Form CMS-10310 Attachment C1 - Cogntive Interview Guide Consumers Careg

Interview protocols for consumer interviews

Consumer Testing Hospital Outpatient Measures

January 27 & 28, 2010

Testing materials checklist

Verify video/audio recording equipment and DVDs

Desktop for testing

Laptop for note-taking

Interviewer clock

Pens and notepads in each testing room

Website/Mockups of all materials

Protocols

Procedures for obtaining informed consent

As interviewees arrive, greeter should have them read and sign the informed consent form (if not enough time, interviewer should do this prior to starting). Give each person an unsigned copy of the form to keep.

Testing goals

The testing materials will include:

• The current Hospital Compare tool, available on the medicare.gov website

• Paper based mock-ups of pages the measures, table and graph displays, and explanatory text for: (1) Quality Care for Patients Having Surgery (2) Quality Care for Chest Pain or Heart Attack, and (3) Appropriate Use of Medical Imaging.

The interview will focus on the following issues:

• Assessing participants’ understanding of the content and language on the site, focusing specifically on:

  • The displays and language describing the surgical care measures. The team will test the domain descriptions, labels, tables, graphs and explanatory language for the outpatient surgical measures to determine whether consumers are able to interpret the displays as shown.

  • The displays and language describing the chest pain and heart attack measures. The team will test the domain descriptions, labels, tables, graphs and explanatory language for the outpatient chest pain and heart attack measures to determine whether consumers are able to interpret the displays as shown.

  • The displays and language describing the medical imaging measures. The team will test the domain descriptions, labels, tables, graphs and explanatory language for the outpatient medical imaging measures to determine whether consumers are able to interpret the displays as shown.

Timeline for interviews (90 minutes total)

Time in minutes for each section	Topic	Elapsed time at end of section
5	Introduction: Welcome And Overview	5
10	SECTION 1: INTRODUCTION TO SITE	15
10	SECTION 2: YOUR SELECTED HOSPITALS, COLLAPSED	25
15	SECTION 3: SURGICAL CARE MEASURES	40
20	SECTION 4: HEART ATTACK/CHEST PAIN MEASURES	60
20	SECTION 5: MEDICAL IMAGING MEASURES	80
5	Closing	85

Welcome and Overview of Discussion

Welcome

• Thank you for agreeing to participate in this discussion today.

• My name is {NAME} and I’ll be leading our discussion. I work for a company called {L&M Policy Research Policy Research/Mathematica Policy Research}, a health policy research firm.

Background—explain purpose of the discussion

• We’ve been hired by the Department of Health and Human Services (HHS) to help them understand how to get useful information to people who may need hospital services or who are helping to care for someone who may need hospital services.

• We are helping HHS make improvements to a website they have about hospital services. This website, called Hospital Compare, provides information on how well hospitals care for their patients. You can use this website as a tool to gather information about hospitals in your area, or when making decisions about where to get hospital care.

• When HHS puts information about hospitals on the website, they want to make sure that it makes sense and helps people when making decisions about hospital care. That’s why we’re here talking to you and other people – we would like to hear your opinions about the information on the website.

• Everything you tell us will be confidential. To protect your privacy, we won’t connect your name with anything that you say.

Ground rules

• Please be open and frank. We’re not looking for “right” answers. If something is unclear or confusing to you, it’s bound to be confusing to other people too.

• We’re recording these conversations, for research purposes, to help us remember everything that’s said, but we will not use anyone’s name or share this information beyond our research group.

• Some people working on this project are listening and watching behind the glass, and we are recording this so we can make sure we don’t miss anything. Because we’re recording, please try to speak in a voice at least as loud as the one I’m using now so that we can make sure the tape is picking up our voices.

• We’ll be here about an hour and a half. Any questions before we get started?

Warm-up and Introduction

Introductions

• Tell me about your experience using Internet. {Probe: Do you use the Internet? How often? What kinds of things do you use it for? Have you ever looked for health information on the Internet? What kind of health information?

SECTION I: INTRODUCTION TO HOSPITAL COMPARE

• As I mentioned earlier, we are helping HHS make improvements to the Hospital Compare website. Hospital Compare is a tool you can use to search for and compare hospitals based on how well they provide care. Have you ever visited Hospital Compare?

