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Biomedical subjects

J H Hibbard

Publications and source records attributed to J H Hibbard.

At least 19 recordsLinked to original sources
PubMed2001

The demand for consumer health information.

Using data from an evaluation of a community-wide informational intervention, we modeled the demand for medical reference books, telephone advice nurses, and computers for health information. Data were gathered from random household surveys in Boise, ID (experimental site), Billings, MT, and Eugene, OR (control sites). Conditional difference-in-differences show that the intervention increased the use of medical reference books, advice nurses, and computers for health information by approximately 15, 6, and 4%. respectively. The results also suggest that the intervention was associated with a decreased reliance on health professionals for information.

Adolescent↗
PubMed2001

Mode of payment, practice characteristics, and physician support for patient self care.

PURPOSE: The purpose of this study was to assess the influence of payment mode and practice characteristics on physicians' attitudes toward and support of self-care among their patients. It is a common practice for health plans and health insurance companies to distribute and make available various self-care services and products to members. These self-care products are generally part of a larger demand-management strategy. The adoption and dissemination of self-care products by both fee-for-service and capitated systems of care suggest an implicit assumption that there is no connection between physician payment mode and the support of self-care products by physicians for their patients. This study empirically examines this assumption. METHODS: Physicians from three Northwest communities were sampled and face-to-face interviews were conducted (N=448). RESULTS: The findings show that younger, primary care, and female physicians are more supportive of self care for their patients. Physicians with more income from capitation or salary are also more supportive of self care for their patients. After controlling for other factors, physician mode of payment is the only statistically significant predictor of support for self care. Research and policy implications are discussed. CONCLUSION: The findings suggest that physicians who are paid on a capitation basis have more motivation to have patients be less reliant on the formal care structure. It is unclear whether the payment mode generates this support, or if physicians supportive of patient self care self-select themselves into capitated systems of care.

Attitude of Health Personnel↗
PubMed2001

Making health care quality reports easier to use.

BACKGROUND: Although there is evidence that consumers want comparative quality information, most studies indicate that consumers make limited use of the data in decision making. The reasons for the limited use appear to be the complexity of the information and the difficulty of processing and using the amount of information in reports. The purpose of this investigation was to determine whether there are approaches to reporting comparative information that make it easier for consumers to comprehend the information. Further, the degree to which consumers who have a low level of skill can accurately use that information when it is presented in a format that is easier to use was examined. METHODS: The study used an experimental design to examine how different presentation approaches affect the use of information. Participants were randomly assigned to different conditions and were asked to review information and complete a decision task related to using comparative information and making health plan selections. Two separate convenience samples were used in the study: an elderly Medicare sample (N = 253), and a nonelderly sample (N = 239). RESULTS: The findings indicate that there are data presentation approaches that help consumers who have lower skills use information more accurately. Some of these presentation strategies (for example, relative stars) improve comprehension among the lower skilled, and other strategies (for example, evaluative labels) appear to aid those in the midrange of comprehension skill. CONCLUSIONS: Using these approaches in reporting would likely increase the use of the comparative information and increase the efficacy of reporting efforts.

Adolescent↗
PubMed2001

Does providing consumer health information affect self-reported medical utilization? Evidence from the Healthwise Communities Project.

OBJECTIVE: To determine whether providing health information to residents of Boise ID had an effect on their self-reported medical utilization. RESEARCH DESIGN: The Healthwise Communities Project (HCP) evaluation followed a quasi-experimental design. SUBJECTS: Random households in metropolitan zip codes were mailed questionnaires before and after the HCP. A total of 5,909 surveys were returned. MEASURES: The dependent variable was self-reported number of visits to the doctor in the past year. A difference-in-differences estimator was used to assess the intervention's community-level effect. We also assessed the intervention's effect on the variance of self-report utilization. RESULTS: Boise residents had a higher adjusted odds of entering care (OR = 1.27, 95% CI 0.88, 1.85) and 0.1 more doctor visits compared with residents in the control cities; however, for both outcomes, the effects were small and not significant. Although the means changed little, the data suggest that the variance of utilization in Boise decreased. CONCLUSIONS: The HCP had a small effect on overall self-reported utilization. Although the findings were not statistically significant, a posthoc power analysis revealed that the study was underpowered to detect effects of this magnitude. It may be possible to achieve larger effects by enrolling motivated people into a clinical trial. However, these data suggest that population-based efforts to provide health information have a small effect on self-reported utilization.

Adult↗
PubMed2001

The impact of a community-wide self-care information project on self-care and medical care utilization.

This study assesses the effects of the Healthwise Communities Project (HCP) on use of self-care resources and health care utilization. The intervention included the distribution of the Healthwise Handbook, the provision of a telephone advice line, and a Web site. All of these products use a symptom-based approach and are aimed at a general population. A quasi-experimental design was used with two comparison communities. Measurements over time assessed the effects of the HCP while controlling for secular trends. Survey and utilization data are used to assess the effect of the intervention. Findings indicate that the community intervention increased the use of self-care resources. Users believe that these products help them make better decisions regarding when to seek care and how to self-treat problems. Most believe that using the self-care resources saved them from seeking unnecessary care. The findings from the utilization data provide some evidence to support this conclusion.

