Is the impact of hospital performance data greater in patients who have compared hospitals?

<p>Abstract</p> <p>Background</p> <p>Public information on average has limited impact on patients' hospital choice. However, the impact may be greater in consumers who have compared hospitals prior to their hospital choice. We therefore assessed whether patients who have compared hospitals based their hospital choice mainly on public information, rather than e.g. advice of their general practitioner and consider other information important than patients who have not compared hospitals.</p> <p>Methods</p> <p>337 new surgical patients completed an internet-based questionnaire. They were asked whether they had compared hospitals prior to their hospital choice and which factors influenced their choice. They were also asked to select between four and ten items of hospital information (total: 41 items) relevant for their future hospital choice. These were subsequently used in a hospital choice experiment in which participants were asked to compare hospitals in an Adaptive Choice-Based Conjoint analysis to estimate which of the hospital characteristics had the highest Relative Importance (RI).</p> <p>Results</p> <p>Patients who have compared hospitals more often used public information for their hospital choice than patients who have not compared hospitals (12.7% vs. 1.5%, p < 0.001). However, they still mostly relied on their own (47.9%) and other people's experiences (31%) rather than to base their decision on public information. Both groups valued physician's expertise (RI 20.2 [16.6-24.8] in patients comparing hospitals vs. 16.5 [14.2-18.8] in patients not comparing hospitals) and waiting time (RI 15.1 [10.7-19.6] vs. 15.6 [13.2-17.9] respectively) as most important public information. Patients who have compared hospitals assigned greater importance to information on wound infections (p = 0.010) and respect for patients (p = 0.022), but lower importance to hospital distance (p = 0.041).</p> <p>Conclusion</p> <p>Public information has limited impact on patient's hospital choice, even in patients who have actually compared hospitals prior to hospital choice.</p

Different patient subgroup, different ranking? Which quality indicators do patients find important when choosing a hospital for hip- or knee arthroplasty?

<p>Abstract</p> <p>Background</p> <p>Patients are increasingly expected to become active, critical consumers in healthcare. They can use comparative healthcare information presented on websites to make informed choices for healthcare providers. However, the use of this information has been limited so far. An obstacle can be that the information is not perceived as relevant by patients. Presenting only the most important quality indicators might improve the usefulness of this information. The aim of this study was to explore which quality indicators different subgroups of patients find important when choosing a hospital for total hip arthroplasty (THA) or total knee arthroplasty (TKA).</p> <p>Methods</p> <p>In this explorative, cross-sectional study, questionnaires were distributed to 265 patients who underwent or had to undergo THA/TKA. Participants were asked to rank the importance of three types of quality indicators: patient experience indicators, clinical performance indicators, and indicators about hospital services. We used random effects regression analyses to assess the relative importance of the indicators in different subgroups of patients.</p> <p>Results</p> <p>110 patients (response rate 41.5%) who underwent or had to undergo THA/TKA participated. Conduct of doctors, the presence of procedures to prevent adverse effects of thrombosis and information about the specialist area of orthopaedists were the most important patient experience indicator, clinical performance indicator and indicator about hospital services, respectively. We found a few differences between patient subgroups in the importance attached to the quality indicators.</p> <p>Conclusions</p> <p>This study provides a first insight into which quality indicators patients find important when choosing a hospital for THA/TKA, and shows that subgroups of patients differ in the value they attach to these indicators. More extended research is needed to establish the indicators that should at least be presented in succinct overviews of comparative healthcare information for patients choosing a hospital for THA/TKA.</p

Safety of vaccination against influenza A (H1N1) during pregnancy in the Netherlands: results on pregnancy outcomes and infant&apos;s health: cross- sectional linkage study

