AF4Q In The News

Can personal health care narratives persuade people to use comparative quality information when choosing a physician?

Testing a Personal Narrative for Persuading People to Value and Use Comparative Physician Quality of Care Information: An Experimental Study
Authors: Jessica Greene, Judith H. Hibbard, Rebecca M. Sacks

The authors conducted an online experiment to test whether a first-person cartoon narrative that educated consumers about physician variation in quality performance could persuade consumers to value and use comparative information on physician quality performance. The cartoon narrative was developed by the Wisconsin Collaborative for Healthcare Quality as part of the Aligning Forces for Quality initiative. The participants were randomized to either view the cartoon character’s narrative, a brief text on physician quality variation, or a control group with no additional information. All participants were shown a display of four physicians, one of whom had the highest quality performance but was more expensive and less convenient. While there was no overall relationship between viewing the narrative or reading text and choosing the top-quality physician, higher numerate participants who viewed the narrative had 2.7 times the odds of selecting the top-quality physician. The results indicate that personal narratives can persuade people with high numeracy skills to consider quality when choosing a physician, and suggest that future research is needed to identify strategies to support those with lower numeracy skills in selecting high-quality health providers.

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Is Anyone Paying Attention to Physician Report Cards?

Performance measurement and public reporting was a central component of the nearly decade-long Aligning Forces for Quality (AF4Q) initiative funded by the Robert Wood Johnson Foundation. All 16 participating alliances were required to produce and release practice-level physician quality information (PQI) to the public in the form of "report cards." Our study estimated the impact of these public reporting efforts on consumers' awareness and use of PQI. Among chronically ill adults who were not aware of PQI at the baseline, when PQI became available in their communities for the first time, along with quality measures that were applicable to their specific chronic conditions, their likelihood of seeing PQI increased by 3.8 percentage points.

Can claims-based process quality indicators yield global composite measures of physician practice quality?

To make physician quality reports more reliable and interpretable, sponsors often create composite measures to reduce the number of indicators included in such reports. As part of the larger evaluation of the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) initiative, we examined the validity of creating a global composite measure of physician practice quality constructed from commonly used Healthcare Effectiveness Data and Information Set (HEDIS) indicators. Our findings suggest that despite growing interest in composite measurement in both policy and practice, stakeholders must carefully consider the context and purpose of creating such measures, specifically when considering them as part of a strategy to reward physicians based on performance.

When health systems deliver consistent care, do clinics perform better?

Increasingly, health systems promote their brands as delivering high-quality, integrated health care; essential to the development of a reputable brand is the ability to provide a consistent, high-quality product at all points of care. We found that larger health systems were more likely to deliver a combination of high-performance and consistent care than smaller systems. Our study also suggests that future research is needed to explore the mechanisms that drive the relationship between consistency of care and performance within health systems