Increasing Use of Publicly Reported Pediatric Quality Data
Condition: Pregnancy
Study type: Interventional

Summary: 
      Numerous factors prevent consumers from making effective use of publicly reported information
      about the quality of health care, including limited recognition that quality of care varies
      between physicians, lack of awareness of the existing quality websites, limited internet
      access, and low health literacy and numeracy. In the proposed randomized controlled trial we
      will evaluate the impact of providing assistance for using and interpreting information about
      the quality of pediatric care on the Massachusetts Health Quality Partners Quality Insights
      website among a population of low income pregnant women. Results of the study will advance
      our understanding of effective strategies for overcoming barriers to using publicly reported
      information among vulnerable populations.
    

Detailed description: 
      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.
    

Intervention name(s): Patient Navigator Intervention
Intervention type(s): Other
Intervention description(s): The Patient Navigator Intervention will include 2 - 20 minute sessions with a patient navigator in which women are shown publicly available health care quality data about local pediatric practices on a non-profit quality collaborative's web site.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Quality of care; Pediatric; Pregnancy; Low-income; Low literacy