title: Identifying Quality Indicators Used by Patients to Choose Secondary Health Care Providers: A Mixed Methods Approach.
abstract: BACKGROUND
  Patients in health systems across the world can now choose between different health care providers. Patients are increasingly using websites and apps to compare the quality of health care services available in order to make a choice of provider. In keeping with many patient-facing platforms, most services currently providing comparative information on different providers do not take account of end-user requirements or the available evidence base.
  
  
  OBJECTIVE
  To investigate what factors were considered most important when choosing nonemergency secondary health care providers in the United Kingdom with the purpose of translating these insights into a ratings platform delivered through a consumer mHealth app.
  
  
  METHODS
  A mixed methods approach was used to identify key indicators incorporating a literature review to identify and categorize existing quality indicators, a questionnaire survey to formulate a ranked list of performance indicators, and focus groups to explore rationales behind the rankings. Findings from qualitative and quantitative methodologies were mapped onto each other under the four categories identified by the literature review.
  
  
  RESULTS
  Quality indicators were divided into four categories. Hospital access was the least important category. The mean differences between the other three categories hospital statistics, hospital staff, and hospital facilities, were not statistically significant. Staff competence was the most important indicator in the hospital staff category; cleanliness and up-to-date facilities were equally important in hospital facilities; ease of travel to the hospital was found to be most important in hospital access. All quality indicators within the hospital statistics category were equally important. Focus groups elaborated that users find it difficult to judge staff competence despite its importance.
  
  
  CONCLUSIONS
  A mixed methods approach is presented, which supported a patient-centered development and evaluation of a hospital ratings mobile app. Where possible, mHealth developers should use systematic research methods in order to more closely meet the needs of the end user and add credibility to their platform.
authors.affiliation: Imperial College London, London, United Kingdom. dominic.king@imperial.ac.uk.
authors.forename: Dominic
authors.identifier: http://orcid.org/0000-0002-1898-842X
authors.initials: D
authors.lastname: King
authors.forename: Sameer
authors.identifier: http://orcid.org/0000-0002-1467-8176
authors.initials: S
authors.lastname: Zaman
authors.forename: Saman Sara
authors.identifier: http://orcid.org/0000-0002-7419-9564
authors.initials: SS
authors.lastname: Zaman
authors.forename: Gurnaaz Kaur
authors.identifier: http://orcid.org/0000-0002-6580-8401
authors.initials: GK
authors.lastname: Kahlon
authors.forename: Aditi
authors.identifier: http://orcid.org/0000-0003-3935-7915
authors.initials: A
authors.lastname: Naik
authors.forename: Amar Singh
authors.identifier: http://orcid.org/0000-0003-2096-8230
authors.initials: AS
authors.lastname: Jessel
authors.forename: Niraj
authors.identifier: http://orcid.org/0000-0002-5158-2616
authors.initials: N
authors.lastname: Nanavati
authors.forename: Akash
authors.identifier: http://orcid.org/0000-0002-9682-1174
authors.initials: A
authors.lastname: Shah
authors.forename: Benita
authors.identifier: http://orcid.org/0000-0001-7581-6651
authors.initials: B
authors.lastname: Cox
authors.forename: Ara
authors.identifier: http://orcid.org/0000-0001-7815-7989
authors.initials: A
authors.lastname: Darzi
keywords: hospital ratings; mHealth; mobile phone; patient choice