• I’m now going to briefly show you the website to give you an idea of what it looks like and what kinds of information you can find.

• Let’s pretend today that you have recently moved to a new location and you are interested in learning about the hospitals in that area.  One of things you might do is go to the Hospital Compare tool to look at information about the hospitals available in your area.

• Interviewer should open the Medicare homepage and take the participants to the Hospital Compare tool.

• On Step 1, explain how users can search by Hospital name, zip code, city, state/territory, or county, but use the city search, selecting Baltimore.

• On Step 2, explain how users can then choose to search by General Search, Medical Condition Search, or Surgical Procedure Search, but use the General Search.

• On Step 3, let participants look over the information for a minute or two, then explain how users then can select up to 3 hospitals to compare.

Now we are going to stop using the current site and start to use some paper printouts of what the screens might look like.

SECTION II: COLLAPSED MEASURES

After going through the tool as we just did, you get to this page with information for the 3 hospitals you selected. For our discussion today, I’d like you to pretend that you selected the following 3 hospitals to compare: Edgefield Hospital, Mitchell Hospital, and River View Hospital. Please note that since this is new information that is not yet on the website, these are not real hospitals.

{Hand participant Pages 1 of the mock up of Your Selected Hospitals, Collapsed} Take a minute to look over this information and then we’ll talk about it.

• In your own words, what kind of information is available on this page? What is this table showing you?

• Which, if any, terms are you unfamiliar with? What, if anything, is confusing or unclear?

• If you were looking at this page on the web site, what, if anything, would you do next? {Probe: What topics would you be interested in? Why do you say that? How would you get more information about those topics? What would you do?}

• What does the label, “Measures Based on Standards of Care” mean to you?

{Probe: What do you think is meant by standards of care?}

• Take a look at the information under this “Measures Based on Standards Care” category. What kinds of information are available here? {Probe: How is the information organized?}

• What does the label, “Surgical Care” mean to you? {Probe: What types of things do you think would be included here?}

• Did you notice the “…Learn more about surgical care and why these measures are important” link? How likely, if at all, would you be to click on this link? Why? What do you think you will see if you click on it?

• What does the label, “Heart Attack or Chest Pain” mean to you?

{Probe: What types of things do you think would be included here?}

• What does the label, “Appropriate Use of Medical Imaging (tests like Mammograms, MRIs, CT Scans)” mean to you? {Probe: What types of things do you think would be included here?}

SECTION III: SURGICAL CARE MEASURES

Let me show you what you would see if you clicked on the {Show Information} button next to Surgical Care. {Hand participant the mockups for the Surgical Care Measures} Take a minute to look this over and then we’ll talk about it.

• In your own words, what is this page about?

• If you were to choose a hospital based on this information alone, which hospital would you select? Why?

• Who do you think this information is for? {Probe: Are you interested in this information? Why or why not? Are there particular topics that you are interested in? Why?}

• {If participant has not mentioned the inpatient/outpatient subcategories}: Did you notice this row that says inpatient surgery?

• Why do you think the table includes information about both inpatient surgery and outpatient surgery?

• What do you think is the difference between the information presented on the outpatient surgery section versus the inpatient surgery section?

• Which, if either, of these is important to you? Inpatient surgery? Outpatient surgery? Both? Why do you say that?

• Do you have a preference for which information appears first, the information about inpatient surgery or the information about outpatient surgery? Why do you say that?

• Did you notice the text in the blue box that says “Not all the data in this measure has been checked for accuracy”?

• What do you think that means?

• Is this information important to you? If so, why? If not, why not?

• Now that you have read this, does this change the way you view this information? If so how? {Probe: Earlier, you mentioned that you would select Hospital X based on this information alone. Do you still feel the same way now that you know that some data have not been checked for accuracy?}

• Do you have any preference for where this information should appear? {Probe: would you prefer to see this information on the home page or first page of the website? Would you prefer to see it on the first page we looked at? Would you prefer to see this information here on this page? If so, where?}

Now let’s take a look at these measures.