Objective This study aims to assess the safety of Influenza A(H1N1), vaccination administered during the second and third trimester and containing MF59 and thiomersal (Focetria â ), measured by pregnancy outcomes and infant&apos;s health. Design Cross-sectional linkage study. Setting and sample A sample of pregnant women, eligible for prenatal screening, were invited to participate. Methods Questionnaire data were linked with the Netherlands Perinatal Registry (n = 1920). Information on infant growth, development (n = 1739) and infection-related contacts with the general practitioner (GP) during the first year of life (n = 1671) was obtained. Main outcome measures Multivariate logistic regression was used to assess the association between H1N1 vaccination and small-forgestational-age infant, preterm delivery and a composite adverse outcome, i.e. low Apgar-score, neonatal intensive care unit admission, neonatal resuscitation or perinatal death. Influence of maternal vaccination on growth, development and GP infectionrelated contact rates were assessed using multivariate linear mixed modelling and multivariate negative binomial regression, respectively. Results Response rate was 21%. Though we found differences in characteristics between unvaccinated and vaccinated women, in the multivariate analyses no association was found between H1N1 vaccination and small-for-gestational-age (odds ratio [OR] 0.84; 95% confidence interval [95% CI] 0.50-1.43), preterm delivery (OR 0.98; 95% CI 0.59-1.62) and the composite adverse outcome (OR 0.84; 95% CI 0.44-1.60). We found no differences in weight-for-age (À0.05; 95% CI À0.13 to 0.04), length-for-age (À0.01; 95% CI À0.09 to 0.06), head-circumference-for-age (À0.05; 95% CI À0.13 to 0.03), developmental scores (À0.06; 95% CI À0.28 to 0.17) and infection-related GP contact rates (incidence rate ratio 1.07; 95% CI 0.91-1.28) between infants of unvaccinated and vaccinated mothers. Conclusion Pregnancy outcomes did not differ between H1N1-vaccinated and unvaccinated women. Furthermore, growth, development and GP infection-related contact rates, assessed after the first year of life, were similar in offspring of vaccinated and unvaccinated mothers. Keywords Infant, influenza, pregnancy, safety, vaccination. Tweetable abstract No increased risk for adverse pregnancy outcomes and infant&apos;s health following influenza vaccination. Please cite this paper as: van der Maas N, Dijs-Elsinga J, Kemmeren J, van Lier A, Knol M, de Melker H. Safety of vaccination against influenza A (H1N1) during pregnancy in the Netherlands: results on pregnancy outcomes and infant&apos;s health: cross-sectional linkage study. BJOG 2015; DOI: 10.1111/1471-0528.13329. Introduction In spring 2009 an influenza A (H1N1) pandemic occurred. Influenza during pregnancy increases the risk of hospitalisation due to respiratory complications, especially for women with co-morbidity. 1-3 Furthermore, during the 2009 pandemic, an increased risk of adverse pregnancy outcomes after infection was reported. 4-6 Therefore, the Dutch Health Council advised all pregnant women in the second and third trimester to be vaccinated. 7 A thiomersal-containing vaccine, adjuvanted with MF59 (Focetria â ; Sanofi Pasteur MSD, Lyon, France) was used. Until that moment, there were no universal vaccination programmes for healthy pregnant women in the Netherlands. In 2009, information on the safety of influenza vaccination during pregnancy was scarce and merely based on nonadjuvanted seasonal influenza vaccines. No safety signals were acknowledged in these studies, i.e. no serious adverse events, no differences in adverse pregnancy outcomes or infant hospital admissions, no excess of malformations or childhood malignancies. The Centre for Infectious Disease Control of the Netherlands, part of the Dutch National Institute for Public Health and the Environment (RIVM), monitored the determinants of acceptance, coverage and safety of the H1N1 vaccination campaign among pregnant women. Data on acceptance and coverage have been reported previously. 20 The current paper describes and discusses the safety of vaccination with Focetria â during the second and third trimesters of pregnancy. To assess the possible impact of the vaccination, data on pregnancy outcomes and growth, development and infection-related contacts with the general practitioner (GP) of the infants up to 1 year of age were retrieved from three different sources and linked to data of a questionnaire survey. Methods and materials Study population and setting All pregnant women in the Netherlands are offered screening for infectious diseases, i.e. hepatitis B, syphilis and HIV infection, around week 12 of gestation (in any case before the week 15). The Centre for National Population Screening of RIVM is responsible for this screening programme. The Department for Vaccine Supply and Prevention Programmes of RIVM is responsible for data management. Data are registered in a nationwide database. A random sample of nearly 15 000 pregnant women, eligible for vaccination against influenza A (H1N1) in November and December 2009 and known to the Department for Vaccine Supply and Prevention Programmes were asked to participate in a questionnaire study on determinants of acceptance and vaccine coverage. Medical ethical approval of this study was not necessary because only routinely collected data were used and participants were not subjected to imposed rules or acts. All participants signed written informed consent for the respective study parts. Furthermore, the Board of the PRN approved the study. The latter included approval obtained upon assessment by a privacy commission. Data collection The PRN is a joint effort of four professional organisations that provide perinatal care in the Netherlands: Royal Organisation of Midwives in the Netherlands, National Organisation of General Practitioners, Dutch Association of Obstetrics and Gynaecology and Paediatric Association of the Netherlands. PRN covers about 95% of all deliveries. Only pregnancies from 16 weeks onwards are registered in PRN, so information on early abortions is not available. Participating midwives, obstetricians and GPs performing deliveries fill in predefined forms concerning a large number of variables for each birth. Data processing and data cleaning are performed in a systematic way to enhance comparability and enable trend analysis. Questionnaire data were linked