***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the effects of CAHPS health plan performance information on plan choices and decision processes by New Jersey Medicaid beneficiaries . DATA SOURCES / STUDY SETTING The study sample was a statewide sample of all new Medicaid cases that chose Medicaid health plans during April 1998 . The study used state data on health maintenance organization ( HMO ) enrollments and survey data for a subset of these cases . STUDY DESIGN An experimental design was used , with new Medicaid cases r and omly assigned to experimental or control groups . The experimental group received a CAHPS report along with the st and ard enrollment material s , and the control group did not . DATA COLLECTION The HMO enrollment data were obtained from the state in June 1998 , and evaluation survey data were collected from July to October 1998 . PRINCIPAL FINDINGS No effects of CAHPS information on HMO choices were found for the total sample . Further examination revealed that only about half the Medicaid cases said they received and read the plan report and there was an HMO with dominant Medicaid market share but low CAHPS performance scores . The subset of cases who read the report and did not choose this dominant HMO chose HMOs with higher CAHPS scores , on average , than did those in an equivalent control group . CONCLUSIONS Health plan performance information can influence plan choices by Medicaid beneficiaries , but will do so only if they actually read it . These findings suggest a need for enhancing dissemination of the information as well as further education to encourage informed choices Most plan report cards that compare the performance of health plans have framed the decision about plan choice as an opportunity to get better- quality care . This study uses a controlled experimental design to examine the effect of reframing the  health plan choice decision to one that emphasizes protecting oneself from possible risk . The findings show that framing the health plan decision using a risk message has a consistent and significant positive impact on how consumers comprehend , value , and weight comparative performance information OBJECTIVE To assess whether presentation approaches design ed to be more meaningful result in greater weighting of quality information in decisions . An emerging body of research indicates that the way information is presented affects how it is interpreted and how it is weighted in decisions . Comparative health plan performance reports are not being used by consumers possibly because the information presented is difficult to use . The next generation of these reports should be design ed to support decision making . DESIGN AND STUDY PARTICIPANTS The study uses a controlled experimental design . Participants ( n = 162 ) were r and omly assigned to different conditions and asked to complete tasks related to using quality information and making health plan selection s. Dependent variables included the amount of weight given to quality information in choices and decision accuracy . RESULTS Some presentation approaches make it easier for users to process and integrate quality data into their choices . However , other presentation formats influence consumers '  decisions in ways that undermine their self-interest . CONCLUSIONS Findings indicate that presenting quality data in a more evaluable format increases the weight it carries in consumer decisions . Every change made in the presentation of comparative data has the potential to influence decisions . Those who disseminate information have a responsibility to be aware of how they use that influence and to direct it in productive and defensible ways . The alternative is to manipulate people in ways that are unknown , are not thought out , or are not defensible , but are no less manipulative Many consumers are offered two or more employer-sponsored health insurance plans  , and competition among health plans for subscribers is promoted as a mechanism for balancing health care costs and quality . Yet consumers may not receive the information necessary to make informed health plan choices . This study tests the effects on health plan choice of providing supplemental decision-support material s to inform consumers about expected health plan costs . Our main finding is that such information induces consumers to bear more risk , especially those in relatively good health . Thus our results suggest that working-age , privately insured consumers currently may be over-insuring for medical care Abstract Objective : To assess whether crude league tables of mortality and league tables of risk adjusted mortality accurately reflect the performance of hospitals . Design : Longitudinal study of mortality occurring in hospital . Setting : 9 neonatal intensive care units in the United Kingdom . Subjects : 2671 very low birth weight or preterm infants admitted to neonatal intensive care units between 1988 and 1994 . Main outcome measures : Crude hospital mortality and hospital mortality adjusted using the clinical risk index for babies ( CRIB ) score . Results : Hospitals had wide and overlapping confidence intervals when ranked by mortality in annual league tables ; this made it impossible to discriminate between hospitals reliably . In most years there was no significant difference between hospitals , only r and om variation . The apparent performance of individual hospitals fluctuated substantially from year to year . Conclusions : Annual league tables are not reliable indicators of performance or best practice ; they do not reflect consistent