DO STARS HELP PATIENTS TO CHOOSE A HOSPITAL FOR SURGERY? A HOSPITAL CHOICE EXPERIMENT

Purpose: Hospital performance is often presented in numbers, mostly in percentages, while adding a visual cue may influence patients’ attention for these items and thereby their hospital choice. This study aims to assess whether adding stars to numerical information influence the relative importance patients assign to quality of care information when they choose between hospitals

Method: 665 former surgical patients from three hospitals 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 (characteristics) containing 2 levels, and asked which hospital they would choose if they would require surgery again. Hospital attributes were included if frequently reported by patients as most important for future hospital choices. These included general hospital information (e.g. atmosphere), quality of care information (e.g. % patients with “text-book” outcome) and surgery-specific information (e.g. possibility for minimally invasive procedure). Respondents were randomized to a questionnaire with or without stars added to numerical information on the item % patients with “textbook outcomes”. A better hospital performance was assigned more stars, ranging from 1 to 4 stars. Patients were asked whether the stars had helped in their hospital choice. Hierarchical 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.

Result: 308 (46.3%) questionnaires had complete data and were included in the analysis. The 152 participants with and 156 participants without stars added to the numerical information did not differ in the relative importance they assigned to the item % patients with “textbook outcomes” (19.0% [17.3%-20.8%] versus 17.8% [15.6%-20.0%]). Only 22 participants (16.2%) indicated the stars helped in their hospital choice, but these patients did not assign a higher relative importance to this item than participants indicating the stars had not helped (22.1% [17.1%-27.1%] versus 18.2% [16.1%-20.2%]).

Conclusion: Adding stars to numerical information on quality of care helps only a small group of patients choose between hospitals, had no influence on the relative importance they assign to this item and thus seems to have little impact on patients hospital choice.