Percent of outpatients having surgery who were given an antibiotic at the right time (within one hour before surgery) to help prevent infection (a higher percentage is better)

Percent of outpatients having surgery who were given the right kind of antibiotic to help prevent infection (a higher percentage is better)

• Tell me in your own words what these labels mean to you. {Probe: What are the measures about?}

• Which hospital is doing the best according to these measures? Why do you say that?

• What, if anything, is unclear or should be changed? {Probe: How would you re-write or change these labels?}

• Did you notice the footnote for Edgefield Hospital?

• If yes, what do you think this footnote means? What does that tell you about these hospitals?

• If no, please take a minute to read the footnote now and tell me what you think it means. Does that change the way view these hospitals? What could make this footnote stand out more?

Now I’d like to have you take a closer look at what you would see if you chose to view these measures in the form of a table. {Hand participant the Surgical Measures Table Display.}

• What is different on this page than the last page we looked at? {Probe: Did you notice the column with the US Average and the State Average? What do those columns mean? Why do you think those are provided?}

• What does this information tell you? How, if at all, would you use the information?

• How is Mitchell Hospital doing? Why do you say that? In your own words, what does 92% mean? What do you think about how it is performing compared to the United States Average? How is Mitchell performing compared to the State average?

• How is Edgefield Hospital doing? Why do you say that? In your own words, what does 69% mean? What do you think about how it is performing compared to the United States Average? Compared to the State average?

• Did you notice that the footnotes have been omitted? What do you think about that?

Now I’d like to have you take a closer look at what you would see if you chose to view this information in the form of a graph. {Hand participant the 1^st page of the Surgical Care Measures Graph Display}{Moderator will alternate between showing Graph 2/Version (that includes the text “higher percentages are better” and Graph 2/Version 2 (that shows “longer bars are better”).}

• What do you think about this graph? {Probe: What were your first impressions of this graph? When you first saw it what was your reaction?)

• In your own words, what is the graph about? What is this graph showing you?

• If you had to choose a hospital based on the information here, which hospital would you choose? Why do you say that?

• What do you think the numbers in the bars mean?

• What are the differences between the hospitals on this graph?

• How do the hospitals compare to the US Average? How do they compare to the Average for the State?

• Did you notice the text above the graph (Why is this important?)?

  • In your own words, what does this text mean?

  • Are there any parts that are unclear or hard to understand?

• How useful, if at all, did you find this information? {Probe: Does it provide the information you need to understand the measure?}

• Did you notice the text at the top of the graph (higher percentages are better)?

• What, if anything, is unclear or should be changed? {Probe: How would you re-write or change this text?}

Now I’d like to have you look at one more graph. {Hand participant Bar Graph 2, Version 2, showing “longer bars are better”}

• What do you think about this graph? {Probe: Is there anything different about this graph and the previous graph I showed you?)

• Did you notice the text in the graph “longer bars are better”?

• Which do you prefer: “higher percentages are better” or “longer bars are better”?

SECTION IV: HEART ATTACK/CHEST PAIN MEASURES

Let me show you what you would see if you clicked on the {Show Information} button next to Heart Attack/Chest Pain. {Hand participant pages 1 & 2 of the Heart Attack/Chest Pain Measures} Take a minute to look this over and then we’ll talk about it.

• In your own words, what is this page about?

• If you were to choose a hospital based on this information alone, which hospital would you select? Why?

• Who do you think this information is for? {Probe: Are you interested in this information? Why or why not? Are there particular topics that you are interested in? Why?}

Now let’s take a look at some of these measures.

Percent of outpatients with heart attack who got drugs to break up blood clots within 30 minutes of arrival (a higher percentage is better)

{Point to the 1^st measure on page 1}

• Tell me in your own words what this label means to you. {Probe: What is the measure about?}

• Which hospital is doing the best according to this measure? Why do you say that?

• What, if anything, is unclear or should be changed? {Probe: How would you re-write or change this label?}

Now I’d like to have you take a closer look at what you would see if you chose to view this measure in the form of a table. {Hand participant the Chest Pain/Heart Attack Table Display, and point to the 1^st measure.}

• What is different on this page than the last page we looked at? {Probe: Did you notice the column with the US Average and the State Average? What do those columns mean? Why do you think those are provided?}

• What does this information tell you? How, if at all, would you use the information?

