Do Australian health consumers understand and intend to use Patient Reported Experience Measures (PREMs) when selecting a hospital?: A qualitative exploration of online hospital report cards

Background This study explores Australian consumers’ perceptions, comprehension, and intended use of Patient Reported Experience Measures (PREMs) from Hospital Report Cards in future hospital decision-making, with a focus on health literacy.Methods. Data Sources From May to July 2023, a diverse sample of Australian consumers who had a recent hospital admission were interviewed.Study Design A qualitative study investigating consumers’ perceptions, comprehension, and intention to use PREMs. A single interview was conducted with each of the 15 participants, utilising two distinct qualitative techniques. In phase I, semi-structured interviews explored perceptions of PREMs. In Phase II, cognitive interviews assessed comprehension of PREMs using three online Hospital Report Cards: Medibank, Cal Hospital Compare, and a purpose designed report card incorporating various display formats. Participants were selected based on age, gender, and education through a professional recruitment agency. The interviews were recorded, transcribed and thematically analysed.Results The study found limited awareness and low importance attributed to PREMs, with none of the participants previously accessing such data for hospital decision-making. Comprehension was influenced by the design of the report cards, with simplified metrics aiding those with lower health literacy but confusing those with higher health literacy. Numerical and tailored PREMs designs were preferred. Distrust of PREMs, reliance on informal sources such as family and friends, and percieved lack of hospital choice appeared to diminish PREMs importance. Participants intention to use PREMs in future hospital choices was influenced by rural constraints, age, percieved cognitive challenges during illness, and reliance on informal healthcare information.Discussion Despite global investments in public reporting initiatives, this study highlights low consumer awareness, limited importance attributed to PREMs, and poor comprehension. Consumers displayed modest intention to utilise report cards in future hospital choices. Addressing these barriers requires improved communication formats and policy changes, alongside flexible report card designs to accommodate varying levels of health literacy.