Designing and Testing a Report Card on Hospice Performance: Incorporating Consume

描述(申请人提供)：每年约有150万美国人选择在临终关怀中度过他们生命的最后几个月或几周，这是一种旨在让患者呆在家里舒适的临终关怀方法，同时为家庭照顾者提供社会和情感服务。面对这一决定的人几乎无法获得高质量的数据来指导他们的选择。国家质量论坛(NQF)最近批准消费者使用基于家庭临终关怀评估(FEHC)调查的综合评分和17个支持指标。尽管之前的工作是向消费者展示医疗质量数据，但人们对消费者在审查临终关怀质量数据时关注的是什么，以及消费者的偏好可能如何影响与质量数据的互动知之甚少。目标：该项目的目标是双重的。首先，为了确定消费者在选择临终关怀时想要和需要知道什么，我们将(A)探讨他们对NQF批准的临终关怀质量指标的理解和优先顺序，(B)确定有临终关怀经验的消费者和没有临终关怀经验的消费者的理解和优先顺序有何不同，(C)引出可能需要教育消费者了解临终关怀质量信息的主题，以及(D)注意消费者需要但尚未提供的其他质量措施。其次，我们将测试询问潜在消费者的偏好和提供推荐是否会产生更符合消费者偏好和优先顺序的选择，以及对他们的选择更高的信心和易用性评级的改善。方法：这项研究包括在美国5个大都会地区对有和没有接受过临终关怀的消费者进行的一系列10个焦点小组。将对成绩单中的定性数据进行分析，以解决第一个目标。第二个目标将通过一个基于网络的实验来实现，在这个实验中，将向受试者展示模拟成绩单。一半的受试者将收到一份标准的成绩单，他们可以在那里自由选择；另一半的受试者将收到一份改进的成绩单，其中会推荐一家可能是理想匹配的临终关怀机构。一半的增强报告卡组将被询问他们选择临终关怀的偏好，然后得到根据他们的偏好量身定做的建议提示。另一半人将被提供一个临终关怀建议，总体评分很高，与他们的偏好无关。所有受试者都将被问及易用性和对他们所做选择的信心。影响：通过一个深思熟虑和彻底的传播计划，从这个项目中获得的见解将为新的联邦、州和地方临终关怀质量报告倡议提供信息并加以改进。了解将偏好纳入质量数据呈现的价值，可以让消费者更广泛地对卫生保健质量信息感兴趣和使用。 公共卫生相关性：这将是第一项评估消费者对国家质量论坛(NQF)批准的临终关怀质量措施的情绪的研究，并探索将消费者偏好纳入医疗质量数据展示的价值。这项研究将考察消费者如何理解和解释批准的质量衡量标准，确定哪些方面可能需要关于临终关怀和临终关怀质量的额外教育，并测试将消费者偏好纳入医疗保健质量数据的报告中是否提高了易用性评级和对提供者选择的信心。

DESCRIPTION (provided by applicant): Each year, some 1.5 million Americans will choose to spend their final months or weeks of life in hospice care, an approach to end-of-life care aimed at keeping patients at home and comfortable while supporting family caregivers with social and emotional services. People facing this decision have access to few or no quality data to inform their choice. The National Quality Forum (NQF) recently approved for consumer use a composite score and 17 supporting indicators based on the Family Evaluation of Hospice Care (FEHC) survey. Despite previous work on presenting health care quality data to consumers, little is known about what consumers look for when reviewing hospice quality data and how consumer preferences may impact interaction with quality data. Aims: The aims of the project are twofold. First, to identify what consumers want and need to know when faced with choosing a hospice, we will (a) explore their understanding and prioritization of the NQF-approved hospice quality indicators, (b) identify how understanding and prioritizations differ among consumers with and without experience with hospice care, (c) elicit topics for which education may be necessary for consumers to understand hospice quality information, and (d) note additional quality measures that consumers need but that are not yet provided. Second, we will test whether asking potential consumers about preferences and providing recommendations produces choices more consistent with consumers' preferences and priorities, as well as higher confidence in their choices and improvements in ease-of-use ratings. Methods: This study consists of a series of 10 focus groups conducted in 5 metropolitan areas of the U.S. among consumers with and without previous exposure to hospice care. Qualitative data from the transcripts will be analyzed to address the first aim. The second aim will be addressed with a web based experiment where mock report cards will be presented to subjects. Half of the subjects will receive a standard report card where they are free to make their own choice; the other half will be presented an enhanced report card that makes a recommendation of a hospice that might be a good match. Half of the enhanced report card group will be queried about their preferences for selecting a hospice and then be prompted with a recommendation tailored to their preferences. The other half will be offered a suggestion of a hospice with a high general rating unrelated to their preferences. All subjects will be asked about ease of use and confidence in the choice they made. Implications: Through a thoughtful and thorough dissemination plan, the insights gained from this project will inform and improve nascent Federal, state and local hospice quality reporting initiatives. Knowledge about the value of incorporating preferences into the presentation of quality data can inform consumer interest in and use of information about health care quality more broadly. PUBLIC HEALTH RELEVANCE: This will be the first study to assess consumer sentiment about the quality measures for hospice care approved by National Quality Forum (NQF) and to explore the value of incorporating consumer preferences into displays of health care quality data. The study will examine how consumers understand and interpret approved quality measures, identify where additional education about hospice and hospice quality may be necessary, and test whether ease of use ratings and confidence in provider choice are enhanced by the incorporation of consumer preference into report card presentations of health care quality data.