title: How Patient Comments Affect Consumers' Use of Physician Performance Measures.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  A random sample of working-age adults (N=848) from an online panel representing the noninstitutionalized population of the United States.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: *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.
authors.forename: David E
authors.initials: DE
authors.lastname: Kanouse
authors.forename: Mark
authors.initials: M
authors.lastname: Schlesinger
authors.forename: Dale
authors.initials: D
authors.lastname: Shaller
authors.forename: Steven C
authors.initials: SC
authors.lastname: Martino
authors.forename: Lise
authors.initials: L
authors.lastname: Rybowski
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D014481:United States