to the database of midwives, obstetricians and paediatricians from PRN based on date of birth of mother and child and four digits of postal code. In this way, forms were combined when multiple obstetric professionals were involved in the care process during pregnancy, delivery or the postpartum period. No other personal data were accessible to the researchers. Three dichotomous pregnancy outcomes were defined: 1 Small-for-gestational-age, defined as a birthweight below the tenth centile, adjusted for gestational age and based on Dutch averages 22 2 Preterm delivery, i.e. birth before 37 weeks of gestation 3 A composite indicator for other severe adverse outcomes, including at least one of the following: low Apgar-score (score &lt; 7 at 5 minutes after delivery), admission to Neonatal Intensive Care Unit, resuscitation of the newborn or perinatal death. Growth and development of infants is monitored by Dutch child healthcare centres, for which attendance amounts to 99%. 24,25 Development is measured by &apos;van Wiechen schedule&apos; with age-specific milestones according to the 90th centile for Dutch children. Vaccine and vaccination Pregnant women eligible for vaccination could receive their vaccination at the GP practice. GPs offered these H1N1 vaccinations free of charge from 9 November 2009 onwards. The H1N1 vaccination campaign was finished before Christmas, with only a few people vaccinated in 2010. A two-dose schedule was used with an interval of 3 weeks between the doses. The only vaccine used was Focetria â , delivered as multi-dose containers with thiomersal as a preservative, MF59C.1 as adjuvant and 7.5 lg influenza virus surface antigens of A/California/7/2009 (H1N1)-like virus per dose. In this study, vaccination status was self-reported. Covariates All but three covariates were retrieved from the selfreported questionnaires Statistical analysis Differences in characteristics of vaccinated and unvaccinated women were tested using Pearson&apos;s chi-square test or Fisher&apos;s exact test (for dichotomous and categorical variables) or Student&apos;s t-test (for continuous variables). Multivariate logistic regression analysis was used to assess the association between H1N1-vaccination and the three defined adverse pregnancy outcomes. To improve comparison of the models for the three outcomes, all models included the same set of possible confounders, i.e. year of birth, country of birth, educational level, selfreported use of alcohol, tobacco and drugs during pregnancy, parity, underlying medical condition as reason for vaccination, maternal problems, H1N1 infection and philosophy of life, e.g. religion, anthroposophy. Associations are presented as odds ratios (ORs) with 95% confidence interval (95% CI). The z-scores, i.e. standard deviation scores, for head-circumference-for-age, length-for-age and weight-for-age were calculated using Dutch references. 22 A z-score is computed to determine the outcome of an individual in relation to reference measurements of a comparable population with the same age and sex. The z-scores were analysed using a linear mixed effect model, with random intercept and random slope for age. We compared z-scores between infants of vaccinated and unvaccinated mothers, and adjusted for birthweight, sex and number of previous pregnancies. Differences in D-scores between infants of vaccinated and unvaccinated mothers were assessed using a linear mixed effect model with random intercept and random slope for age, adjusted for educational level of the mother and whether or not the mother was born in the Netherlands. Counts of the total number of infection-related contacts in the first year of life, registered in the medical record of the GP, were analysed using negative binomial regression, adjusted for educational level, country of birth of the mother and SGA infant. Differences in contact rates were expressed as an incidence rate ratio. Before the study, we estimated that about 2200 pregnant women had to be included to detect an increase in the prevalence of abnormal postnatal growth from 2.5% to 5%, measured through length and weight (a = 0.05, b = 0.20), based on an expected vaccination coverage of 33-50%. Hereby, abnormal growth is defined as length or weight below the 2.5th centile or above the 97.5th centile compared with a reference group of Dutch infants of the same sex and age. Analyses were performed using SAS version 9.3, z-scores for growth were computed using R. In all analyses, a Pvalue &lt; 0.05 was considered statistically significant. Furthermore, unvaccinated mothers and their offspring were set as reference in all analyses. Results Study population Twenty-one per cent of the 14 529 invited women participated in the coverage study, of whom 88% (n = 2672) were interested in further studies. Of the women who gave permission to use questionnaire data, 66.7% (n = 1357) were vaccinated, 32.9% (n = 669) received no vaccination and 0.4% (n = 8) had an unknown vaccination status. Safety of influenza vaccination during pregnancy Vaccinated women were older than unvaccinated women, had a higher educational level, were more often multipara, more frequently had an underlying medical condition as a reason for vaccination and less often reported a religious background or a specific life philosophy such as anthroposophy compared with unvaccinated women Pregnancy outcomes Of the 1736 women with data linked to PRN, 1184 women (68%) were vaccinated and 552 (32%) were not. They gave birth to 902 boys and 819 girls. Of 15 infants, the sex was unknown. No maternal deaths were reported. Logistic regression showed no association between H1N1 vaccination and SGA infants (crude OR 0.81, adjusted OR 0.84; 95% CI 0.50-1.43) ( Growth and development We found no statistically significant difference in the z-score for weight-for-age between infants of unvaccinated and vaccinated mothers (À0.05; 95% CI À0.13 to 0.04), adjusted for sex, number of infants in the household and birthweight. This indicates that the weight of infants of vaccinated mothers and unvaccinated mothers is distributed similarly compared with a reference group of Dutch infants of the same age and sex. Similar results were found for length-forage and head-circumference-for-age (z-score À0.01 [95% CI À0.09 to 0.06] and À0.05 [95% CI À0.13 to +0.03], respectively). Background characteristics Vaccinated* (n = 1357); n (%) Not vaccinated (n = 669); n (%) P-value*

