Utah Department of Health
Office of Health Care Statistics
This focus group met Saturday, September 17, 2005 at 10:30 AM as part of a prenatal class previously scheduled. There were 14 women and 11 men. The process was explained to the group and they agreed to be recorded.
Facilitator: What I am going to be showing you is a booklet that is going to be published by the Department of Health and HealthInsight. You’re going to have an opportunity to help shape this publication by your comments. It will not be published until it has been shared with a number of community groups and professionals to make sure that it says what it’s intended to say, to make sure that people get the actual message that is intended. So you have the first opportunity to be able to comment on it. I have one copy for each of you, don’t open it just yet. Why don’t you just look at the cover. This magazine will be distributed in doctor offices, in public places like libraries, maybe grocery stores we really don’t know, but if you saw this publication would you be likely to pick it up and want to look at it based on the title, and the pictures on the front?
Man: From a guys point of view, no. It looks like it is just for a lady.
Man: I say the average hospital charges would get my interest.
Man: It would depend on how many other publications were around it, if there were a lot of different kind of magazines I might not just because it says a newborn guide.
Facilitator: So you might want to know what that means. Other thoughts?
Woman: I would have to say no, because it kind of looks cheesy.
Facilitator: Cheesy, ok so if you could elaborate on that a little bit. If it were glossy and bound it would be more appealing?
Woman: No, it just it is kind of sappy you have this lady sitting there smiling at her belly and this little footprint and to me I don’t know…it’s not something that I would be interested in picking up even pregnant.
Man: It didn’t really capture the hospital charges or quality and safety below the title, so.
Facilitator: It gets a little bit lost in there?
Man: Yes.
Woman: I think that the bottom part that talks about the Utah Department of Health makes it look like a government report so I probably wouldn’t want to (read it).
Facilitator: All right, any other thoughts about the cover? If you have a thought, jump in any time.
Woman: It doesn’t stand out. If you were looking at a bunch of magazines or something, like why would you pick up this one.
Facilitator: Ok, so it really doesn’t jump out at you?
Woman: Yea.
Facilitator: I would like you to just flip through it, you really don’t have enough time to read the whole thing, but just flip through all the pages and get a feel for what is in there.
Ok, in just glancing through what do you think is the purpose of the publication?
Man: To inform.
Facilitator: To inform, ok.
Man: To help you compare different hospitals across the state.
Facilitator: To compare.
Man: How many beds and how much is it going to cost you to go there, depending on your insurance you can’t go to any hospital you want.
Facilitator: Other thought about that?
Man: Now…so how do you know what hospital X is and hospital TT.
Facilitator: This is not quite ready for publication and so until we have validated all the data we are not going to put real names in it. But when it is published those will be real names, it will tell you who everybody is and also what county they are in case you don’t know.
Woman: It would be interesting to me to have the hospital name.
Facilitator: So you could check up on your hospital, you have already chosen your hospital right? At this point in your pregnancy it would just be to check up on your hospital. What if you had not yet selected a hospital?
Man: It would be nice to know.
Facilitator: So you think this might be helpful in making a decision? (Several nodding heads.) I need you to say yes rather than nodding your head.
Man: Yes.
Man: Yes.
Woman: Yes.
Man: Yes.
Facilitator: My tape recorder doesn’t have video capabilities.
Woman: Yes.
Facilitator: Great. Would you turn to page 7 (average hospital charges for vaginal delivery) please and look at that chart. What do you think that chart is telling you?
Man: The average cost and cases of complicated and non-complicated pregnancies.
Facilitator: Is that meaningful to you complicated vs. not?
Man: What’s complication?
Facilitator: So you are not sure what that means?
Man: Right.
Facilitator: You would need a little bit more information.
Man: It would be meaningful if the hospital had like less cases of non-complicated vs. complicated because it looks like most hospitals have more non-complicated.
Man: But what about the hospitals that maybe they specialize in that, of course their numbers are going to be a lot higher.
Facilitator: So, you’re not sure exactly whether that tells you how good the hospital is.
Man: Right.
Woman: Because if you go into labor before a certain number of weeks they are going to send you to a certain hospital, of course you are going to have more complications.
