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Media Coverage And Dissemination Of Provider Quality “Report Cards”: Are Consumers Responding?
Public reporting of comparative provider quality information (CQI) has grown substantially in the last decade.
New Contribution
Past empirical work testing the impact of publication of quality report cards on consumers has typically used “revealed” choice models that share two key limitations: 1) strong assumptions about consumer awareness and use of reports published on the internet while often neglecting the effect of proactive dissemination strategies used by producers and media coverage of these reports, and 2) a focus on the choice decision rather than consumer awareness of and attitudes towards CQI as a key intermediary factor that may inform their choices. We will address these gaps in literature in this study.
Data Sources and Measurement
Access World News database is used to capture the intensity of regional media coverage of quality reports by systematic search and coding of relevant articles published in the local print newspapers for fourteen diverse geographical regions in the United States. Aligning Forces for Quality (AF4Q) Community Quality Reporting Tracking Database is used to generate estimates of regional availability and applicability of information contained in the report cards. AF4Q alliance websites and site tracking information on quality report dissemination is used to generate a ranking of “intensity” of dissemination by reporting organizations (i.e., AF4Q alliances). Aligning Forces for Quality Consumer Survey, a panel dataset of chronically ill adults is used to capture consumer awareness, use and attitudes towards CQI at two points in time (2008 and 2012).
Empirical Analyses
We run linear individual fixed effects regression models to generate estimates of the effect of dissemination and local media coverage of CQI on awareness and use of CQI, while accounting for regional media coverage of patient safety practices of providers, time-varying individual-level socio-demographic and health-related variables, and time-varying area-level factors.
Results
Between 2008 and 2012, the mean awareness and use of CQI both increased by 2 percentage points (31% to 33% and 9% to 11%, respectively). Availability of any report and applicable report increased modestly between 2008 and 2012 (6.42 to 8.99 and 1.17 to 2.23, respectively). Dissemination of CQI by AF4Q alliances increased on average by about 4 points between 2008 and 2012 (0.67 to 4.78), where each point is equivalent to use of one additional dissemination strategy. Regional media coverage of CQI on average decreased between 2008 (2.42 “idealized” news items) and 2012 (1.96“idealized” news items). We find that availability of one additional applicable report significantly increases use (by 1.2 % points) but not awareness of CQI. We also find sizable increases in use (but not awareness) with increase in media coverage of CQI; one additional idealized news article increases use of CQI by about 1.1 percentage points, representing an increase of nearly 12 % over the baseline level of use.
Conclusions
More selective targeting of information to consumers for whom it is relevant and dissemination strategies focused on heightening media “footprint” of report cards would likely lead to substantial improvement in their use by consumers.