The relative importance of quality of care information when choosing a hospital for surgical treatment: a hospital choice experiment

OBJECTIVE To assess the impact of quality of care and other hospital information on patients' choices between hospitals. METHODS 665 former surgical patients were invited to respond to an Internet-based questionnaire including a choice-based conjoint analysis. Each patient was presented with 12 different comparisons of 2 hospitals, with each hospital characterized by 6 attributes containing 2 levels. Hospital attributes were included if frequently reported by patients as most important for future hospital choices. These included both general hospital information (e.g., atmosphere), information on quality of care (e.g., percentage of patients with "textbook outcome"), and surgery-specific information (e.g., possibility for minimally invasive procedure). Hierarchial Bayes estimation was used to estimate the utilities for each attribute level for each patient. Based on the ranges of these utilities, the relative importance of each hospital attribute was determined for each participant as a measure of the impact on patients' choices. RESULTS 308 (46.3%) questionnaires were available for analysis. Of the hospital attributes that patients considered, surgery-specific information on average had the highest relative importance (25.7 [23.9-27.5]), regardless of gender, age, and education. Waiting time and hospital atmosphere were considered least important. The attribute concerning the percentage of patients with "textbook outcomes" had the second greatest impact (18.3 [16.9-19.6]), which was similar for patients with different adverse outcome experience. CONCLUSIONS Surgery-specific and quality of care information are more important than general information when patients choose between hospitals.Medical Decision MakingAnalysis and support of clinical decision makin

Choosing between Hospitals: The Influence of the Experiences of Other Patients

OBJECTIVE: . Publicly available information on hospital performance is increasing, with the aim to support consumers when choosing a hospital. Besides general hospital information and information on outcomes of care, there is increasing availability of systematically collected information on experiences of other patients. The aim of this study was to assess the influence of previous patients' experiences relative to other information when choosing a hospital for surgical treatment. METHODS: . Three hundred thirty-seven patient volunteers and 280 healthy volunteers (response rate of 52.4% and 93.3%, respectively) filled out an Internet-based questionnaire that included an adaptive choice-based conjoint analysis. They were asked to select hospital characteristics they would use for future hospital choice, compare hospitals, and choose the overall best hospital. Based on the respondents' choices, the relative importance (RI) of each hospital characteristic for each respondent was estimated using hierarchical Bayes estimation. RESULTS: . Information based on previous patients' experience was considered at least as important as information provided by hospitals. "Report card regarding physician's expertise" had the highest RI (16.83 [15.37-18.30]) followed by "waiting time for outpatient clinic appointment" (14.88 [13.42-16.34]) and "waiting time for surgery" (7.95 [7.12-8.78]). Patient and healthy volunteers considered the same hospital attributes to be important, except that patient volunteers assigned greater importance to "positive judgment about physician communication" (7.65 v. 5.80, P < 0.05) and lower importance to "complications" (2.56 v. 4.22, P < 0.05). CONCLUSION: . Consumers consider patient experience-based information at least as important as hospital-based information. They rely most on information regarding physicians' expertise, waiting time, and physicians' communication when choosing a hospital.Analysis and support of clinical decision makin

Choosing a Hospital for Surgery: The Importance of Information on Quality of Care