Facilitator: So you would expect to see more complicated cases in those places.
Man: Is their any kind of medium range that we are trying to look for? I mean so what it is big and high is that bad, good, indifferent? It really doesn’t tell me. It’s just a comparison to all of these hospitals but what is it.
Man: Is there a rating system?
Facilitator: So you don’t know exactly what it means. These are all
averages by the way; of all the cases done at that hospital this would be
the average cost.
Woman: The one thing that it says is “deliveries in this category had no surgical procedures” and I was just trying to read down to find what surgical procedures meant to see if it included an episiotomy, you know that is pretty routine and I couldn’t find any where it said what those surgical procedures were.
Facilitator: So you looked at the chart and then you read the information to see if you could get more out of it?
Woman: Exactly.
Facilitator: That’s a nice segue, thank you very much. If you read does it help explain the chart?
Man: Yes.
Woman: The only thing that I think is a little unclear is between no complication and with complication. It says no extra medical services needed vs. extra medical services needed. What are those extra medical services?
Facilitator: It would be nice to know what extra is, what complicated means, what surgical procedures add on are?
Woman: Like if you had to add an anesthesiologist cost to it vs. no complication.
Facilitator: That would be nice to know?
Woman: It would be nice to know by the region you live like the salt lake valley, it seems to complicate matters showing the whole state to have 100 to look at instead of 7 or 8.
Facilitator: Ok, so if they could break it down into regions.
Woman: Yea.
Facilitator: And you had a comment.
Man: No complications seem to be normal as expected and then cesarean maybe some people plan them, would that be expected or not expected, is having an epidural expected or not expected. Is an episiotomy is that expected or not.
Facilitator: So it would be helpful to say this is what we consider to be perfectly normal and these are the things that would be included?
Man: Yes.
Woman: Yes.
Man: Just something with more detail, a reference.
Facilitator: All right, can I get you to
turn to page 13. I want you to do the same thing, look at the chart and
tell me what you think that is about.
Man: After you have already had a C-section it basically gives you how many
actually a ratio of how many can deliver vaginally.
Facilitator: Is VBAC meaningful to you all…vaginal birth after c-section?
Woman: Now I would say yes, but if I were earlier in my pregnancy and hadn’t chosen my hospital I would say it would not have meant anything.
Man: Unless we had already had a cesarean right?
Woman: Yea.
Facilitator: How many first births? Most of you. Ok.
Woman: I was just wondering why is it important to know Obstetrician and Anesthesiologist on staff or both.
Facilitator: Ok, so why is that in there and what does that tell you, what do you gain by knowing that. Ok, nodding.
Ok, again the verbiage, the wording, the words do they help you describe what’s in there to understand what that chart is saying?
Woman: One question I had was the rate per 100 is that 100 women that already had a vaginal birth or is that per 100 women having a cesarean?
Facilitator: Ok, so that is not real clear. I could explain that, but that is not why I am here. I am just here to get your responses.
Man: In looking back a page it looks like this page is just point less, really. The other page had a lot more interesting information in regards to actual cesarean.
Facilitator: So the actual number of people that fall into the VBAC category you think is probably small.
Man: They wouldn’t want to know.
Woman: I would want to know if I had had a c-section.
Facilitator: If you had had a cesarean you would want to know that?
Man: The thing is, is that most people who had already had a cesarean already know who their doctor is and are already comfortable and are not wanting to look at that.
Facilitator: Ok. So if I may paraphrase what I think you said. This would be a more useful document to first timers.
Woman: Just to kind of second that, how the cover says a newborn guide, I don’t know how many second time moms are going to be picking up vs. first time moms unless you saw the hospital charges quality and safety and would be interested in those.
Facilitator: So the more important title there is charges quality and safety not that it is a newborn guide?
Woman: I think it would be more appealing to first time moms and to second and third just not as much I do not think.
Woman: I think that the newborn guide is not a very good title because this mainly has to do with the hospital. If I found newborn guide I would think it is going to tell me what to do with a newborn and things like that.
Facilitator: Ok.
