CMS-10360 Intensive Interview Guide_Physicians_ HAC_HAI_ED

INTERVIEW PROTOCOLS FOR PHYSICIAN INTERVIEWS

Consumer Testing Measures for Hospital-Acquired Conditions (HACs),
Healthcare Associated Infections (HAIs), and Emergency Department
(ED) Throughput
Dates TBD

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 the HAC, HAI, and ED measures, table and/or graphic displays,
and explanatory text.
The interview will focus on the following:
Assessing physicians’ understanding of, interest in, and preferred format for displaying
the new measures, focusing specifically on:
o The alternative displays and language describing the HAC, HAI, and ED
measures.
o How physicians view the new measures as indicators of quality and safety;
whether they see them as potentially useful to patients; and whether they think
descriptions given are appropriate and understandable to themselves and to
patients.

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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
{CONTRACTOR NAME}, 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 changes to a website they already have about hospital
services. This website, called Hospital Compare, provides information on how well
hospitals care for their patients.
When HHS puts information about hospitals on the website, they want to make sure that
it’s clear, understandable, and as useful as possible. 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. We’ll be asking for your feedback about the information that will be targeted to
the general public and about other information that you, as a physician, might want or
look for.
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
Introductions
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Before we get started, can you tell me a bit about you and your work?
o How long have you been in practice?
o In what sort of setting do you practice? (Group practice? Solo practice? Other?)
o Can you tell me a little but about the services you provide? What kinds of patients
you work with?
o How much of your time is spent providing services in a hospital setting?

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 information
about 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.
{Interviewer will provide a brief overview of Hospital Compare to give participant a
general idea of how the tool can be used to search for information about hospitals,
using local geographic area as an example.}
Let’s pretend today that a patient of yours asks about getting hospital care in a location
where you don’t know the medical professionals. One of things you might do is go to the
Hospital Compare tool to look at information about the hospitals available in your area.
Have you seen or used this information before? Did you know it was there? Has anyone
ever asked you about this?
Now we are going to stop using the current site and start to use some paper printouts of what the
screens might look like.
{Note: In order to mitigate possible order bias, interviewers will systematically alternate the
order in which the measure sets are presented to respondents for review. This order will be
captured in note-taking templates and protocols.}

Section II: Introduction to HAC Measures
After going through the tool as we just did, you get to this page with information for hospitals in
the location you selected.
{Interviewer hands respondent mockup of Hospital Compare ‘Results’ page, listing hospitals
in selected geographic area and data available.}
Take a minute to look over this information and then we’ll talk about it.
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In your own words, what kind of information is available, based on the information 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 topics would you be interested in?
What kind of information do you think you would find under these topics?
Would this information be useful to patients? Why do you say that?
Right now, the information on Hospital Compare is organized and labeled a different way, but a
lot of the information about heart attack, heart failure, pneumonia, surgical care, pediatric
asthma, and medical imaging is already available. You can also compare hospitals on these
measures, and see how different states compare.
Some of the new information I’d like us to focus on would fall under the Safety and Timeliness
categories.
Earlier, I showed you the Hospital Compare website and some of the information that’s available
there about hospitals. Right now, it includes some very specific information about what
hospitals do for patients who have surgery or certain conditions (like heart attack, heart failure,
and pneumonia). It’s organized a little differently, but the information that’s there now would
fall in the “Effectiveness” category.
Today, I want to get your feedback about some new information that will be posted in the
“Safety” and “Timeliness” Categories.
What do you think about the term “safety” when you think about health care?
What does that mean to you, in terms of hospital care?
Can you think of any examples of hospital care that might not be safe?

Section III: HAC Measures
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
these are not real hospitals. And let’s pretend you selected a tab that showed Safety measures
for those three hospitals.
Then you might come to pages that look like this.
{Interviewer hands respondent first page of mock-up for HAC measures, showing general
definition of HACs, plus table showing results for 3 hospitals.}

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HAC Measures: Definition
In your own words, what is this telling you?
What kind of information do you expect to see, based on this?
Is this important information, in your view?
Does this information relate to what you know about hospital care?
What else would you need to know here?
Would this information be useful to patients? Why do you say that?
Is there anything here that you think might be unclear or confusing to patients?
o Is there anything that you think might be misleading to them?
o What questions would they have, or would they ask you, about it?
How (if at all) do you think this information could be improved, to make it more
understandable or useful to patients?

