comprehension of the risk-adjusted mortality rates and included an experimental hospital choice. RESULTS: The intelligibility of five technical terms was tested: risk-adjusted, actual and expected death rate, reference range and national average. The percentages of correct answers for the five technical terms were in the range of 75.0-60.2%. Between 23.8% and 5.1% of the respondents were not able to answer the question about the technical term itself. The least comprehensible technical terms were "risk-adjusted death rate" and "reference range". The intelligibility of the 20 items that were used to test the comprehension of the risk-adjusted mortality was between 89.5% and 14.2%. The two items that proved to be least comprehensible were related to the technical terms "risk-adjusted death rate" and "reference range". For all five technical terms it was found that a better comprehension correlated significantly with better hospital choices. DISCUSSION: We found a better than average intelligibility for the technical terms "actual and expected death rate" and for "national average". The least understandable were "risk-adjusted death rate" and "reference range". Since the self-explanatory technical terms "actual and expected death rate" and "national average" are easy to understand and the comprehension is correlated with hospitals choices, we recommend using them for the presentation of measures which contain risk-adjusted mortality. The technical terms "risk-adjusted death rate" and "reference range" should stay in the background, since comprehension problems can be expected and explanations would have to be provided.

Reaching the Elderly: Understanding of health and preventive experiences for a tailored approach - Results of a qualitative study.

BACKGROUND: Often preventive measures are not accessed by the people who were intended to be reached. Programs for older adults may target men and women, older adults, advanced old age groups and/or chronically ill patients with specific indications. The defined target groups rarely participate in the conception of programs or in the design of information materials, although this would increase accessibility and participation. In the German "Reaching the Elderly" study (2008-2011), an approach to motivating older adults to participate in a preventive home visit (PHV) program was modified with the participatory involvement of the target groups. The study examines how older men and women would prefer to be addressed for health and prevention programs. METHODS: Four focus groups (N = 42 participants) and 12 personal interviews were conducted (women and men in 2 age groups: 65-75 years and ≥ 76 years). Participants from two districts of a major German city were selected from a stratified random sample (N = 200) based on routine data from a local health insurance fund. The study focused on the participants' knowledge about health and disease prevention and how they preferred to be approached and addressed. Videos of the focus groups were recorded and analysed using mind mapping techniques. Interviews were digitally recorded, transcribed verbatim and subjected to qualitative content analysis. RESULTS: A gender-specific approach profile was observed. Men were more likely to favor competitive and exercise-oriented activities, and they associated healthy aging with mobility and physical activity. Women, on the other hand, displayed a broader understanding of healthy aging, which included physical activity as only one aspect as well as a healthy diet, relaxation/wellness, memory training and independent living; they preferred holistic and socially oriented services that were not performance-oriented. The "older seniors" (76+) were ambivalent towards certain wordings referring to aging. CONCLUSIONS: Our results suggest that gender-specific needs must be considered in order to motivate older adults to participate in preventive services. Age-specific characteristics seem to be less relevant. It is more important to pay attention to factors that vary according to the individual state of health and life situation of the potential participants.

["That you stay free, but always know there is this support rod that I need"]. / "Dass man also frei bleibt, aber immer das Gefühl hat: Da ist diese Haltestange, die ich brauch"

OBJECTIVE: Models of integrated care (IC) have a high potential to improve psychiatric care in a sectored health care system. The present study aims to delineate differences in the perception of psychiatric care after introduction of a regional IC-model in schizophrenic patients and family caregivers. METHODS: Six focus group interviews with n = 32 schizophrenic patients and three with n = 17 family caregivers either from the region with IC-model or a nearby control region were conducted. Categories of the contents of transcribed interviews were developed and subsequently compared between persons with and without experience of IC. RESULTS: Most participants of the IC-group were not aware to participate in an IC-model. Differences between IC- vs. non-IC groups were primarily related to feelings of security and experiences of flexibility of care which was ensured by the outpatient nursing service in the IC-model. This was noticeable both in daily living and in coping with crisis. No substantial differences were found with regard to the experience of cooperation of professionals, information and psychoeducation of patients as well as support for family caregivers, amongst others. CONCLUSIONS: IC will play an important part in the psychiatric care of schizophrenic patients. It has the potential to integrate sustainable relations, general availability and needs-related care provision.