differences between hospitals . Any action prompted by the annual league tables would have been equally likely to have been beneficial , detrimental , or irrelevant . Mortality should be compared between groups of hospitals using specific criteria —such as differences in the volume of patients , staffing policy , training of staff , or aspects of clinical practice —after adjusting for risk . This will produce more reliable estimates with narrower confidence intervals , and more reliable and rapid conclusions . Key messages League tables are being used increasingly to evaluate hospital performance in the United Kingdom In annual league tables the rankings of nine neonatal intensive care units in different hospitals had wide and overlapping confidence intervals and their rankings fluctuated substantially over six years Annual league tables of hospital mortality were inherently unreliable for comparing hospital performance or for indicating best practice s The UK government 's commitment to using annual league tables of outcomes such as mortality to monitor services and the spread of best practice s should be reconsidered Prospect i ve studies of risk adjusted outcome in hospitals grouped according to specific characteristics would provide better information and be a better use of re OBJECTIVE To determine whether an intervention design ed to inform and guide patients in choosing a primary care provider ( PCP ) could increase satisfaction and trust . DESIGN A r and omized controlled trial conducted at the Santa Clara Medical Center of the Kaiser Permanente Medical Care Program in Northern California . PATIENTS AND METHODS Patients needing a PCP were r and omly assigned to Informed Choice ( provider-level information offered ) , Guided Choice ( PCP names provided based on the similarity of patients ' and practitioners ' patient-centered beliefs , and patients then chose ) , or Usual Care . One year later , mailed question naires asked about patients ' trust and satisfaction , perceptions of the choice process , and trust and satisfaction with Kaiser Permanente . More than 5000 adult patients were linked with a PCP as part of the project , and completed surveys were returned by 2437 patients . RESULTS Neither intervention arm generated better matches on patient-practitioner beliefs than Usual Care ; however , trust and satisfaction were higher among Guided Choice patients . Across study arms , patient-practitioner belief discrepancy showed a consistent positive association with trust , satisfaction , and attitudes toward Kaiser Permanente . CONCLUSIONS The discrepancy between patient and practitioner beliefs about care is an important determinant of trust and satisfaction , and involving patients in the selection of their PCP can have an independent positive effect . It should be possible to build on the experience of this project to develop programs that better match patients and practitioners within managed care plans OBJECTIVE To examine the effect of providing the Medicare & You h and book on consumers ' attitudes and behavior regarding health plan decision making . DATA SOURCE A national sample of 3,738 Medicare beneficiaries who were surveyed in late 1999 and early 2000 was employed . Data were collected using a mail survey with telephone follow-up ; the response rate was 76 percent . STUDY DESIGN Medicare beneficiaries were r and omly assigned to a control group that received no Medicare-related in formation as part of the study , or to a treatment group that received a copy of the 2000 version of the Medicare & You h and book as part of a national mailing . Half of the treat men t group ( the " re-mail " group ) received a second copy of the h and book along wit h their mail survey instrument . PRINCIPAL FINDINGS The control and treatment groups did not differ regarding their level of satisfaction with or confidence in their current choice of health plan according to predicted mean values . Treatment group beneficiaries had a significantly higher propensity to either change or consider changing health plans relative to beneficiaries in the control group . Controlling for other factors , 5 percent of treatment group members switched health insurance plans during the prior month compared to 3 percent of control group members . there were no significant differences in predicted values between the re-mail and no re-mail groups in any of the models . Type of supplemental insurance was also highly related to all three outcomes . CONCLUSIONS Findings from this and a prior parallel study suggest th at messages contained in the Medicare & You h and book can have an influence on beneficiaries and the Medicare market . Thus , careful attention should be given to the wording and intent of these messages . This is particularly relevant given the current administration 's emphasis on increasing enrollment in Medicare+Choice plans and findings from earlier research reporting that beneficiaries felt the h and book was pressuring them to enroll in managed care OBJECTIVE To examine the effect of providing new Medicare information material s on consumers ' attitudes and behavior about health plan choice . DATA SOURCE New and experienced Medicare beneficiaries who resided in the Kansas City metropolitan statistical area during winter 1998 - 99 were surveyed . More than 2,000 computer-assisted telephone interviews were completed across the two beneficiary population s with a mean response rate of 60 percent . STUDY DESIGN Medicare beneficiaries were r and omly assigned to a control group or one of three treatment groups that received varying