This project creates the first scientific foundation assessing the potential for systematically integrating patients'narrative accounts into public reports on health care providers that also include standardized quality measures. Effectively integrated, patients'accounts hold the potential to more effectively convey patient- reported experience, more fully engage consumers in informed choices, and enhance consumers'understanding of standardized quality metrics. Conversely, if patient comments proliferate in their current form as self-reported, partial anecdotes, they threaten to distract public attention from other more reliable quality measures. This project is intended to foster the first set of outcomes while mitigating the second. The proposed research builds on insights from previous studies of bounded rationality to investigate new ways of integrating narrative patient accounts with other measures of clinician quality, employing a mix of qualitative, quantitative, and experimental methods to: (1) identify and test several methods of eliciting patient/consumer accounts, (2) evaluate elicitation methods for their reliability and validity capturing reported patient experiences, as well as their trustworthiness and value to other consumers, (3) compare qualitative reports with standard survey-based measures (e.g. CAHPS), (4) test methods for incorporating qualitative patient accounts into public reporting systems, and assess their impact on consumer behavior and perceptions, and (5) establish relationships with public report sponsors, patient advocates and consumer groups to assess real-world implementation opportunities and challenges in assisting consumers to use reports that integrate narrative and standardized measures of quality. The project has a three year time-line. The first year will focus on developing reliable methods of eliciting patient accounts that capture all essential facets of interactions with clinicians. In the second year the focus shifts to exploring how best t integrate accounts into public reporting websites in ways that complement consumers'understanding and use of standardized quality metric derived from patient surveys or clinical records. In the final year of the project, the agenda shifts to exploring how to most effectively translate the lessons from this research to ongoing quality improvement and public reporting initiatives. The project will be pursued by an interdisciplinary team, with guidance from an advisory board composed of representatives from community coalitions, patient advocacy programs and organizations representing consumers.

Public Health Relevance

Relevance Patient accounts about interactions with clinicians are increasingly available to the public and increasingly sought out by health care consumers. In their current form, they threaten the public reporting exercise, by potentially diverting the publi's attention away from more reliable measures of quality and by potentially undermining the legitimacy of patient-reported experiences. This project explores the proposition that patients'narrative accounts can be converted into an asset for quality reporting in health care by obtaining more representative narratives, eliciting accounts in a more reliable manner, and presenting accounts in ways that complement rather than distract from quantitative measures of quality.

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))
Program Officer
Torio, Celeste
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Yale University
Public Health & Prev Medicine
Schools of Medicine
New Haven
United States
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Schlesinger, Mark; Grob, Rachel (2017) Treating, Fast and Slow: Americans' Understanding of and Responses to Low-Value Care. Milbank Q 95:70-116
Grob, Rachel; Schlesinger, Mark; Parker, Andrew M et al. (2016) Breaking Narrative Ground: Innovative Methods for Rigorously Eliciting and Assessing Patient Narratives. Health Serv Res 51 Suppl 2:1248-72