HAC Measures: Measure Labels
First, tell me in your own words what each of these measure labels mean to you.
o {Probe: What are the measures about?}
Is there anything here that might be unclear or confusing to patients?
o {Probe: How would you re-write or change these labels, to make them more
understandable or useful to patients?}
Is this important? Are some of these more important than others?
What does this information tell you? How, if at all, would you use the information?
HAC Measures: Table Display, Rates
Based on what you see here, how often would you say these kinds of things happen in
hospitals?
o {probe: Do participants understand that the numbers are rates per thousand
discharges?}

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Based on what you see here, what do you think about safety at Edgefield Hospital?
Which of the items shown here is a more serious area of concern for Edgefield Hospital?
Why? How serious are they?
o {probe: based on numbers of patients affected; based on comparisons to national
rates}
Is there anything here that you think might be unclear or confusing to patients?
o Is there anything that you think might be misleading to them?
o What questions would they have, or would they ask you, about it?
How (if at all) do you think this information could be improved, to make it more
understandable or useful to patients?
Now, I’d like to get your feedback on some slightly more detailed explanations about what these
measures are about (for example, if you clicked on the “Read more . . .” link).
{Interviewer hands respondent narrative explanation about HACs and definitions of HAC
measures.}
HAC Measures: Explanatory Text
How important is this information?
Who do you think would be interested in this information? Would your patients be
interested? Why do you say that?
Is there anything here that you think would be confusing or hard to understand?
How do you think this information could be improved, to make it more understandable or
useful to patients?
o What else does it need to say?
HAC Measures: Measure Definitions
The next pages show definitions of each of the measures you saw in the table. Take a minute to
look these over.
Are these helpful definitions? Is there anything here that you think is unclear?
Does this add information that you think is important to know? What information is
particularly important?
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Are these definitions enough information for your patients?
information for you or other doctors?

Are they enough

How do you think this information could be improved, to make it more
understandable or useful to patients?

Section IV: HAI Measures
Now, I’d like to show you some other information you might find under the Safety tab for those
three hospitals.
{Interviewer hands respondent first page of mock-up for HAI measures, showing general
definition of HAIs, plus table showing results for 3 hospitals.}
HAI Measures: Definition
In your own words, what is this telling you?
What kind of information do you expect to see, based on this?
Is this important information, in your view?
Would this information be useful to patients? Why do you say that?
Is there anything here that you think might be unclear or confusing to patients?
o Is there anything that you think might be misleading to them?
o What questions would they have, or would they ask you, about it?
How (if at all) do you think this information could be improved, to make it more
understandable or useful to patients?
HAI Measures: Measure Labels
First, tell me in your own words what this measure label mean to you.
o {Probe: What is this measure about?}
Is there anything here that might be unclear or confusing to some people?
o {Probe: How would you re-write or change this label?}

HAI Measures: Graphic Display

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Based on what you see here, how often would you say this happens in hospitals?
{Probe: What is meant by “rates per thousand central line days”?}
Based on what you see here, what do you think about Mitchell Hospital?
How does River View Hospital compare to the U.S. average?
Now, I’d like to get your feedback on some slightly more detailed explanations about what this
measure (for example, if you clicked on the “Read more . . .” link).
{Interviewer hands respondent narrative explanation about HAIs and definitions of HAI
measures.}
HAI Measures: Explanatory Text
How important is this information?
Who do you think would be interested in this information?
Would this information be useful to patients? Why do you say that?
Is there anything here that you think might be unclear or confusing to patients?
o What questions would they have, or would they ask you, about it?
How (if at all) do you think this information could be improved, to make it more
understandable or useful to patients?
HAI Measures: Measure Definition
The next pages show a definition of the measure you saw in the graph. Take a minute to look
these over.
Is this helpful? Is there anything here that you think is unclear?
Does this add information that you think is important to know? What information is
particularly important?
Are these definitions enough information for your patients?
information for you or other doctors?

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Are they enough

Section V: ED Throughput Measures
We’re getting near the end – but now, I’d like to show you some information you might find
under the Timeliness tab for those three hospitals.
{Interviewer hands respondent mock-up for ED measures.}
Time Spent in ED: Definition
In your own words, what is this telling you?
Is this important information, in your view?
Would this information be useful to patients? Why do you say that?
Is there anything here that you think might be unclear or confusing to patients?
o Is there anything that you think might be misleading to them?
o What questions would they have, or would they ask you, about it?
How (if at all) do you think this information could be improved, to make it more
understandable or useful to patients?

ED Measures: Measure Labels
First, tell me in your own words what these measures mean to you.
o {Probe: What is the difference between them?}
Is there anything here that might be unclear or confusing to some people?
o {Probe: How would you re-write or change these labels?}

ED Measures: Tabular Display
Based on what you see here, what do you think about ED wait times in the U.S.?
Which hospital is doing the best job? What makes you say that?
How does River View Hospital compare to the U.S. average?

ED Measures: Explanatory Text
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How important is this information?
Who do you think would be interested in this information?
Is there anything here that you think might be unclear or confusing to patients?
o What questions would they have, or would they ask you, about it?
How (if at all) do you think this information could be improved, to make it more
understandable or useful to patients?
ED Measures: Measure Definitions
Take a minute to look over the definitions.
Does this add any important information?
particularly important?

What information do you think is

Is this helpful? Is there anything here that you think is unclear?
Are these definitions enough information for your patients?
information for you or other doctors?

Are they enough

Section VI: 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 checks to see if observers have anything else they wish to probe.}
Thank you very much for taking the time to meet with me today. Your insights have been very
helpful!

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