Adam J. Schwartz (
Kathleen J. Yost is a professor of health services research in the Department of Health Sciences Research at the Mayo Clinic College of Medicine and Science in Rochester, Minnesota.
Health Aff (Millwood). 2021 Jan;40(1):138-145. doi: 10.1377/hlthaff.2020.00085.
The past decade witnessed a rapid rise in the public reporting of surgeon- and hospital-specific quality-of-care measures. However, patients' interpretations of star ratings and their importance relative to other considerations (for example, cost, distance traveled) are poorly understood. We conducted a discrete choice experiment in an outpatient setting (an academic joint arthroplasty practice) to study trade-offs that patients are willing to make in choosing a provider for a hypothetical total joint arthroplasty. Two hundred consecutive new patients presenting for hip or knee pain in 2018 were included. The average patient was willing to pay $2,607 and $3,152 extra for an additional hospital or physician star, respectively, and an extra $11.45 to not travel an extra mile for arthroplasty care. History of prior surgery and prior experience with rating systems reduced the relative value of an incremental star by $539.25 and $934.50, respectively. Patients appear willing to accept significantly higher copayments for higher quality of care, and surgeon quality seems relatively more important than hospital quality. Further study is needed to understand the value and trust patients place in publicly reported hospital and surgeon quality ratings.
过去十年见证了公众对医生和医院特定医疗质量措施的报告迅速增加。然而，患者对星级评分的理解及其与其他考虑因素（例如成本、旅行距离）的相对重要性却知之甚少。我们在门诊环境（学术关节置换实践）中进行了一项离散选择实验，以研究患者在选择提供者进行假设的全关节置换术时愿意做出的权衡。2018 年，200 名连续出现髋部或膝关节疼痛的新患者被纳入研究。平均每位患者愿意分别额外支付 2607 美元和 3152 美元，以获得额外的医院或医生星级评分，并且愿意多支付 11.45 美元，以便在进行关节置换护理时不必多走一英里。既往手术史和对评分系统的既往经验分别使每个额外星级的相对价值降低了 539.25 美元和 934.50 美元。患者似乎愿意为更高的医疗质量接受更高的共付额，并且外科医生的质量似乎相对比医院的质量更重要。需要进一步研究以了解患者对公开报告的医院和外科医生质量评分的价值和信任。
