title: How do pregnant women use quality measures when choosing their obstetric provider?
abstract: Given increased public reporting of the wide variation in hospital obstetric quality, we sought to understand how women incorporate quality measures into their selection of an obstetric hospital.
  
  
  
  We surveyed 6141 women through Ovia Pregnancy, an application used by women to track their pregnancy. We used t tests and chi-square tests to compare response patterns by age, parity, and risk status.
  
  
  
  Most respondents (73.2%) emphasized their choice of obstetrician/midwife over their choice of hospital. Over half of respondents (55.1%) did not believe that their choice of hospital would affect their likelihood of having a cesarean delivery. While most respondents (74.9%) understood that quality of care varied across hospitals, few prioritized reported hospital quality metrics. Younger women and nulliparous women were more likely to be unfamiliar with quality metrics. When offered a choice, only 43.6% of respondents reported that they would be willing to travel 20 additional miles farther from their home to deliver at a hospital with a 20 percentage point lower cesarean delivery rate.
  
  
  
  Women's lack of interest in available quality metrics is driven by differences in how women and clinicians/researchers conceptualize obstetric quality. Quality metrics are reported at the hospital level, but women care more about their choice of obstetrician and the quality of their outpatient prenatal care. Additionally, many women do not believe that a hospital's quality score influences the care they will receive. Presentations of hospital quality data should more clearly convey how hospital-level characteristics can affect women's experiences, including the fact that their chosen obstetrician/midwife may not deliver their baby.
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Gourevitch
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Ateev
authors.initials: A
authors.lastname: Mehrotra
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: Galvin
authors.affiliation: Blue Cross Blue Shield of Massachusetts, Boston, MA, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Karp
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Avery
authors.initials: A
authors.lastname: Plough
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA.|Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Neel T
authors.initials: NT
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002585:Cesarean Section; D002755:Choice Behavior; D005260:Female; D006801:Humans; D009721:Nurse Midwives / Q000592:standards; D009774:Obstetrics; D010298:Parity; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards*; D014481:United States; D055815:Young Adult
keywords: cesarean delivery rates; obstetric quality; provider selection; survey