• How is Riverview Hospital doing? Why do you say that? In your own words, what does 40% of 5 patients mean? What do you think about how it is performing compared to the United States Average? How is Riverview performing compared to the State average?

• How is Edgefield Hospital doing? Why do you say that? In your own words, what does “0 patients” mean to you? Based on the information you see here, would you feel comfortable going to Edgefield Hospital? Why or why not?

• Did you notice that the footnotes have been omitted? What do you think about that?

Now I’d like to have you take a closer look at what you would see if you chose to view this information in the form of a graph. {Hand participant page 7 of the Heart Attack Graph Display}

• What do you think about this graph? {Probe: What were your first impressions of this graph? When you first saw it what was your reaction?)

• In your own words, what is the graph about? What is this graph showing you?

• If you had to choose a hospital based on the information here, which hospital would you choose? Why do you say that? {Probe for understanding the directionality of the measure (lower minutes are better).}How confident are you in your choice? {Probe: if not confident, ask why. If very confident, inquire about footnotes and data quality.}

• What do you think the numbers in the bars mean?

• What are the differences between the hospitals on this graph?

• How do the hospitals compare to the US Average? How do they compare to the Average for the State?

• Did you notice the text above the graph (Why is this important?)?

  • In your own words, what does this text mean?

  • Are there any parts that are unclear or hard to understand? {Probe: “What do you think “standards for care” means?}

• How useful, if at all, did you find this information? {Probe: Does it provide the information you need to understand the measure?}

• What, if anything, is unclear or should be changed? {Probe: How would you re-write or change this text?}

Now let’s go back and take a look at some of the other measures. {Return to page 1 of Heart Attack Table Display and point to the 2^nd measure}

Average number of minutes before outpatients with heart attack who needed specialized care were transferred to another hospital (a lower number of minutes is better)

• Tell me in your own words what this label means to you. {Probe: What is the measure about? According to this measure, where does the patient receive care? Why would a patient be transferred to another hospital for care? Why do you say that?}

• Which hospital is doing the best according to this measure? Why do you say that? {Probe for understanding the directionality of the measure (lower minutes are better).}

• In your own words, what do the numbers in the cells mean? {Probe: What does 14 minutes mean for Mitchell Hospital? What does “0 patients” mean for Edgefield}

• What, if anything, is unclear or should be changed? {Probe: How would you re-write or change this label?}

Now please look at another way to describe this information. {Hand participant the alternate versions of the measure label}

Alternate Measure Label

Average number of minutes before outpatients with heart attack who needed specialized care were transferred to another hospital that can give them this care (a lower number of minutes is better)

• What this label mean? {Probe: What is the measure about?}

• What is the difference between this label and the previous label?

• Which label do you prefer? Why?

Now I’d like to have you take a closer look at what you would see if you chose to view this information in the form of a graph. {Hand participant page 8 of the Chest Pain/Heart Attack Graph Display}

Average number of minutes before outpatients with heart attack who needed specialized care were transferred to another hospital (a lower number of minutes is better)

• In your own words, what is this graph showing you?

• If you had to choose a hospital based on the information here, which hospital would you choose? Why do you say that? {Probe for understanding the directionality of the measure (lower minutes are better).}

• What are the differences between the hospitals on this graph?

• How do the hospitals compare to the US Average? How do they compare to the Average for the State?

• Did you notice the text at the top of the graph (Why is this important?)?

• In your own words, what does this text mean? {Probe: what does “specialized care” mean?}

• Does it change the way you view these hospitals? If so, how?