Objective. To assess whether patients use information on quality of care when choosing a hospital for surgery compared with more general hospital information. Methods. In this cross-sectional study in 3 Dutch hospitals, questionnaires were sent to 2122 patients who underwent 1 of 6 elective surgical procedures in 2005-2006 (aorta reconstruction [for treatment of aneurysm], cholecystectomy, colon resection, inguinal hernia repair, esophageal resection, thyroid surgery). Patients were asked which information they had used to choose this hospital and which information they intended to use if they would need similar surgical treatment in the future. Results. In total, 1329 questionnaires were available for analysis (response rate 62.6%). Most patients indicated having used the hospital's good reputation (69.1%) and friendly hospital atmosphere (63.3%) to choose a hospital. For future choices, most patients intended to use the fact that they were already treated in that hospital (79.3%) and the hospital's good reputation (74.1%). Regarding quality-of-care information, patients preferred a summary measure (% patients with ''textbook outcome'') over separate more detailed measures (52.1% v. 38.0%, chi 2 = 291, P < 0.01). For future choices, patients intend to use more information items than in 2005-2006, both in absolute terms (9 v. 4 items, t = 38.3, P < 0.01) as relative to the total number of available items (41.3% [40.1%-42.5%] v. 29.2% [28.1%-30.2%]). Conclusion. Patients intended to use more information for future choices than they used for past choices. For future choices, most patients prefer a summary measure on quality of care over more detailed measures but seem to value that they were already treated in that hospital or a hospital's good reputation even more.Analysis and support of clinical decision makin

The Relative Importance of Quality of Care Information When Choosing a Hospital for Surgical Treatment: A Hospital Choice Experiment

OBJECTIVE: To assess the impact of quality of care and other hospital information on patients' choices between hospitals. METHODS: 665 former surgical patients were invited to respond to an Internet-based questionnaire including a choice-based conjoint analysis. Each patient was presented with 12 different comparisons of 2 hospitals, with each hospital characterized by 6 attributes containing 2 levels. Hospital attributes were included if frequently reported by patients as most important for future hospital choices. These included both general hospital information (e.g., atmosphere), information on quality of care (e.g., percentage of patients with "textbook outcome"), and surgery-specific information (e.g., possibility for minimally invasive procedure). Hierarchial Bayes estimation was used to estimate the utilities for each attribute level for each patient. Based on the ranges of these utilities, the relative importance of each hospital attribute was determined for each participant as a measure of the impact on patients' choices. RESULTS: 308 (46.3%) questionnaires were available for analysis. Of the hospital attributes that patients considered, surgery-specific information on average had the highest relative importance (25.7 [23.9-27.5]), regardless of gender, age, and education. Waiting time and hospital atmosphere were considered least important. The attribute concerning the percentage of patients with "textbook outcomes" had the second greatest impact (18.3 [16.9-19.6]), which was similar for patients with different adverse outcome experience. CONCLUSIONS: Surgery-specific and quality of care information are more important than general information when patients choose between hospitals.Analysis and support of clinical decision makin

The importance of experienced adverse outcomes on patients' future choice of a hospital for surgery

OBJECTIVE To assess whether patients who experience adverse outcomes during hospitalisation or after discharge differ in the information they would use for future choices of a hospital for surgery compared with patients without any adverse outcomes. DESIGN Cross-sectional questionnaire study, including questions on (1) adverse outcome occurrence during hospitalisation and after discharge, (2) information patients would use for future hospital choice and (3) priority of information. SETTING Three hospitals in the western part of The Netherlands. STUDY SAMPLE All 2122 patients who underwent elective aorta reconstruction (for treatment of aneurysm), cholecystectomy, colon resection, inguinal hernia repair, oesophageal resection or thyroid surgery in the period 2005-2006, of whom 1329 (62.6%) responded. RESULTS Patients who experienced postdischarge adverse outcomes intend to use more information items to choose a future hospital (on average 1.6 items more). They more often would use the item on information provision during hospitalisation (OR 2.35 (1.37 to 4.03)) and information on various quality-of-care measures, compared with patients without adverse outcomes. Patients who experienced in-hospital adverse outcomes would not use more information items but more often would use the item on mortality after surgery (OR 1.93 (1.27 to 2.94)) and extended hospital stay (OR 1.61 (1.10 to 2.36)). However, when asked for priority of information, previous treatment in that hospital is mentioned as the most important item by most patients (32%), regardless of adverse outcome occurrence, followed by hospital reputation and waiting time. CONCLUSIONS Adverse outcome experience may change the information patients use (on quality of care) to choose a future hospital