Increasing Use of Publicly Reported Pediatric Quality Data

Efforts to increase transparency regarding health care quality and safety are partially
guided by the belief that making performance information publicly available will enable
patients to make more informed choices. Although the amount of information reported on
websites and through other channels 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 navigators have helped
patients take greater advantage of the complex health care delivery environment, and use of
patient navigators may be an effective approach to engage consumers and to help them to
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 the 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.
English speaking women ages 16-45 attending the prenatal clinic at a large urban medical
center will be recruited, enrolled, consented and randomized to the navigator intervention
or an informational pamphlet control between 24-34 weeks of gestation. Women randomized to
the intervention arm will receive two 20 minute sessions with a trained patient navigator
who will guide women in navigating and interpreting information about the quality of care
provided at local pediatric practices on the Massachusetts Health Quality Partners web site.
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 outcome will be the average performance on quality 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.

Inclusion Criteria:

- 20-34 weeks of pregnancy

- comfortable speaking English

- ages 16-50

Exclusion Criteria:

- age 15 or younger

- age 51 or greater

- not comfortable speaking or understanding English

- less than 20 or greater than 34 weeks of pregnancy