Man: I actually want to know on page 13 how much the VBAC has to do with the baby’s guide and how that has to do with already having a cesarean does that have to do with the care or the cut in the uterus and the hospital can’t really change whether you are going to have to do it or not depending on your body.
Man: It’s out of your control. It depends on a woman, so if I look at this choosing a hospital I guess it would be by experience but that does not mean that they are any more capable than any other hospital.
Man: Or explain to them why you should care. Match it up with some other kind of data or how it correlates with something else.
Facilitator: Ok. I want you to look at page 20 please.
Woman: I wanted to say one more thing. When they compare to state average I would be more curios about national average than state average because you do not know how backwards the rural hospitals are. What ever that would change the average.
Woman: So the whole state maybe awful.
Woman: I would like to see all the country.
Facilitator: So how many of you think the national numbers would be useful.
Woman: Yea.
Man: Yes.
Man: Yes.
Woman: Maybe have the state and the national to see how your state compares to national.
Facilitator: Ok, page 20 the glossary, how useful is this information do you think?
Man: If it is inclusive enough it would be very useful; depending on if it has enough information in there this is only what a page.
Man: It might have been more useful if it was referred to earlier on so that you knew it was here in all of those other papers.
Woman: I think that some of these definitions would help like VBAC if it included things like normal delivery care, what was not a normal delivery, but you would need to know earlier you don’t necessarily know it is at the end of the book.
Woman: Maybe don’t even have a glossary page, have it somewhere else.
Man: If there is only a page a little more than a page you might want to put the terms defined right on the page it refers to.
Woman: I agree.
Man: Or maybe a footnote or something.
Facilitator: Ok, so instead of separate in the back where you might not find it?
Woman: Maybe just up in the front the first page.
Facilitator: Ok, the last page. How useful is that information?
Man: Good.
Man: It would be nice to have a map of Utah that maybe actually showed the hospitals, having just moved here from else where I don’t know the town very well so I don’t know where they are.
Man: It’s useful to me because we are planning on moving, and I can see because it has city, it has county and city so if you knew where you were moving you could just ..
Man: Is the guide going to contain the hospital rankings, now you have to go through all the different things to see where they are. Are you going to rank the hospitals?
Facilitator: How do you suggest that they could be ranked to be useful?
Man: I do not know, we were talking about national averages would it be possible to have higher national averages of charges or not and state charges and where they rank as far as.
Man: Rank each category
Woman: By state, by region.
Man: I am not sure that you could rank overall that would be hard to do.
Woman: I think it would be useful most to just look at cesarean rates, I think we should be really prepared about charges in the end. What the grade of your hospital you know that you are going to the number one hospital in the valley that says something about the doctors, staff and everybody.
Man: If the number two hospital costs you thirty thousand less and had you know .01 percent difference in quality of care. I love my baby and my wife but, I don’t want to pay thirty thousand more for almost the exact same care.
Facilitator: It could be useful to you?
Man: Yes.
Woman: I think showing who owns the hospital, like some of them are IHC hospitals, some are what ever so that you can know if your insurance pays.
Man: And insurance carrier per hospital.
Man: And what is the bed thing, is that the total number of mothers they are going to take in? If it is a lower number are you going to have to share a room? What does that mean? Because that does not mean anything to me as far as I want my own room period.
Facilitator: You don’t care if they have 500 beds as long as they have a private room for you?
Man: That’s right.
Facilitator: Since you asked the question can you please look at page 15.
The word rating appears on that page, I just wanted to know what you think
about that.
Man: I didn’t know if that was beds for the total hospital or beds for the prenatal.
Facilitator: Ok, so that would be helpful if that was more clear. It is all the beds by the way.
Man: That’s what I am saying, you never know.
Man: Some are small like nineteen.
Man: Yea.
Facilitator: Page 15 quality and safety ratings, does this make sense what this is saying? Do you feel like you know more about these hospitals?
Man: How many stars does this have? Usually it is out of five stars. Oh, one is high.
Woman: This is backwards. One star is usually lower than average.
Man: It might be better just to have a number rating instead.
Man: Does that really have to do with the hospital isn’t that more of a doctors issue?
