Vulnerable Patients’ Perceptions of Health Care Quality and Quality Data

Background. Little is known about how patients served by safety-net hospitals utilize and respond to hospital quality data. Objective. To understand how vulnerable, lower income patients make health care decisions and define quality of care and whether hospital quality data factor into such decisions and definitions. Methods. Mixed quantitative and qualitative methods were used to gather primary data from patients at an urban, tertiary-care safety-net hospital. The study hospital is a member of the first public hospital system to voluntarily post hospital quality data online for public access. Patients were recruited from outpatient and inpatient clinics. Surveys were used to collect data on participants’ sociodemographic characteristics, health literacy, health care experiences, and satisfaction variables. Focus groups were used to explore a representative sample of 24 patients’ health care decision making and views of quality. Data from focus group transcripts were iteratively coded and analyzed by the authors. Results. Focus group participants were similar to the broader diverse, low-income clinic population. Participants reported exercising choice in making decisions about where to seek health care. Multiple sources influenced decision-making processes including participants’ own beliefs and values, social influences, and prior experiences. Hospital quality data were notably absent as a source of influence in health care decision making for this population largely because participants were unaware of its existence. Participants’ views of hospital quality were influenced by the quality and efficiency of services provided (with an emphasis on the doctor-patient relationship) and patient centeredness. When presented with it, patients appreciated the hospital quality data and, with guidance, were interested in incorporating it into health care decision making. Conclusions. Results suggest directions for optimizing the presentation, content, and availability of hospital quality data. Future research will explore how similar populations form and make choices based on presentation of hospital quality data.