Abstract
Study objectives We aimed to investigate how different presentation formats influence comprehension and use of comparative performance information (CPI) among consumers. Methods An experimental between-subjects and within-subjects design with manipulations of CPI presentation formats. We enrolled both consumers with lower socioeconomic status (SES)/cognitive skills and consumers with higher SES/cognitive skills, recruited through an online access panel. Respondents received fictitious CPI and completed questions about interpretation and information use. Between subjects, we tested (1) displaying an overall performance score (yes/no); (2) displaying a small number of quality indicators (5 vs 9); and (3) displaying different types of evaluative symbols (star ratings, coloured dots and word icons vs numbers and bar graphs). Within subjects, we tested the effect of a reduced number of healthcare providers (5 vs 20). Data were analysed using descriptive analysis, analyses of variance and paired-sampled t tests. Results A total of 902 (43%) respondents participated. Displaying an overall performance score and the use of coloured dots and word icons particularly enhanced consumer understanding. Importantly, respondents provided with coloured dots most often correctly selected the top three healthcare providers (84.3%), compared with word icons (76.6% correct), star ratings (70.6% correct), numbers (62.0%) and bars (54.2%) when viewing performance scores of 20 providers. Furthermore, a reduced number of healthcare providers appeared to support consumers, for example, when provided with 20 providers, 69.5% correctly selected the top three, compared with 80.2% with five providers. Discussion Particular presentation formats enhanced consumer understanding of CPI, most importantly the use of overall performance scores, word icons and coloured dots, and a reduced number of providers displayed. Public report efforts should use these formats to maximise impact on consumers. BACKGROUND Comparative performance information (CPI) about healthcare providers has been embraced in Western countries, both in efforts to empower patients and as part of competition-based healthcare reforms.1–4 These reports highlight variations in recommended processes of care and/or patient outcomes and experiences across healthcare providers. Especially, web-based CPI reports have become common in practice in the past 10– 15 years. It has become clear, however, that CPI is only used by a small number of consumers.5–8 An important precondition for effective use by consumers, namely the availability of adequate information, has not always been met.9 10 Another reason is that many people have difficulty understanding CPI.2 11–13 CPI usually consists of many quality indicators, described in medical or policy jargon,10 14 15 and often expressed in numerical terms.15 However, many consumers lack the basic health literacy and numeracy skills needed to comprehend such scores.16–18 Addi