Efforts to increase transparency regarding health care quality are partially guided by the belief that this information will enable consumers to make more informed choices. Although the amount of information reported on websites has increased dramatically, use by consumers remains limited and largely restricted to white, college-educated and middle-aged consumers. There are many barriers that prevent patients from making effective use of current public reporting websites, including failure to recognize that quality may vary between providers, lack of awareness of publicly reported data, limited internet access, and low health literacy and numeracy. Innovative approaches are therefore needed to overcome barriers to using these data, particularly in vulnerable populations, to ensure a health care system in which every consumer can benefit from public reporting. Patient navigator's help patients 'navigate'through the complex health care delivery environment, and use of patient navigators may be an effective approach to engage consumers and to help them interpret the information presented in public reports. The scientific aims of the study are: 1) to test the efficacy of an office-based patient navigator to assist low-income pregnant women in using publicly reported data to select a pediatric care provider;2) to assess the efficacy of the intervention in subgroups defined by parity, race/ethnicity, and health literacy;3) to evaluate th importance of publicly reported information about quality compared to other factors when selecting a pediatric provider;and 4) to assess the intervention's impact on self-management of health care. Women attending the prenatal clinic at a large urban medical center will be enrolled, and randomized to the navigator intervention or an informational pamphlet control. Women randomized to the intervention arm will receive two 20 minute sessions with a trained patient navigator who will guide them in navigating and interpreting information about the quality of care provided at local pediatric practices as presented on the Massachusetts Health Quality Partners website. Women randomized to the control arm will receive a pamphlet detailing how to use the Massachusetts Health Quality Partners website, but will not have trained patient navigators. A survey designed for the purpose of this study will be administered at baseline and post-intervention. Health literacy, numeracy and level of activation for self-management of health care will also be assessed as potential mediators of intervention effectiveness. The primary study outcomes will be the average performance on clinical quality and patient experience measures for the practices selected in the intervention and control groups. Secondary outcomes will include analyses of efficacy among groups of women defined by parity and an assessment of the relative importance of factors considered when choosing a pediatric care provider. Successful completion of the study aims will yield important new knowledge about the value of guided web site navigation as a strategy to reduce disparities in the use of publicly reported information.

Public Health Relevance

Numerous factors prevent consumers from making effective use of publicly reported information about the quality of health care, including limited recognitio that quality of care varies between physicians, lack of awareness of existing websites, limited internet access, low health literacy and numeracy. In the proposed randomized controlled trial we will evaluate the impact of providing assistance in the use and interpretation of information about the quality of pediatric care on the Massachusetts Health Quality Partners Quality Insights website among a population of low-income pregnant women. Results of the study will advance our understanding of effective strategies for overcoming barriers to using publicly reported information among vulnerable populations.

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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Baystate Medical Center
United States
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Goff, Sarah L; Mazor, Kathleen M; Guhn-Knight, Haley et al. (2017) Factors That Matter to Low-Income and Racial/Ethnic Minority Mothers When Choosing a Pediatric Practice: a Mixed Methods Analysis. J Racial Ethn Health Disparities 4:1051-1060
Goff, Sarah L; Mazor, Kathleen M; Pekow, Penelope S et al. (2016) Patient Navigators and Parent Use of Quality Data: A Randomized Trial. Pediatrics 138:
Goff, Sarah L; Youssef, Yara; Pekow, Penelope S et al. (2016) Successful Strategies for Practice-Based Recruitment of Racial and Ethnic Minority Pregnant Women in a Randomized Controlled Trial: the IDEAS for a Healthy Baby Study. J Racial Ethn Health Disparities 3:731-737
Goff, Sarah L; Pekow, Penelope S; White, Katharine O et al. (2013) IDEAS for a healthy baby--reducing disparities in use of publicly reported quality data: study protocol for a randomized controlled trial. Trials 14:244