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Patients need better, not more, information in choosing a high-quality hospital

Health think-thank the King's Fund has warned against the idea that more information is always better and suggests the government should be cautious about patients' ability to make full use of the 'information revolution' in a new report published today.  

The research, conducted in partnership with the London School of Economics and Political Science and IESE Business School, used focus groups and online experiments to find out how the design of information influences which hospitals patients choose. It concluded that simply allowing all information currently available about the quality of care to be put into the public domain would not result in people making more informed choices about their care.  

Barbara Fasolo, from LSE's Department of Management, was part of the research team which found that patients do not have firm or stable preferences about what is important to them when choosing a hospital. It also found that despite people's tendency to choose their local hospital rather than travelling further to a hospital with higher ratings of clinical quality, it is possible to prompt people to pay more attention to the importance of clinical quality by re-ordering information and making some aspects of quality more prominent.  

This reinforces the need for information providers to pay attention to how information is presented. It also suggests that there is a real opportunity to influence or 'nudge' people to pay more attention to clinical quality when choosing a hospital.  

However, the report concluded that while the use of nudges has the potential to improve the choices people make, more research is needed to evaluate their effects on decision-making for different groups of people.  

Other recommendations include the following.  

·   Policy-makers must recognise that encouraging patients to select a high-quality provider based on clinical quality measures is a difficult task and requires a high level of numeracy; patients may need support with these complex decisions

·   Given the complexity of decisions faced by patients, patient choice may not be a strong driver of clinical quality improvement.

·   Published information about the quality of services needs to be clear, easily understood, consistent and comparable if patients are to make more informed choices.

·   Exposing people to differences in quality between hospitals and confronting them with trade-offs made some people feel uneasy. Patients may benefit from information which reassures them that hospitals meet the required standards of care, despite not necessarily ranking highly.  

Anna Dixon, Director of Policy at The King's Fund and one of the report's authors, said: 'The coalition government has recently set out a vision where patients have better access to information and more control over their care. To help people make informed choices, information providers must ensure information is salient, easy to understand and clearly presented.  

'Information providers should be cautious about patients' abilities to make complex decisions without some support. Innovative approaches such as using nudges can help, but there needs to be an evidence-based approach to public reporting in future. Importantly, some people, particularly those who are less numerate, will need support and advice and the opportunity to discuss potential choices if they are to make informed choices about their care.'  

Choosing a high-quality hospital: The role of nudges, scorecard design and information, is available to download..


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