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。虽然网站上报告的信息量大幅增加，但消费者的使用仍然有限，主要限于白色、受过大学教育的中年消费者。有许多障碍阻止患者有效利用当前的公共报告网站，包括未能认识到质量可能 提供者之间存在差异，对公开报告的数据缺乏认识，互联网接入有限，卫生知识和算术水平低。因此，需要采取创新方法，克服使用这些数据的障碍，特别是在弱势群体中，以确保卫生保健系统中的每个消费者都能从公开报告中受益。患者导航器帮助患者“导航”通过复杂的医疗保健提供环境，并且患者导航器的使用可能是吸引消费者并帮助他们解释公开报告中呈现的信息的有效方法。 该研究的科学目的是：1）测试基于办公室的患者导航器的有效性，以帮助低收入孕妇使用公开报道的数据选择儿科护理提供者; 2）评估干预措施在由奇偶性，种族/民族和健康素养定义的亚组中的有效性; 3）在选择儿科提供者时，与其他因素相比，评估公开报道的质量信息的重要性; 4）评估干预措施对医疗保健自我管理的影响。在大型城市医疗中心的产前诊所就诊的妇女将被招募，并随机分配到导航仪干预组或信息小册子对照组。随机分配至干预组的女性将接受两次20分钟的治疗，由一名经过培训的患者导航员指导她们导航和解释马萨诸塞州健康质量合作伙伴网站上提供的当地儿科实践中提供的护理质量信息。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，但没有经过培训的患者导航员。将在基线和干预后进行针对本研究目的设计的调查。健康素养，算术和自我管理的保健激活水平也将作为干预措施有效性的潜在媒介进行评估。主要研究结果将是干预组和对照组中所选实践的临床质量和患者体验指标的平均表现。次要结果将包括对根据产次定义的妇女群体的疗效分析，以及对选择儿科护理提供者时考虑的因素的相对重要性的评估。成功完成这项研究的目标将产生重要的新知识，了解网站导航作为减少公开报道信息使用差异的一项战略的价值。 公共卫生相关性：许多因素阻碍消费者有效利用关于医疗保健质量的公开报道信息，包括对医生之间医疗保健质量差异的认识有限，缺乏对现有网站的认识，互联网接入有限，健康素养和计算能力低。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提供有关儿科护理质量信息的使用和解释方面的帮助对低收入孕妇人群的影响。研究结果将促进我们对克服弱势群体使用公开报道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.