1. Health Consumerism Project in the North Texas Area
Chiao-Chin Lin, Liam O’Neill and Crystee Cooper
ABSTRACT
INTRODUCTION/BACKGROUND
METHODS
CONCLUSION
References
Thanks to:
RESULTS
DISCUSSION
The Dallas-Fort Worth Hospital Council
Foundation (DFWHCF) is a nonprofit research
and education organization and has served as the
regional hub of claims data and analytics
since 1999.
The health consumerism project employs a
retrospective analysis of the general population in the
DFW metroplex. Tarrant County was selected to
process the health consumerism survey in order to
collect qualitative and quantitative data on health care
consumption and value. Health consumerism is a
movement to facilitate patients' engagement in to make
more informed health care decisions. Healthcare
consumerism aims to achieve positive effects of
patient's’ involvement, provided preventive health
measures, and improve patient satisfaction.
Dr. Crystee Cooper, DHEd, MPH, LSSGB, CHES, Director of Health Services Research
Dr. Liam O’Neill, Associate Professor and Academic Adviser
Grace Chang, Candidate for Master of Music in Southwestern Baptist Theological Seminary
Josh Frisbie, Candidate of Master of Health Administration
Qianzi Zhang, MPH
Jialiang Liu, Candidate of PhD-Biostatistics
Misty, Assistant Director of Student & Academic Services
Chelsea Derry, Coordinator of Academic Services
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The purpose of this paper is to compare health consumerism experiences
in North Texas with the historical consumerism progress in the UK and Germany.
The consumerism survey is designed to understand the health preferences of
patients who benefit from the effective responds of health providers. Summarizing
key findings and combining proper analytics that measure health improvement,
utilization and overall healthcare costs helps health systems perform precisely on
patterns of the Triple Aim (reduced costs, improved outcomes, and heightened
patients experiences).
The aim of Affordable Care Act (ACA) is to improve healthcare access by
expanding health insurance. Since the ACA focus on engagement and health
improvement, it helps increase participation in wellness, health improvement and
disease management programs. Moreover, the health care reform raises
awareness healthcare issues and relevant decision. Ultimately, the ACA is
designed to reduce employee and dependent health risks.
In Germany, the Social Health Insurance (SHI) system is mainly funded
through employers and employees. Its governance is through a network of public
law institutions with physicians’ associations and SHI funds as key stakeholders.
Therefore, care users participate through assigning to SHI funds, and recently
complement through stakeholder involvement of patient representatives. The
freedom to choose providers is a long lasting tradition in Germany. However, user
choices was extended and overturned in the 1990 reforms in form of freedom to
choose a SHI fund but freedoms to choose providers is regarded as driving up
costs. Hence, patients have to pay a fee for consulting a specialist without a
referral from their primary care doctor since 2005. Significance of economic forces
are the key policy driver in Germany that marginalize clientele-oriented strategies.
In the UK, the market mechanism provides an effective method to improve
standards and empower patients. Allowance of switching doctors enables patients
to apply alternatives. In fact, no comprehensive gate-keeper system is built to
control access to specialists. The NHS extends the providers choices in England.
The mission of health consumerism project is to defend community
members’ right to health care and to improve patient empowerment by increasing
patient autonomy and informed consent.
The development and validation of the consumerism survey took about
two weeks. The questionnaire consists of forty-four questions that take around 10
to 12 minutes to complete. Total numbers of effective Consumerism Surveys
collected are nearly 120. There were 28 rejections and 4 missing data. The
response rate was 79 percent.
The consumerism survey was progressed on face-to-face base. Fifty
responders filled in the printer-out paper based survey. Seventy responders
replied to online survey website named “SurveyMonkey.” The surveyor sent the
online questionnaire through school and personal email to his contacts and
fortunately received rapid responses in a week. On the first day of our survey, we
noticed that the race diversity issue and decided to adopt different strategies to
reduce selection bias.
The samples of the consumerism survey were mainly distributed and
located in Tarrant County. Three responses are from the Tarrant County
Courthouse. Five responses came from neighborhood visits to black community.