Let’s look at one last measure in this section. {Return to page 1 of the Chest Pain/Heart Attack Display and point to the 4th measure}

Average number of minutes before outpatients with heart attack (or chest pain that suggests a possible heart attack) got an ECG (a lower number of minutes is better)

• Tell me in your own words what this label means to you. {Probe: What is the measure about? What is being measured? What do you think an “ECG” is?}

• Which hospital is doing the best according to this measure? Why do you say that? {Probe for understanding the directionality of the measure (lower minutes are better).}

• In your own words, what do the numbers in the cells mean? {Probe: What does 16 minutes mean for River View Hospital? What does 0 minutes for Mitchell Hospital mean?}

• What, if anything, is unclear or should be changed? {Probe: How would you re-write or change this label?}

Now let’s take a look at what you would see if you chose to view this information in the form of a table. {Go to page x of the Chest Pain/Heart Attack Table Display and point out the last measure.}

• How is Edgefield Hospital doing? Why do you say that? What do you think about how it is performing compared to the United States Average? How is it performing compared to the State average?

• How is Mitchell Hospital doing? {Probe for understanding of the footnote}

• Did you notice that the footnote has been omitted? How do you feel about that?

Now let’s take a look at what you would see if you chose to view this information in the form of a graph. {Go to page x, the last page, of the Chest Pain/Heart Attack Graph Display}

• If you had to choose a hospital based on the information here, which hospital would you choose? Why do you say that?

• Did you notice the text above the graph (Why is this important?)?

  • In your own words, what does this text mean?

  • Are there any parts that are unclear or hard to understand? {Probe: what do you think “ECG” means?

  • Does it change the way you view these hospitals? If so, how?

SECTION V: MEDICAL IMAGING MEASURES

Let me show you what you would see if you clicked on the button next to Appropriate Use of Medical Imaging (tests like Mammograms, MRIs and CT scans). {Hand participant the Medical Imaging Measures, pages 1 & 2} Take a minute to look this over and then we’ll talk about it.

• In your own words, what is this page about?

• Did you read the text in the blue box? Tell me in your own words what that means to you. {Probe: Are there any parts that are unclear or confusing? Are you familiar with the term “imaging tests”?}

• Do you have any questions after reading this text? {Probe: What kinds of imaging tests is this referring to? Where are these tests taking place? What do you think we mean by “doing imaging tests in the most appropriate ways”? How can you tell if imaging facilities are doing imaging tests appropriately?}

• What do you think about the length of this text? {Probe: would you delete anything? Is there anything you would add?}

• If you were to choose a hospital based on these four measures, which hospital would you select? Why?

• Who do you think this information is for? {Probe: Who would use it? What type of patients? Are you interested in this information? Why or why not? Are there particular topics that you are interested? Why?}

Now let’s take a look at some of these measures.

Percent of outpatients with low back pain who had an MRI without trying recommended treatments first, such as physical therapy.

• Tell me in your own words what this label means to you. {Probe: What is the measure about? What is being measured?}

• What is this measure saying about diagnosis and treatment for back pain? {Probe: what does it say about getting diagnosed before or after getting treatment? {If participant correctly answers that you should get treatment before getting an MRI, ask: "why does it say you should get treatment before you get an MRI?"

• Which hospital is doing the best according to this measure? Why do you say that?

• In your own words, what do the numbers in the cells mean?

• What would a higher percentage mean? What would a lower percentage mean? {Probe: What does 26% mean for Mitchell Hospital? What does 60% mean for Edgefield Hospital?}

• What type of patients do you think are included in this topic?

• What do you think is meant by “treatment”? What do you think is meant by “without having treatment first”?

• In your own words, when is an MRI appropriate? {Is better to have more or fewer MRIs? Why do you say that?}

• What, if anything, is unclear or should be changed? {Probe: How would you re-write or change this label?}

Percent of outpatients who had a follow-up mammogram or ultrasound after a screening mammogram.

• Tell me in your own words what this label means to you. {Probe: What is the measure about?}

• Which hospital is doing the best according to this measure? Why do you say that?

• What do you think is meant by a “screening mammogram”? What do you think is meant by a “follow-up mammogram”?

• In your own words, what do the numbers in the cells mean? {Probe: What does 5% mean for Mitchell Hospital? What does 22% mean for River View Hospital?}

• What type of patients do you think are included in this topic?

• Is it better to have more or fewer follow-up mammograms? Why do you say that?