Man: Yea.
Man: Yea.
Man: This doctor could deliver all over at other hospitals and he might be really good or he could be horrible.
Man: This is just obstetric trauma vaginal delivery?
Man: Yea.
Man: It might be the ratings had to do with what they actually have on hand because not all the hospitals can do everything. So if you are at a hospital they may have to send you to another hospital. It might be nice if the ratings could reflect that.
Facilitator: Ok.
Woman: What is the average. Some say higher than and some lower than but what is the average?
Facilitator: But what is the average, ok.
Did you see anything else in there that caught your eye? Any other questions that it raised? Anything else that you would like to see, in a booklet of this kind?
Man: I think you need pictures somewhere. To much reading with all the charts
Woman: Maybe some differentiation between pages, I look at this and I think that I don’t feel like looking through all this. Maybe if on the front it just said a hospital guide I would be like that’s interesting let me check it out. If there was a guide in the back that had a page number an index that I could look up a specific hospital, to direct me more. With this I just feel like I don’t want to look through this all same looking stuff.
Facilitator: Kind of overwhelming?
Woman: Yea, all the numbers. I am not a numbers person. It takes me a long time to understand the diagram the chart. I need a little bit more efficient for myself to not say never mind I give up and move to something else.
Man: It kind of seems like it’s a consumer reports for hospitals in Utah. And Consumer Reports does a really good job of displaying their information and also they have a paragraph of information, text that describe what is going on and why the did this test and then they give it where as this doesn’t have anything that really describes why this chart should be important to me
Facilitator: Ok, good.
Woman: I think you need more variety where it changes to different things, as I looked at it I thought it was all about the same thing until we delved into it. When the charts change from the cost to the quality ratings it would help if they put a little more difference to it broke it up and made it a little more, to make you want to read it more. Easier in chunks than just one big thing.
Man: Maybe actually color-code the sections.
Man: I think that you need a more urgent title if you want someone to read this. To really make them want to pick it up. Fear is one thing that will make people read so. I mean you hear of people getting the wrong knee operated on and what ever.
Man: With your second child I think that you would be really more getting into this, to take the hours to digest this information. Because the first time people are so overloaded with information.
Man: Especially if you had a bad experience the first time. You want to get to a better experience.
Facilitator: After looking through this, reading this, theoretically digesting it, what do you think that you could do differently because of this?
Man: Are you asking to the actual guide or do you mean actual difference as to where we would go?
Facilitator: Would this change your life.
Man: Would this make me feel better or worse about the hospital? Probably wouldn’t unless it was some kind of huge really, really bad all the time, I would probably just change my mind slightly and I would go to another source for another viewpoint to say if the hospital is good.
Woman: For me I think it would be easier to digest and kind of retain if it was say Cottonwood Hospital then list how it fairs for all the topics charge, quality, safety. I mean it is hard to look at all of these different charts for all of the hospitals and try to make a whole understanding.
Man: I think it would be great information personally, because our doctor will only deliver at Cottonwood so if I look and see that their nursing staff is horrible then I would think that I would need to get a new doctor, I mean if he is not willing to go somewhere else.
Man: A lot of it for us, is my sister gave birth at Cottonwood so we had one experience to hear I guess. So other than that we looked at what is closest to work and what is closest to home and if you look and the closest one to our home sucks then I will drive 10 minutes farther.
Man: As long as it is covered by insurance, you have to have some type of group that is covered by insurance. So what if it is ranked number one if it is not covered by your insurance you are screwed.
Man: You have to know where you can go. Where personally you can go.
Man: It would make it much more readable, I would put hints or facts unrelated to the hospital to keep as they thumb through it, something keeps their attention.
Facilitator: Something interesting.
Man: Exactly.
Man: Maybe make it more of a newborn guide. So there are tips on what to expect with your first child. How to prepare for the hospital. I know that’s not your job I guess, but that would also give another reason to pick it up and keep it.
Facilitator: If what we want is for you to read it we should make it interesting
so that you will?
Thank you very much; you have been very, very helpful. I need to collect
these because they are not quite ready to be distributed.