Five samples came from Mexico grocery stores and 5 samples were from Costco
near to the Hulen Mall area; 5 answers met in the cafeteria area of Target near the
7th street and 7 responders were located on the campus of University of North
Texas Health Science Center. Twenty responses were from Southwestern Baptist
Theological Seminary and relevant social networks to the systematic churches.
During summer, there are frequent thunderstorms in the DFW metroplex.
The surveyor had planned to progress the surveys on the TRE railways and the
Fort Worth Downtown area. Unfortunately, there was a thunderstorm right before
the noon of the day. Therefore, the plan was abandoned and change to the other
possible indoor locations like mexican restaurants and grocery stores.
The paper based surveys were not convenient to distribute to volunteers
especially alternative surveyors may not know the certain amount of
questionnaires they could get responses. For example, a friend may take more
blank questionnaires than she can manage with in reality and it may cause
unpredictable delays. Therefore, it is crucial to follow up the progress within two
days to make sure that the questionnaires have been processed smoothly.
The results of online and paper-based surveys were input into excel
worksheet and analyzed to explain the consumer behaviors.
5. Care coordination describes the facilitating process of appropriate delivery of
health care services. The content of care coordination includes access, quality, and
cost. 70% of responders say they didn’t receive care 3 or more times for the same
condition. 66% and 23% of responders think that health providers always and
usually listen to your reasons for the visit respectively. 83% of them think that health
providers always or usually provider easy explanation about their concerns. 77% of
them regard that health providers always or usually show concerns for their physical
health and well-being. 37% of responders think health providers sometimes talk too
fast. 21% of them say that health providers sometimes interrupt their conversation.
However, 85% of responders think that health providers always or usually answer all
of questions to their satisfaction. 89% of them mention that health providers care
about them as a whole person. In fact, there are only 16% of responders say that
health providers always or usually apply multi-media to explain. The figure shows
that health providers seldom use pictures, drawings, models, or videos to interact
with their patients yet. On the other hand, 75% of them think that written information
provided by health providers were easy to understand. 6 out of 10 responders
received reminders before clinical visits.
6. Medication adherence defines the patients take
medications as prescribed by their healthcare
providers, or follow healthy lifestyles. Timing,
dosage, and frequency of medication intakes are
observed during the consumerism survey.
Medication adherence deliver an important indicator
of overall quality.
The figures show that more than half of the
responders are not willing to have someone to
monitor their medications. The situation has raised
my attention so I list their demographic information
and try to figure out the main reason. Among those
who are not willing to have someone to monitor
their medications, 46% are white, 28% are black,
and 18% are Asian. There is no significant
differences between races and willingness to have
someone to monitor medications (p-value= 0.44).
46%
28%
1%
18%
2%
5%
Race: Not Willing Others to
Monitor Mediations
White
Black/African
American
American
Indian/Alaska Native
Asian
Native
Hawaiian/Pacific
Islander
15%
11%
36%
30%
5%
3%
Education Levels: Not Willing
Others to Monitor Mediations
No Degree Completed
High School Graduate,
Diploma, or Equivalent
(for example GED)
Associate Degree
Bachelor Degree
Master Degree
0%
10%
20%
30%
18-24 25-34 35-44 45-54 55-64 65-74 75 or
older
Age Groups: Not Willing Others
to Monitor Mediations
Most of those who are not willing to
have someone to monitor their
medications are with relatively higher
educational background (at least with
bachelor degrees).
Most patient engagement and care
coordination indicators show more than 70%
satisfaction on personal health services. However,
there are 4 sections that require further
improvements such as encouraging patients to ask
questions (62%) and talk about all of personal heal
questions or concerns (66%); health providers
seldom use pictures, drawings, models, or videos t
explain (28%); written information is not quite easy
understand (68%).
Besides, their age groups are
majorly fall around 25-34 and 55-64; they
rarely forget to take their medications. To
sum up, the reasons that customers who
reject to have someone to monitor their
medications can be attributed to privacy
concerns.
7. Telemedicine is an innovative way to perform clinical services
through telecommunication and information technologies. Telemedicine
aims to improve access of healthcare services especially in rural areas.
Therefore, access, quality, and cost are the major concerns. 89% of
responders show that health providers did not apply any kind of
telemedicine yet. However, among those with using experience of
telemedicine, convenience of hours is the major factor that persuade
them to adopt telemedicine.