• What do you think is meant by “too much unnecessary follow-up”? {Probe: are any of these hospitals providing too much unnecessary follow-up? Are any not providing enough follow-up?}

• What, if anything, is unclear or should be changed? {Probe: How would you re-write or change this label?}

{Moderator will only discuss one of the measures around CT scans, alternating between the CT Scan of the Chest and the CT Scan of the Abdomen.}

Percent of all outpatient CT scans of the chest that were “combination” (double) scans.

• Tell me in your own words what this label means to you. {Probe: What is the measure about?}

• Which hospital is doing the best according to this measure? Why do you say that?

• In your own words, what do the numbers in the cells mean?

• What would a higher percentage mean? What would a lower percentage mean? {Probe: What does 1% mean for Mitchell Hospital? What does 11% mean for River View Hospital?}

• What do you think is meant by “combination” (double) scan? What is the difference between a double scan and a single scan? {Probe: is it better to have a double or a single scan? Why?}

• In your own words, what does it mean when a hospital has a very high percent? {Probe: what does that tell you about the hospital? Why do you think some hospitals may have high percents and others may have low percents? Who do you think determines whether a patient receives a double scan or a single scan?}

• What do you think would be an example of a “very high” percent? {Probe: would 50% be considered “very high”? would 90% be considered “very high”?}

• What, if anything, is unclear or should be changed? {Probe: How would you re-write or change this label?}

Percent of all outpatient CT scans of the abdomen that were “combination” (double) scans.

• Tell me in your own words what this label means to you. {Probe: What is the measure about?}

• Which hospital is doing the best according to this measure? Why do you say that?

• In your own words, what do the numbers in the cells mean?

• What would a higher percentage mean? What would a lower percentage mean? {Probe: What does 39% mean for Edgefield Hospital? What does 6% mean for River View Hospital?}

• What do you think is meant by “combination” (double) scan? What is the difference between a double scan and a single scan? {Probe: is it better to have a double or a single scan? Why?}

• In your own words, what does it mean when a hospital has a very high percent? {Probe: what does that tell you about the hospital? Why do you think some hospitals may have high percents and others may have low percents? Who do you think determines whether a patient receives a double scan or a single scan?}

• What do you think would be an example of a “very high” percent? {Probe: would 50% be considered “very high”? would 90% be considered “very high”?}

• What, if anything, is unclear or should be changed? {Probe: How would you re-write or change this label?}

Now I’d like to have you take a closer look at what you would see if you chose to view this information in the form of graphs. {Hand participant the Medical Imaging Graph Displays, pages 5-12}

Percent of outpatients with low back pain who had an MRI without trying recommended treatments first, such as physical therapy.

• What do you think about this graph? {Probe: What were your first impressions of this graph? When you first saw it what was your reaction?}

• In your own words, what is the graph about? What is this graph showing you?

• If you had to choose a hospital based on the information here, which hospital would you choose? Why do you say that? {Probe for understanding the directionality of the measure (lower percents are better).}

• What do you think the numbers in the bars mean?

• What are the differences between the hospitals on this graph?

• How do the hospitals compare to the State average?

Now let’s talk about the text above the graph –“What does this measure tell you about appropriate use of MRIs for low back pain?”. Take a minute to look this over and then we’ll talk about it.

• What does this information tell you?

• Are there any parts that are unclear or hard to understand?

• Did you notice the “risks” link? How likely, if at all, would you be to click on this link? Why? What do you think you will see if you click on it?

• Here’s a pop-up box you would get if you clicked on the link. Please take a minute to read that over and then we’ll talk about it. {Give participant the definition of “What are the risks of having an MRI?” on page 6}.

  • What does this information tell you? In your own words, what are the risks associated with MRIs? {Probe: are there risks of radiation?}

  • Are there any parts that are unclear or hard to understand? {Probe: what is “contrast”?}

  • How useful, if at all, did you find this information? {Probe: Does it provide the information you need to understand the risks associated with MRIs? What, if any, other information would you need?}

  • After reading this text, does it change the way you view these hospitals in the graph? If so, how?

• When should MRIs for low back pain be done? When should MRIs not be done? What should happen before getting an MRI? {Probe: what kinds of treatment should patients be given to relieve their pain?}

• Why should patients try treatment for low back pain before getting an MRI?

• For this measure, what does a high percent mean?

• What can patients do to ensure hospitals are appropriately using MRIs?

