Article Text

Download PDFPDF

On selecting quality indicators: preferences of patients with breast and colon cancers regarding hospital quality indicators
  1. Benjamin H Salampessy1,
  2. Ward R Bijlsma2,
  3. Eric van der Hijden1,
  4. Xander Koolman1,
  5. France R M Portrait1
  1. 1 Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
  2. 2 Department of Healthcare Procurement, Menzis, Enschede, The Netherlands
  1. Correspondence to Benjamin H Salampessy, Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands; b.h.salampessij{at}


Background There is an increasing number of quality indicators being reported publicly with aim to improve the transparency on hospital care quality. However, they are little used by patients. Knowledge on patients’ preferences regarding quality may help to optimise the information presented to them.

Objective To measure the preferences of patients with breast and colon cancers regarding publicly reported quality indicators of Dutch hospital care.

Methods From the existing set of clinical quality indicators, participants of patient group discussions first assessed an indicator’s suitability as choice information and then identified the most relevant ones. We used the final selection as attributes in two discrete choice experiments (DCEs). Questionnaires included choice vignettes as well as a direct ranking exercise, and were distributed among patient communities. Data were analysed using mixed logit models.

Results Based on the patient group discussions, 6 of 52 indicators (breast cancer) and 5 of 21 indicators (colon cancer) were selected as attributes. The questionnaire was completed by 84 (breast cancer) and 145 respondents (colon cancer). In the patient group discussions and in the DCEs, respondents valued outcome indicators as most important: those reflecting tumour residual (breast cancer) and failure to rescue (colon cancer). Probability analyses revealed a larger range in percentage change of choice probabilities for breast cancer (10.9%–69.9%) relative to colon cancer (7.9%–20.9%). Subgroup analyses showed few differences in preferences across ages and educational levels. DCE findings partly matched with those of direct ranking.

Conclusion Study findings show that patients focused on a subset of indicators when making their choice of hospital and that they valued outcome indicators the most. In addition, patients with breast cancer were more responsive to quality information than patients with colon cancer.

  • health policy
  • health services research
  • hospital medicine
  • performance measures
  • decision making

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors WRB conducted the patient groups discussions. WRB and BHS were involved in selecting attributes and levels, constructing the experimental design, and designing, planning and distributing the questionnaire. BHS conducted the statistical analysis and wrote the manuscript. All authors reviewed, provided critical input and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.