Each year, some 1.5 million Americans will choose to spend their final months or weeks of life in hospice care, an approach to end-of-life care aimed at keeping patients at home and comfortable while supporting family caregivers with social and emotional services. People facing this decision have access to few or no quality data to inform their choice. The National Quality Forum (NQF) recently approved for consumer use a composite score and 17 supporting indicators based on the Family Evaluation of Hospice Care (FEHC) survey. Despite previous work on presenting health care quality data to consumers, little is known about what consumers look for when reviewing hospice quality data and how consumer preferences may impact interaction with quality data.
Aims :
The aims of the project are twofold. First, to identify what consumers want and need to know when faced with choosing a hospice, we will (a) explore their understanding and prioritization of the NQF-approved hospice quality indicators, (b) identify how understanding and prioritizations differ among consumers with and without experience with hospice care, (c) elicit topics for which education may be necessary for consumers to understand hospice quality information, and (d) note additional quality measures that consumers need but that are not yet provided. Second, we will test whether asking potential consumers about preferences and providing recommendations produces choices more consistent with consumers'preferences and priorities, as well as higher confidence in their choices and improvements in ease-of-use ratings. Methods: This study consists of a series of 10 focus groups conducted in 5 metropolitan areas of the U.S. among consumers with and without previous exposure to hospice care. Qualitative data from the transcripts will be analyzed to address the first aim.
The second aim will be addressed with a web based experiment where mock report cards will be presented to subjects. Half of the subjects will receive a standard report card where they are free to make their own choice;the other half will be presented an enhanced report card that makes a recommendation of a hospice that might be a good match. Half of the enhanced report card group will be queried about their preferences for selecting a hospice and then be prompted with a recommendation tailored to their preferences. The other half will be offered a suggestion of a hospice with a high general rating unrelated to their preferences. All subjects will be asked about ease of use and confidence in the choice they made. Implications: Through a thoughtful and thorough dissemination plan, the insights gained from this project will inform and improve nascent Federal, state and local hospice quality reporting initiatives. Knowledge about the value of incorporating preferences into the presentation of quality data can inform consumer interest in and use of information about health care quality more broadly.

Public Health Relevance

This will be the first study to assess consumer sentiment about the quality measures for hospice care approved by National Quality Forum (NQF) and to explore the value of incorporating consumer preferences into displays of health care quality data. The study will examine how consumers understand and interpret approved quality measures, identify where additional education about hospice and hospice quality may be necessary, and test whether ease of use ratings and confidence in provider choice are enhanced by the incorporation of consumer preference into report card presentations of health care quality data.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZHS1-HSR-W (01))
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Sandmeyer, Brent
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Altarum Institute
Ann Arbor
United States
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Smith, Brad; McDuff, Jessica; Naierman, Naomi et al. (2015) What consumers want to know about quality when choosing a hospice provider. Am J Hosp Palliat Care 32:393-400