Primary care physicians' use of publicly reported quality data in hospital referral decisions

Despite government investment in public reporting of hospital quality data, patients still rely on recommendations from their primary care physicians (PCPs). Little is known about how physicians make hospital referrals.

To characterize factors that influence PCPs' hospital referral choices.

Web-based physician survey.

PCPs affiliated with 3 Massachusetts hospitals.

Physician demographics, familiarity with public reporting, and opinions about which factors would influence hospital referral decisions for an elderly patient with pneumonia.

Of 194 PCPs who received invitations, 92 (47%) responded. Although 93% maintained admitting privileges, only 20% admitted patients. The following were considered "very" important in referral decisions: "familiarity with the hospital" (70%), "patient preference" (62%), and "admitting arrangements with a hospitalist group" (62%). "Publicly available quality measures" were "not at all" important to 42%. Only 61% were aware of hospital quality reporting; 16% were familiar with Hospital Compare, a Centers for Medicare and Medicaid Services (CMS) Web site. No physicians reported ever using quality information to make a referral decision or discussing it with patients. No physician factors were associated with awareness of publicly reported data. PCPs identified the following factors as being "very" important in determining the quality of pneumonia care: antibiotics within 6 hours of arrival (66%), appropriate initial antibiotic (63%), and blood cultures performed prior to the administration of antibiotics (51%).

Although PCPs most valued the information available through Hospital Compare, only 16% were aware of it, and none used publicly reported quality data in referral decisions. Medicare and high-performing hospitals should consider marketing Hospital Compare to PCPs.