• How useful, if at all, did you find this information? {Probe: Does it provide the information you need to understand the measure? What, if any, other information would you need?}

• After reading this text, does it change the way you view these hospitals in the graph? If so, how?

• How would you use this information? {Probe: What would you do with this information? If you had questions or concerns, whom would you talk to about this information? What would you want to ask or say about this?

  • Is it important for you to know whether hospitals have high percents for providing MRIs prior to trying other treatment? If no, why not? If yes, what, if anything, would you do if you thought your hospital had high rates?

Percent of outpatients who had a follow-up mammogram or ultrasound after a screening mammogram. {Hand participant the Medical Imaging Graph Displays, page 7}

• In your own words, what is the graph about? What is this graph showing you?

• If you had to choose a hospital based on the information here, which hospital would you choose? Why do you say that? {Probe for understanding of the appropriate range}

• What are the differences between the hospitals on this graph?

• How do the hospitals compare to the State average?

Now let’s talk about the text above the graph –“What does this measure tell you about appropriate follow-up screenings for mammograms?”. Take a minute to look this over and then we’ll talk about it.

• What does this information tell you?

• Are there any parts that are unclear or hard to understand?

• In your own words, why should you be concerned if a hospital does too many follow-up mammograms? Too few? What else should it say?

• According to this information, what does “follow-up” mean? {Probe: what is a diagnostic mammogram? When are patients asked to come back for follow-up mammograms?}

• What do low percents mean? What do high percents mean? {Probe: what percents are considered very low? what percents are considered very high?}

• Are there any risks associated with mammograms? If so, what are those risks?

• How useful, if at all, did you find this information? {Probe: Does it provide the information you need to understand the measure? What, if any, other information would you need?}

• After reading this text, does it change the way you view these hospitals in the graph? If so, how?

• How would you use this information? {Probe: What would you do with this information? If you had questions or concerns, whom would you talk to about this information? What would you want to ask or say about this?}

{Moderator will only discuss one of the measures around CT scans, alternating between the CT Scan of the Chest and the CT Scan of the Abdomen.}

Percent of all outpatient CT scans of the chest/abdomen that were “combination” (double) scans.

• If you had to choose a hospital based on the information here, which hospital would you choose? Why do you say that? {Probe for understanding the directionality of the measure (lower percents are better).}

• What are the differences between the hospitals on this graph?

• How do the hospitals compare to the State average?

Now let’s talk about the text above the graph –“What does this measure tell you about appropriate use of CT scans of the chest/abdomen?”. Take a minute to look this over and then we’ll talk about it.

• What does this information tell you?

• Are there any parts that are unclear or hard to understand?

• In your own words, what is a double CT scan?

• What type of CT scan of the chest/abdomen should most patients get? {Probe: a single CT scan or a combination CT scan?}

• What are the risks associated with CT scans of the chest/abdomen?

• In your own words, what is “contrast”?

• For this measure, what does a high percent mean?

• How useful, if at all, did you find this information? {Probe: Does it provide the information you need to understand the measure? What, if any, other information would you need?}

• After reading this text, does it change the way you view these hospitals in the graph? If so, how?

• How would you use this information? {Probe: What would you do with this information? If you had questions or concerns, whom would you talk to about this information? What would you want to ask or say about this?}

Now I’d like to have you take a closer look at what you would see if you chose to view this information in the form of a table. {Hand participant the Medical Imaging Table Display, pages 3 & 4}

• What do you think about this information?

• If you were to select a hospital based on this information alone, which hospital would you choose? Why? {Note if participants change their interpretation of the measures}

Before we finish our conversation today, can you tell me what is your overall impression about the information we just discussed? {Probe: Is this information important/useful when looking at hospitals? Would you use the information? If yes, how would you use it? If no, why not? Would you decide to switch to a different hospital based on this information?}

CLOSING

Those are all the questions I have for you.

Do you have any final thoughts they would like to add?

If you’ll give me just a moment, I’ll check in with my colleagues. {See if anyone in the back room or on focus vision has anything else on which to probe.}

Thank you very much for taking the time to meet with me today. Your insights have been very helpful!

20