Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
Department of Healthcare Procurement, Menzis, Enschede, The Netherlands.
BMJ Qual Saf. 2020 Jul;29(7):576-585. doi: 10.1136/bmjqs-2019-009818. Epub 2019 Dec 12.
There is an increasing number of quality indicators being reported publicly with aim to improve the transparency on hospital care quality. However, they are little used by patients. Knowledge on patients' preferences regarding quality may help to optimise the information presented to them.
To measure the preferences of patients with breast and colon cancers regarding publicly reported quality indicators of Dutch hospital care.
From the existing set of clinical quality indicators, participants of patient group discussions first assessed an indicator's suitability as choice information and then identified the most relevant ones. We used the final selection as attributes in two discrete choice experiments (DCEs). Questionnaires included choice vignettes as well as a direct ranking exercise, and were distributed among patient communities. Data were analysed using mixed logit models.
Based on the patient group discussions, 6 of 52 indicators (breast cancer) and 5 of 21 indicators (colon cancer) were selected as attributes. The questionnaire was completed by 84 (breast cancer) and 145 respondents (colon cancer). In the patient group discussions and in the DCEs, respondents valued outcome indicators as most important: those reflecting tumour residual (breast cancer) and failure to rescue (colon cancer). Probability analyses revealed a larger range in percentage change of choice probabilities for breast cancer (10.9%-69.9%) relative to colon cancer (7.9%-20.9%). Subgroup analyses showed few differences in preferences across ages and educational levels. DCE findings partly matched with those of direct ranking.
Study findings show that patients focused on a subset of indicators when making their choice of hospital and that they valued outcome indicators the most. In addition, patients with breast cancer were more responsive to quality information than patients with colon cancer.
越来越多的质量指标被公开报告，旨在提高医院护理质量的透明度。然而，患者很少使用这些指标。了解患者对质量的偏好可以帮助优化向他们提供的信息。
衡量乳腺癌和结肠癌患者对荷兰医院护理质量的公开报告质量指标的偏好。
从现有的临床质量指标集中，患者小组讨论的参与者首先评估了一个指标作为选择信息的适宜性，然后确定了最相关的指标。我们将最终选择作为两个离散选择实验（DCE）的属性。问卷包括选择案例以及直接排名练习，并分发给患者群体。使用混合对数模型分析数据。
基于患者小组讨论，从 52 个指标中选择了 6 个（乳腺癌）和 21 个指标中的 5 个（结肠癌）作为属性。完成问卷的有 84 名（乳腺癌）和 145 名受访者（结肠癌）。在患者小组讨论和 DCE 中，受访者将结果指标视为最重要的指标：反映肿瘤残留（乳腺癌）和救援失败（结肠癌）的指标。概率分析显示，乳腺癌的选择概率百分比变化范围较大（10.9%-69.9%），而结肠癌的变化范围较小（7.9%-20.9%）。亚组分析表明，不同年龄和教育水平的患者偏好差异不大。DCE 结果与直接排名结果部分吻合。
研究结果表明，患者在选择医院时关注指标的一个子集，并且他们最看重结果指标。此外，与结肠癌患者相比，乳腺癌患者对质量信息的反应更为敏感。
