Uwe Sander, University of Applied Sciences Hannover, Hannover, Germany Martin Emmert, Institute of Management (IFM), Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany Benajamin Kolb, University of Applied Sciences Hannover, Hannover, Germany Track: Research Presentation Topic: Health information on the web: Supply and Demand Presentation Type: Poster presentation Submission Type: Single Presentation Last modified: 2014-09-01

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Background
Improving the transparency of information about health care provider quality is one way to improve health care quality. It is assumed that internet information will steer patients towards better performing health care providers and will motivate providers to improve quality. However, the effect of public reporting on hospital quality is still small. One of the reasons is that users find it difficult to understand the formats in which information is presented.
Objective
We analyzed the presentation of risk adjusted mortality rates for coronary angiography on the ten most commonly used German public reporting cards to analyze the impact of information presentation features on the comprehensibility. We addressed four questions: Which information presentation features were presented? Which were preferred by users? Which led to better comprehension? Which had similar effects in our sample to those reported in evidence based recommendations described in literature?
Methods
The study consisted of five steps: (1) Identification of best-practice evidence about the presentation of information on hospital report cards. (2) Selection of a single risk-adjusted quality indicator for the study. (3) Selection of a sample of the public reporting card designs used by German public reporting cards. (4) Identification of information presentation elements on public reporting initiatives in Germany. (5) Finally, an online survey was conducted to address the following questions: Were respondents able to identify the hospital with the lowest risk-adjusted mortality rate? Were respondents’ hospital choices associated with information design elements?
Results
Evidence-based recommendations relating to the following information presentation features relevant to report cards were identified: Evaluative table with symbols, Tables without symbols, Bar charts, Bar charts without symbols, Bar charts with symbols, Symbols, Evaluative word labels, Highlighting, Ordering providers, High values indicate good performance, State explicitly whether high or low values indicate good performance, Incomplete data (“n/a” as a value). Seven of those information presentation features were identified on German public reporting cards and five influenced user decisions and comprehension in the manner reported previously in literature.
Conclusions
This is the first study to systematically analyze the most common used public reporting card designs used in Germany. We propose the following five recommendations for German report cards providing information about mortality rates: Report cards should 1) avoid tables without symbols; 2) use bar charts with symbols; 3) state explicitly whether high or low values represent indicate good performance or identify a “good quality” range; 4) avoid incomplete data (“n/a” as a value) and 5) rank hospitals by performance. The implementation of four of these recommendations should not present insurmountable obstacles. However, ranking hospitals by performance may present substantial difficulties. Ordering by performance is often resisted by providers as it makes report sponsors responsible for determining what constitutes a meaningful difference in mortality rates.