Okay, so you saw the title of this post and thought “No joke.” It’s no secret that the ways in which we are presented with information can shape our understanding of that information and our response to it. Psychologists have known this for decades, and the idea has made its way into advertising as well. That’s why, for example, you’ll see most cereal boxes contain a lot of the attention-grabbing color red on them, and brands are strategically placed on the shelf whose level corresponds with the height of the most likely consumer (e.g., sugary cereals are on the lower to middle shelves for children to see, while the high fiber stuff is usually quite a bit higher–besides, people in the market for that kind of cereal are specifically looking for it rather than making an impulse purchase.)
So, now you’re probably wondering what any of this has to do with health care. Well, ideally, our health care providers ought to be competing against each other on the basis of quality. Of course, for that to happen, we need to know what to measure, how to measure it, and how to communicate those measurements to the consumer in a meaningful way. We’ve still got a lot of work to do in all three areas, but there are some things that certain providers are already tracking, like the provision of beta blockers in heart attack patients, waiting times in emergency rooms, death rates following certain surgical procedures, hospital acquired infection rates, and so forth. But unless you work in a hospital, you probably don’t know much about how the providers in your area rate. Why? Because the data that is being gathered isn’t being communicated very well to consumers.
Step one, then, is to begin communicating that information. Step two, however, is to make sure that that information is communicated in the best way possible. On this point, Brian Elbel, Colleen Gillespie, Kristin Van Busum, Rebecca DiBennardo, Joyce Gyamfi, and Maria Raven of the New York University School of Medicine and the NYU Wagner School of Public Service have some suggestions. I came across a presentation of their research at the recent AcademyHealth meeting in Boston, and felt that it deserved a wider lay audience.
What Elbel’s group did was randomize study participants into 1 of 5 different groups: CMS quality measures presented in graphical format (control), written summaries that identified key tradeoffs, written summaries that identified key tradeoffs and included consumer experiences, and two further groups that involved nudging consumers based on particular consumer needs and preferences, and nudging consumers towards a health center closer to their home. Subjects had to choose which of 4 health centers to visit, although they could also refuse to make a choice. Without showing you all of the specific numbers, what they found was that people’s choice of health center varied significantly depending on how they were presented the quality information. For instance, shown the graphical information, 38% chose health center A while 16% chose health center D. When the same information was presented in a textual format, 24% chose health center A while 32% chose health center D.
Now, the one issue I have with this is that people have different learning styles. Some people are visual learners, some are more auditory, some like to look at pictures, some like to read words and wrestle with the thoughts they produce, and on and on. Therefore, this study by Elbel and his colleagues is an important start. It tells us that we are likely to reach different conclusions about which hospital is best, for example, if we are shown the data graphically versus in a narrative. But the bottom line is that some people are likely to find the graph more instructive and others to learn more from reading a paragraph. So, the search for a single “best” way to present quality data is likely to be fruitless. Instead, more work should be done to figure out how to present the same quality information in numerous complimentary formats that will connect with the greatest number of persons without becoming overwhelming.