8. Patient incentives aim to promote the responsibility of personal cares.
The cost is attributed to financial incentives and the access shows that
patients are able to engage and benefit from the current healthcare
system.
84% of responders indicate that they are aware of family health
history. 36% of responders show that they never see healthcare
providers in the past 3 months; 33% of them see healthcare providers
once in the past 3 months; 13% of them see healthcare providers twice
or three times in the past 3 months. 43% of responders indicate that the
reason of clinical visits is routine examinations; 15% of them indicate
that the reason of clinical visits is prescription refills; 11% of them
indicate that the reason of clinical visits is unusual physical conditions;
5% of them indicate that the reason of clinical visits is to ask for new
medication. 77% of responders think their health providers are trustful;
19% of them think their health providers maybe worth to trust.
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Ask for New Medications Prescription Refills Unusual Physical Conditions Routine Examinations Other (please specify)
Reasons of Clinical Visits
64% of responders are not willing to have others to monitor their personal
medication status. The figure indicates that the patients in North Texas are concerned
about their privacy and do not like others to have knowledge of their prescriptions.
Another assumption is that they think medication adherence should be personal
efforts and rather to behavior out of personally wills and take their own medication
individually. Accordingly, Only 5% of them always or usually forget to take their
medication. 94% of responders indicate that they are motivated by health providers to
maintain their health. 66% of responders show that they could stop taking medication
due to high costs. Moreover, 40% of them say that they could stop taking medication
because of side effects.
1. Disparity states racial or ethnic differences that
contribute to an individual's capability to achieve
better health. The survey plans to discover
disparities in health literacy between education
levels and understanding of health providers’
explanation. Education levels of consumerism
survey responders are diversified. Thirty-eight
percent of respondents have attained Bachelor’s
degrees; 29 % and 6% of responders have Master’s
and Doctoral degrees respectively. Education levels
are independent to understand the health providers’
explanation about concerns (Chi-square value=
12.9 < 16.9, df=9). Moreover, 8.6 out of 10
responders are currently employed. Ninety percent
of responders think that interpreters are not
necessary and 87% of them prefer to speak in
English in health providers’ offices.
86%
14%
Employement Status
Employed
Unemployed
2. Patient engagement is to approach the triple aims of improved health outcomes,
better patient care, and lower costs. Patient engagement includes access and cost
of care. 38% of responders regard that health providers always encourage them to
ask questions. Half of them think that health providers are interested in their
questions or concerns. Around 51% of responders think that health providers talk
about specific goals for their health. 85% of responders think health providers
always or usually answer questions to their satisfaction. 72% of responders think
that health providers provide preventive advice to them. 83% of responders say that
health providers talk about prescription medications during their visits. However,
there are 53% of responders talk about personal problems, family problems, alcohol
use, drug use, or mental and emotional health issues with their health providers.
3. Patient activation states that patients should be
more active and effective to manage their health.
In fact, access and quality of care are
indispensable factors to activate the consumer
awareness. Half of responders show that the
most influential person on their healthcare
decisions is family.
4. Cultural competency states an ability to interact with people from different cultures
and socio-economic backgrounds. Access and quality are critical factors to measure
cultural competency. 44% and 39% of responders think health providers always and
usually provide easy explanation about their concerns respectively. 57% of
responders think that health providers sometimes use unknown medical words; 34%
of them think that health providers never explain to them in medical words.
Nineteen percent of them indicate that partner or spouse is the most influential person.
68% of responders regard that health providers always or usually encourage them to talk
about their health concerns. Twenty-seven percent of them think health providers
sometimes encourage them to talk. Accordingly, encouragement of health providers helps
improve patient engagement.
The health consumerism project condenses a host of different
identities such as symbolic power, deliberative power and choice making
power. The study provides an overview to validate improved access, quality,
and reduced cost has occurred from a consumer’s perspective.
Encouragement of health consumerism will trigger more fundamental
changes in the healthcare system.
From the perspective of looking forward the promising health-related
information, the rapid exchanging knowledge helps empower our consumers
and modify the traditional roles of providers and patients. In the foreseeable
future, consumerism will integrate these factors and recreate personalized
health care services to provide higher quality of care while improving patient
satisfaction.