Objective:To assess the impact of quality of care and other hospital information on patients' choices between hospitals. Methods: 665 former surgical patients 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 containing 2 levels. Hospital attributes were included if frequently reported by patients as most important for future hospital choices. These included both general hospital information (e.g., atmosphere), information on quality of care (e.g., percentage of patients with "textbook outcome"), and surgery-specific information (e.g., possibility for minimally invasive procedure). Hierarchial 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. Results: 308 (46.3%) questionnaires were available for analysis. Of the hospital attributes that patients considered, surgery-specific information on average had the highest relative importance (25.7 [23.9-27.5]), regardless of gender, age, and education. Waiting time and hospital atmosphere were considered least important. The attribute concerning the percentage of patients with "textbook outcomes" had the second greatest impact (18.3 [16.9-19.6]), which was similar for patients with different adverse outcome experience. Conclusions: Surgery-specific and quality of care information are more important than general information when patients choose between hospitals. I nformation on performance of hospitals is increasingly available within the public domain in various countries worldwide. 1 Such information is thought to improve patients' choice and quality of care. However, patients do not seem to use quality information for their hospital choice. Marshall and others, 2 for instance, showed in their literature review of the period 1986-1999 that patients rarely searched for information about hospital performance, that they did not understand or trust information they did find, and that it had a small (although increasing during the time period reviewed) impact on their decision making. More recently, Faber and others 3 concluded in their systematic review that there is limited evidence about the effectiveness of quality information on consumer choice. Furthermore, Fung and others 4 showed in their review that the effect of public reporting on the outcomes of patient care, improvement of patient safety, and patient centeredness remains uncertain, since rigorous evaluation of many reporting systems is lacking. Possible explanations for these findings are that there is too much information, it is not the information patients want, or other information prevails when choices are made.Increased competition between hospitals based on quality is one of the central themes in the health care insur...
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