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How Patient Comments Affect Consumers’ Use of Physician Performance Measures

Kanouse, David E., PhD*; Schlesinger, Mark, PhD; Shaller, Dale, MPA; Martino, Steven C., PhD§; Rybowski, Lise, MBA

doi: 10.1097/MLR.0000000000000443
Original Articles

Background: Patients’ comments about doctors are increasingly available on the internet. The effects of these anecdotal accounts on consumers’ engagement with reports on doctor quality, use of more statistically reliable performance measures, and ability to choose doctors wisely are unknown.

Objective: To examine the effects of providing patient comments along with standardized performance information in a web-based public report.

Design: Participants were randomly assigned to view 1 of 6 versions of a website presenting comparative performance information on fictitious primary care doctors. Versions varied by the combination of information types [Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS), and patient comments] and number of doctors.

Participants: A random sample of working-age adults (N=848) from an online panel representing the noninstitutionalized population of the United States.

Main Measures: Time spent and actions taken on the website, probing of standardized measures, and decision quality (chosen doctor rated highest on quantifiable metrics, chosen doctor not dominated by another choice). Secondary outcomes were perceived usefulness and trustworthiness of performance metrics and evaluations of the website.

Key Results: Inclusion of patient comments increased time spent on the website by 35%–42% and actions taken (clicks) by 106%–117% compared with versions presenting only CAHPS and HEDIS measures (P<0.01). It also reduced participants’ attention to standardized measures (eg, percentage of time probing HEDIS measures dropped by 67%, P<0.01). When patient comments were present, fewer participants chose the doctor scoring highest on standardized metrics (44%–49% vs. 61%–62%, P<0.01).

Conclusions: Including patient comments in physician performance reports enhances consumers’ engagement but reduces their attention to standardized measures and substantially increases suboptimal choices. More research is needed to explore whether integrated reporting strategies could leverage the positive effects of patient comments on consumer engagement without undermining consumers’ use of other important metrics for informing choice among doctors.

*RAND Corporation, Santa Monica, CA

Yale University School of Public Health, New Haven, CT

Shaller Consulting Group, Stillwater, MN

§RAND Corporation, Pittsburgh, PA

The Severyn Group, Ashburn, VA

This study was funded by cooperative agreements U18HS016978 and U18HS016980 with the Agency for Healthcare Research and Quality. We thank Mike Cui of RAND for research assistance and Debra Dean of Westat for logistics support. Preliminary analyses of some of the data reported in this paper were presented at the 2012 Agency for Healthcare Research and Quality annual conference.

The authors declare no conflict of interest.

Reprints: David E. Kanouse, PhD, RAND Health, 1776 Main Street, P.O. Box 2107, Santa Monica, CA 90407-2138. E-mail:

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.