IDEAS for a Healthy Baby: Reducing Disparities in Consumer Use of Quality Data

描述(由申请人提供)：提高医疗保健质量透明度的努力部分是基于这样一种信念，即这些信息将使消费者能够 更明智的选择。尽管网站上报告的信息量大幅增加，但消费者的使用仍然有限，而且主要局限于受过大学教育的白人和中年消费者。有许多障碍阻碍了患者有效利用目前的公共报告网站，包括未能认识到质量可能 不同提供者之间的差异，缺乏对公开报告的数据的认识，互联网接入有限，以及健康素养和算术能力较低。因此，需要采取创新的方法来克服使用这些数据的障碍，特别是在弱势群体中，以确保建立一个每个消费者都能从公共报告中受益的卫生保健系统。患者导航器帮助患者在复杂的医疗保健提供环境中进行导航，使用患者导航器可能是吸引消费者并帮助他们解释公共报告中提供的信息的有效方法。这项研究的科学目标是：1)测试办公室患者导航器的有效性，以帮助低收入孕妇使用公开报告的数据选择儿科护理提供者；2)评估干预措施在按性别、种族/民族和健康素养定义的亚组中的有效性；3)与选择儿科提供者时的其他因素相比，评估公开报告的质量信息的重要性；以及4)评估干预措施对自我保健管理的影响。在大型城市医疗中心的产前诊所就诊的妇女将被登记，并被随机分配到导航器干预或信息小册子对照。被随机分配到干预组的妇女将接受两次20分钟的会议，由训练有素的患者导航员指导她们导航和解释有关当地儿科诊所提供的护理质量的信息，如马萨诸塞州健康质量合作伙伴网站上所示。被随机分配到对照组的女性将收到一本小册子，详细说明如何使用马萨诸塞州健康质量合作伙伴网站，但不会有训练有素的患者导航员。为本研究目的而设计的调查将在基线和干预后进行。健康素养、计算能力和自我保健管理的活跃程度也将被评估为干预有效性的潜在中介因素。主要研究结果将是在干预组和控制组中选择的做法在临床质量和患者体验方面的平均表现。次要结果将包括对按性别划分的妇女群体的疗效分析，以及在选择儿科护理提供者时所考虑因素的相对重要性的评估。研究目标的成功完成将产生关于指导网站导航作为减少使用公开报告的信息方面的差异的战略的价值的重要新知识。 公共卫生相关性：许多因素阻碍消费者有效利用公开报告的有关保健质量的信息，包括对不同医生的保健质量认识不足、对现有网站缺乏认识、互联网接入有限、健康素养和算术能力低。在拟议的随机对照试验中，我们将评估在马萨诸塞州健康质量合作伙伴质量洞察网站上帮助低收入孕妇使用和解释儿科护理质量信息的影响。这项研究的结果将促进我们对克服在弱势群体中使用公开报告的信息的障碍的有效战略的理解。

DESCRIPTION (provided by applicant): Efforts to increase transparency regarding health care quality are partially guided by the belief that this information will enable consumers to make more informed choices. Although the amount of information reported on websites has increased dramatically, use by consumers remains limited and largely restricted to white, college-educated and middle-aged consumers. There are many barriers that prevent patients from making effective use of current public reporting websites, including failure to recognize that quality may vary between providers, lack of awareness of publicly reported data, limited internet access, and low health literacy and numeracy. Innovative approaches are therefore needed to overcome barriers to using these data, particularly in vulnerable populations, to ensure a health care system in which every consumer can benefit from public reporting. Patient navigator's help patients 'navigate' through the complex health care delivery environment, and use of patient navigators may be an effective approach to engage consumers and to help them interpret the information presented in public reports. The scientific aims of the study are: 1) to test the efficacy of an office-based patient navigator to assist low-income pregnant women in using publicly reported data to select a pediatric care provider; 2) to assess the efficacy of the intervention in subgroups defined by parity, race/ethnicity, and health literacy; 3) to evaluate th importance of publicly reported information about quality compared to other factors when selecting a pediatric provider; and 4) to assess the intervention's impact on self-management of health care. Women attending the prenatal clinic at a large urban medical center will be enrolled, and randomized to the navigator intervention or an informational pamphlet control. Women randomized to the intervention arm will receive two 20 minute sessions with a trained patient navigator who will guide them in navigating and interpreting information about the quality of care provided at local pediatric practices as presented on the Massachusetts Health Quality Partners website. Women randomized to the control arm will receive a pamphlet detailing how to use the Massachusetts Health Quality Partners website, but will not have trained patient navigators. A survey designed for the purpose of this study will be administered at baseline and post-intervention. Health literacy, numeracy and level of activation for self-management of health care will also be assessed as potential mediators of intervention effectiveness. The primary study outcomes will be the average performance on clinical quality and patient experience measures for the practices selected in the intervention and control groups. Secondary outcomes will include analyses of efficacy among groups of women defined by parity and an assessment of the relative importance of factors considered when choosing a pediatric care provider. Successful completion of the study aims will yield important new knowledge about the value of guided web site navigation as a strategy to reduce disparities in the use of publicly reported information. PUBLIC HEALTH RELEVANCE: Numerous factors prevent consumers from making effective use of publicly reported information about the quality of health care, including limited recognitio that quality of care varies between physicians, lack of awareness of existing websites, limited internet access, low health literacy and numeracy. In the proposed randomized controlled trial we will evaluate the impact of providing assistance in the use and interpretation of information about the quality of pediatric care on the Massachusetts Health Quality Partners Quality Insights website among a population of low-income pregnant women. Results of the study will advance our understanding of effective strategies for overcoming barriers to using publicly reported information among vulnerable populations.