On selecting quality indicators: preferences of patients with breast and colon cancers regarding hospital quality indicators

BMJ Qual Saf. 2020 Jul;29(7):576-585. doi: 10.1136/bmjqs-2019-009818. Epub 2019 Dec 12.


Background: There is an increasing number of quality indicators being reported publicly with aim to improve the transparency on hospital care quality. However, they are little used by patients. Knowledge on patients' preferences regarding quality may help to optimise the information presented to them.

Objective: To measure the preferences of patients with breast and colon cancers regarding publicly reported quality indicators of Dutch hospital care.

Methods: From the existing set of clinical quality indicators, participants of patient group discussions first assessed an indicator's suitability as choice information and then identified the most relevant ones. We used the final selection as attributes in two discrete choice experiments (DCEs). Questionnaires included choice vignettes as well as a direct ranking exercise, and were distributed among patient communities. Data were analysed using mixed logit models.

Results: Based on the patient group discussions, 6 of 52 indicators (breast cancer) and 5 of 21 indicators (colon cancer) were selected as attributes. The questionnaire was completed by 84 (breast cancer) and 145 respondents (colon cancer). In the patient group discussions and in the DCEs, respondents valued outcome indicators as most important: those reflecting tumour residual (breast cancer) and failure to rescue (colon cancer). Probability analyses revealed a larger range in percentage change of choice probabilities for breast cancer (10.9%-69.9%) relative to colon cancer (7.9%-20.9%). Subgroup analyses showed few differences in preferences across ages and educational levels. DCE findings partly matched with those of direct ranking.

Conclusion: Study findings show that patients focused on a subset of indicators when making their choice of hospital and that they valued outcome indicators the most. In addition, patients with breast cancer were more responsive to quality information than patients with colon cancer.

Keywords: decision making; health policy; health services research; hospital medicine; performance measures.

MeSH terms

  • Choice Behavior
  • Colonic Neoplasms*
  • Hospitals
  • Humans
  • Patient Preference
  • Quality Indicators, Health Care*