Community Health Planning↗
PubMed2001

Health plan decision making with new medicare information materials.

OBJECTIVE: To examine the effect of providing new Medicare information materials on consumers' attitudes and behavior about health plan choice. DATA SOURCE: New and experienced Medicare beneficiaries who resided in the Kansas City metropolitan statistical area during winter 1998-99 were surveyed. More than 2,000 computer-assisted telephone interviews were completed across the two beneficiary populations with a mean response rate of 60 percent. STUDY DESIGN: Medicare beneficiaries were randomly assigned to a control group or one of three treatment groups that received varying amounts and types of new Medicare information materials. One treatment group received the Health Care Financing Administrations's pilot Medicare & You 1999 handbook, a second group received the same version of the handbook and a Medicare version of the Consumer Assessment of Health Plans (CAHPS) report, and a third treatment group received the Medicare & You bulletin, an abbreviated version of the handbook. PRINCIPAL FINDINGS: Results of the study suggest that the federal government's new consumer information materials are having some influence on Medicare beneficiaries' attitudes and behaviors about health plan decision making. Experienced beneficiary treatment group members were significantly more confident with their current health plan choice than control group members, but new beneficiaries were significantly less likely to use the new materials to choose or change health plans than control group members. In general the effects on confidence and health plan switching did not vary across the different treatment materials. CONCLUSIONS: The 1999 version of the Medicare & You materials contained a message that it is not necessary to change health plans. This message appears to have decreased the likelihood of using the new materials to choose or change plans, whereas other materials to which beneficiaries are exposed may encourage plan switching. Because providing more information to beneficiaries did not result in commensurate increases in confidence levels or rate of health plan switching, factors other than the amount of information, such as how the information is presented, may be more critical than volume.

Aged↗
PubMed2001

Who uses self-care books, advice nurses, and computers for health information?

OBJECTIVES: While evaluating the effect of a community-wide informational intervention, this study explored access, health, and demographic factors related to the use of medical reference books, telephone advice nurses, and computers for health information. METHODS: A random sample of households in the intervention city (Boise, Idaho) and two control cities were surveyed about their use of health information in 1996. Shortly thereafter, the Healthwise Communities Project (HCP) distributed health information to all Boise residents. A follow-up survey was conducted in 1998. Overall, 5,909 surveys were completed for a 54% response rate. RESULTS: The HCP intervention was associated with statistically significant increases in the use of medical reference books and telephone advice nurses. The increased use of computers for health information was marginally significant. Few access, health, or demographic factors were consistently associated with using the different resources, except that people with depression used more of all three information resources, and income was not a significant predictor. CONCLUSION: Providing free health information led to an increase in use, but access, health, and demographic factors were also important determinants. In particular, poor health status and presence of a chronic illness were associated with health information use. These results suggest that healthy consumers are less interested in health information, and it may take other incentives to motivate them to learn about prevention and healthy behaviors.

Adult↗
PubMed2001

Beneficiary survey-based feedback on new Medicare informational materials.

In response to the Balanced Budget Act (BBA) of 1997, the Center for Medicare & Medicaid Services (CMS) initiated a massive information and education campaign to promote effective health plan decision-making. Early results suggest that the pilot version of the Medicare & You handbook and other new Medicare informational materials were viewed favorably overall. Despite their limitations, most beneficiaries found the information useful. The longer, more comprehensive materials were not perceived to be more useful than the shorter, less complicated version. Additional research is needed to determine which subgroups of beneficiaries may need more and, possibly less, information.

Aged↗
PubMed2001

Measuring beneficiary knowledge in two randomized experiments.

This article reports results of two studies that measured beneficiaries' knowledge of the Medicare program and related health insurance options using pre- and post-experimental designs. Knowledge was measured using multiple item indexes before and after receiving new informational materials developed by the Centers for Medicare & Medicaid Services (CMS) as part of the National Medicare Education Program (NMEP). Beneficiaries in both studies showed statistically significant gains in knowledge after receiving the new materials. Policy implications for the measurement of knowledge and creation of future versions of the materials are discussed.

Aged↗
PubMed2000

The implications of plan design options for Medicare beneficiaries.

To make an informed selection between traditional Medicare and a Medicare managed care plan, a consumer needs to understand the implications of choosing one over the other. What are the implications of plan design for care, cost, and patient autonomy? Consumers need information about these questions. However, a barrier to developing this consumer information is the lack of a consistent body of evidence. An intermediate step is to tap expert knowledge. The purpose of this study is to use expert consensus (across a spectrum of health care experts) to identify the implications of plan design. Experts were surveyed and the degree to which there is consensus provides an initial picture of what experts judge to be important to the consumer. The findings show that experts agree on several implications associated with choosing managed care over the traditional Medicare plan. They also agree that many of these attributes vary considerably across health plans.