amounts and types of new Medicare information material s. One treatment group received the Health Care Financing Administrations 's pilot Medicare & You 1999 h and book , a second group received the same version of the h and book and a Medicare version of the Consumer Assessment of Health Plans ( CAHPS ) report , and a third treatment group received the Medicare & You bulletin , an abbreviated version of the h and book . PRINCIPAL FINDINGS Results of the study suggest that the federal government 's new consumer information material s are having some influence on Medicare beneficiaries ' attitudes and behaviors about health plan decision making . Experienced beneficiary treatment group members were significantly more confident with their current health plan choice than control group members , but new beneficiaries were significantly less likely to use the new material s to choose or change health plans than control group members . In general the effects on confidence and health plan switching did not vary across the different treatment material s. CONCLUSIONS The 1999 version of the Medicare & You material s contained a message that it is not necessary to change health plans . This message appears to have decreased the likelihood of using the new material s to choose or change plans , whereas other material s to which beneficiaries are exposed may encourage plan switching . Because providing more information to beneficiaries did not result in commensurate increases in confidence levels or rate of health plan switching , factors other than the amount of information , such as how the information is presented , may be more critical than volume This evaluation tested if Consumer Assessment of Health Plans Study ( CAHPS ) information on plan performance affected health plan choices by new beneficiaries in Iowa Medicaid . New cases entering Medicaid in selected counties during February through May 2000 were assigned r and omly to experimental or control groups . The control group received st and ard Medicaid enrollment material s , and the experimental group received these material s plus a CAHPS report . We found that CAHPS information did not affect health plan choices by Iowa Medicaid beneficiaries , similar to previously reported findings for New Jersey Medicaid . However , it did affect plan choice in an earlier laboratory experiment . The value of this information may be limited to a subset of We assessed the efficacy of material s that integrated comparative information on cost , benefits , and quality for employer-based retiree health plans and Medicare Advantage plans in a r and omized experiment to test the impact of content and format . Results indicate that older consumers who received the intervention material  s found the material s easier to use , gained greater knowledge about Medicare from them , were more likely to value comparative quality information , were more likely to select higher quality plans , and were more likely to choose a plan that reflected the dimensions they found most important compared to older consumers receiving the  control material CONTEXT Publicly released report cards on hospital performance are increasingly common , but whether they are an effective method for improving quality of care remains uncertain . OBJECTIVE To evaluate whether the public release of data on cardiac quality indicators effectively stimulates hospitals to undertake quality improvement activities that improve health care processes and patient outcomes . DESIGN , SETTING , AND PATIENTS Population -based cluster r and omized trial ( Enhanced Feedback for Effective Cardiac Treatment [ EFFECT ] ) of 86 hospital corporations in Ontario , Canada , with patients admitted for acute myocardial infa rct ion ( AMI ) or congestive heart failure ( CHF ) . INTERVENTION Participating hospital corporations were r and omized to early ( January 2004 ) or delayed ( September 2005 ) feedback of a public report card on their baseline performance ( between April 1999 and March 2001 ) on a set of 12 process-of-care indicators for AMI and 6 for CHF . Follow-up performance data ( between April 2004 and March 2005 ) also were collected . MAIN OUTCOME MEASURES The co primary outcomes were composite AMI and CHF indicators based on 12 AMI and 6 CHF process-of-care indicators . Secondary outcomes were the individual process-of-care indicators , a hospital report card impact survey , and all-cause AMI and CHF mortality . RESULTS The publication of the early feedback hospital report card did not result in a significant systemwide improvement in the early feedback group in either the composite AMI process-of-care indicator ( absolute change , 1.5 % ; 95 % confidence interval [ CI ] , -2.2 % to 5.1 % ; P = .43 ) or the composite CHF process-of-care indicator ( absolute change , 0.6 % ; 95 % CI , -4.5 % to 5.7 % ; P = .81 ) . During the follow-up period , the mean 30-day AMI mortality rates were 2.5 % lower ( 95 % CI , 0.1 % to 4.9 % ; P = .045 ) in the early feedback group compared with 
    Output:
    
No effects for the composite process-of-care indicators for either condition were found , but there were some improvements in the individual  process-of-care  indicators .
There was an effect on the mortality rates for acute myocardial infa rct ion .
The small body of evidence available provides no consistent evidence that the public release of performance data changes consumer behaviour or improves care .
Evidence that the public release of performance data may have an impact on the behaviour of healthcare professionals or organisations is lacking