Limited English proficiency (LEP) and race/ethnicity have not been well studied in consumer reporting of hospital quality, though these factors present barriers to quality health care. Public quality reports are also underused among minority and LEP groups. The science of consumer reporting is missing core knowledge of how individuals from diverse racial/ethnic groups, including those with LEP, use hospital quality measures, what they value and understand from existing quality reports, and whether additional information or presentation features might encourage higher use. The field is also missing personalized, relevant, easy-to- understand quality reporting templates designed for distinct cultural groups and/or non-English language speakers. These issues are particularly relevant for many Asian American and Pacific Islander (AA/PI) subgroups that have distinct cultural preferences, health disparities, and high proportions of LEP. Childbirth, the most common reason women are hospitalized in the U.S., is a particularly expensive area of the health care system with known health outcome disparities and quality concerns. Pregnant women are likely to be particularly activated consumers with strong interest in hospital quality and sufficient advance notice about the upcoming hospitalization to research the topic. Improving the use of public hospital quality reports for pregnant women across diverse racial/ethnic and LEP groups could help drive overall quality improvement in childbirth and reduce maternal health outcome disparities. In order to address key knowledge gaps in the science of public reporting and to meet quality improvement and disparity reduction goals, we will: (1): Quantify inpatient maternal health quality outcomes and childbirth hospitalization patterns among diverse AA/PI and LEP populations in Hawaii to strengthen empirical evidence on this understudied topic, to determine relevant populations for Aims 2-3, and to provide group-specific results for personalized maternal inpatient quality metrics in Aim 3;(2): Describe utilization, usefulness, ease-of-use, and preferences for public reports of inpatient maternal health quality across diverse AA/PI and LEP groups by interviewing 400 women with a recent hospital delivery. Findings will be contextualized within the constraints, decision inputs, and factors relevant to the childbirth hospital decision, which are expected to vary across groups;and (3): Design and pilot test a personalized, interactive, consumer-focused website concerning the maternal hospital delivery decision, including useful and easy-to-understand inpatient quality measures. This product will draw from empirical evidence, consumer informatics theory, and web design best practices. The usefulness and usability of an English version will be pilot tested in 2 AA/PI groups (n=40) with disparities in Aim 1 and distinct preferences in Aim 2. A non-English version will be tested in an LEP group (n=20) with many speakers in the U.S., large health disparities from Aim 1, and known preferences from Aim 2.

Public Health Relevance

This study will improve the science of consumer reporting of public hospital quality information by describing how individuals from diverse racial/ethnic groups and those with limited English proficiency use maternity- focused hospital quality information, what they value and understand from existing public reports on this topic, and whether additional information or presentation features might encourage higher use. We will use this information to design and test a personalized, consumer-focused website with the goal of improving the use of public hospital quality reports for pregnant women across diverse racial/ethnic and linguistic groups.

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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University of Hawaii
Public Health & Prev Medicine
Schools of Medicine
United States
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Davis, Chevelle Ma; Guo, Mary; Miyamura, Jill et al. (2017) Key Factors in Obstetric Delivery Decision-Making among Asian and Pacific Islander Women by English Proficiency. Hawaii J Med Public Health 76:279-286
Sentell, Tetine; Chang, Ann; Ahn, Hyeong Jun et al. (2016) Maternal language and adverse birth outcomes in a statewide analysis. Women Health 56:257-80
Chang, Ann Lee; Hurwitz, Eric; Miyamura, Jill et al. (2015) Maternal risk factors and perinatal outcomes among pacific islander groups in Hawaii: a retrospective cohort study using statewide hospital data. BMC Pregnancy Childbirth 15:239
Sentell, Tetine; Chang, Ann; Cheng, Yongjun et al. (2014) Maternal quality and safety outcomes for Asians and Pacific Islanders in Hawai'i: an observational study from five years of statewide data. BMC Pregnancy Childbirth 14:298