Aged↗
PubMed1999

Prevalence and predictors of the use of self-care resources.

Health care reform goals are to reduce costs and increase access while maintaining quality of care. A potentially effective avenue for achieving these difficult goals is to activate the untapped potential of consumers in managing their own health care. This study focuses on three Northwest communities and examines the prevalence of the use of self-care resources and the correlates of use. A random sample of households was surveyed using a mail-out questionnaire. The findings indicated that the use of self-care resources was high in the three community populations. Consulting a self-care book was the most commonly used resource, followed by telephone advice nurses. Communities do vary in their level of self-care resource use. Understanding this variability may help communities to expand the use of such resources and lessen the demand for formal health care services. Suggestions for future studies are discussed.

Adolescent↗
PubMed1998

Use of outcome data by purchasers and consumers: new strategies and new dilemmas.

OBJECTIVE: The complexities involved in measuring outcomes of care are perceived as a core challenge of health services research. However, the complexities associated with making outcomes data useable for purchasers and consumers are just beginning to be recognized. The purpose of this paper is to outline some of the barriers to purchaser and consumer use of clinical outcome (and other performance) data and to identify strategies for supporting greater use of these data. Dilemmas associated with current and proposed strategies are highlighted and recommendations are proposed. EVIDENCE: Three recent studies focusing on consumer and purchaser use of outcome data are used to illustrate barriers. The decision research literature is also drawn upon to describe the information processing challenges faced by purchasers and consumers when using performance information for making choices. FINDINGS: Information packaging strategies and decision support tools designed to overcome barriers are described, and dilemmas associated with their use are outlined. One major concern is that if we adopt strategies to make report card data more digestible, we may be trading off some of the market effects (e.g. improved health plan performance) that justify report card efforts in the first place.

Benchmarking↗
PubMed1997

Informing consumer decisions in health care: implications from decision-making research.

Despite the wider dissemination of health plan report cards, little is known about whether consumers will use this information in making plan and provider choices. Studies of human judgment and decision making are reviewed, as are their implications for devising strategies to inform consumers. The limitations of human information processing suggest that many consumers will not use performance information in making choices. Strategies are needed to support consumers who prefer to rely on intermediaries as well as those who wish to apply the information for their own use. Many current strategies are based on assumptions not supported by existing decision-making research. Although there is much to learn about assisting consumers in making informed choices, a great deal is known from decision-making research. Our approaches and our research agenda must be based on this existing foundation of knowledge.

Community Participation↗
PubMed1996

Cross-talk about the menopause: enhancing provider-patient interactions about the menopause and hormone therapy.

Although many women make the menopause transition without problematic symptoms, the current tendency to prescribe hormone replacement therapy (HRT)2 as a preventive measure against potential life-threatening conditions for postmenopausal women has made menopause a medical issue for all women. Informing the millions of women due to experience menopause over the next decades of the possible long-term risks and benefits of HRT presents a major challenge to primary care. Recent research suggests that women are dissatisfied with their interactions with their health-care providers regarding menopause and the options for menopause management. We identify barriers to effective communication between providers and patients about these issues, and make recommendations for both research and practice to facilitate more effective provider-patient interactions concerning menopause and its management.

Communication↗
PubMed1996

Comprehension of quality care indicators: differences among privately insured, publicly insured, and uninsured.

This study explores consumers' comprehension of quality indicators appearing in health care report cards. Content analyses of focus group transcripts show differences in understanding individual quality indicators and among three populations: privately insured; Medicaid; and uninsured. Several rounds of coding and analysis assess: the degree of comprehension; what important ideas are not understood; and what exactly is not understood about the indicator (inter-rater reliability exceeded 94 percent). Thus, this study is an educational diagnosis of the comprehension of currently disseminated quality indicators. Fifteen focus groups (5 per insurance type) were conducted with a total of 104 participants. Findings show that consumers with differing access to and experiences with care have different levels of comprehension. Indicators are not well understood and are interpreted in unintended ways. Implications and strategies for communicating and disseminating quality information are discussed.

Awareness↗
PubMed1996

Condition-specific performance information: assessing salience, comprehension, and approaches for communicating quality.

This study assesses how consumers view condition-specific performance measures and builds on an earlier study to test an approach for communicating quality information. The study uses three separate designs: a small experiment, a cross-sectional analysis of survey data, and focus groups. We test whether providing information on the health care context affects consumer understanding of indicators. Focus groups were used to explore how consumers view performance measures. The cross-sectional survey analysis used survey data from the experiment and the focus groups to look at comprehension and the salience of condition-specific performance measures. Findings show that a general consumer population does view condition-specific performance measures as salient. Further, the findings provide evidence that information on the health care context makes a difference in how consumers understand performance measures.

Breast Neoplasms↗