Abghari et al., 2014 / Survey / 500 orthopedic clinic patients / Most patients had no preference for surgeon age, gender, race, or religion. Surgeon training considered moderately important
Aitken et al., 2013 / Questionnaire / 427 orthopedic patients / Surgeon knowledge, compassion, and politeness are more important than surgeon appearance. Patients prefer "smart casual" dress for surgeons over white coat and scrubs
Alexander et al., 2011 / Survey / 8,140 patients with chronic illness / Patients trust information from physicians and hospitals more than information from personal, governmental, or insurer sources
Al-Refaie et al., 2012 / Logistic regression / 59,841 patients who had surgery for lung, esophagus, or pancreas tumors / Patients who were non-white, did not have private insurance, or had more comorbidities were significantly more likely to receive surgery at a low volume hospitals (p < .05)
Bederman et al., 2009 / Conjoint analysis / 164 lumbar spinal surgery patients / Quality of life factors were most important for patients (p ≤ .0005)
Birkmeyer and Dimick, 2004 / Meta-analysis / >1 million patients for five high-risk surgeries in 2000 / Implementation of Leapfrog standards may have prevented 7,818 of 23,790 surgical deaths from the five procedures in 2000.
Birkmeyer et al., 2003 / Simulated trial / 15,796 Medicare patients who underwent esophagectomy or pancreatic resection from 1994-1999. / With high volume standards for hospitals, over 50% of patients would increase travel times by over one hour. If not set too high, volume standards could be used for select surgeries without making travel times unreasonable
Bliss et al., 2014 / Multivariate regression / 129,609 pancreatectomy patients from 2004-2011 / High volume hospitals had significantly lower mortality, fewer complications, and shorter median length of stay compared to non-high volume centers (p < .001).
Bornstein, Marcus, and Cassidy, 2000 / Survey / 636 community residents / Physician certification and specialization, recommendations from family and friends, and neatness of physician and office were most important factors
Bouche et al., 2008 / Multivariate analysis / 932 breast cancer surgery patients / Patients involved with choosing surgeon were more likely to be treated at low-volume hospitals
Bozic et al., 2012 / Survey / 251 patients being evaluated for elective primary total joint arthroplasty / Surgeon manner, surgeon QI, hospital quality, and surgeon reputation were most important factors for patients
Brown, Clark, and Oakley, 2012 / Commentary / Information on QI report cards / Cardiologists are ethically obligated to use QI when referring patients to cardiac surgeons
Bucknall and Pynsent, 2009 / Questionnaire / 182 orthopedic patients / 89% of patients had no preference for surgeon gender
Canto, 2007 / Commentary / Information on QI report cards / Public QI should be accurate, collected actively, validated, and include more than merely short-term mortality indicators
Carlin, Kralweski, and Savage, 2013 / Survey / 480 knee or hip replacement surgery patients / Information used by patients when selecting a surgeon differed depending on if the patient lived in an urban or rural setting. Only 12.5% of patients used QI in their decision-making
Chang et al., 2009 / Multivariate regression / 8,370 patients who underwent pancreatic resections from 2000-2005 / Access to high volume hospitals was associated with year, age, and race. Non-white and older patients were less likely to be referred to high volume centers (p < .001)
Childs et al., 2005 / Survey / 146 female primary care patients / 51% of patients preferred a male surgeon, 3% preferred a female surgeon, and 46% had no preference for surgeon gender
Collins et al., 2013 / Questionnaire / 98 patients considering palliative surgery / 47% of patients held quality of life to be the most important factor. 39% based their decision in their doctor's recommendation.
Conner-Spady et al., 2014 / Questionnaire / 176 patients undergoing total joint replacement surgery / Surgeon and hospital reputations were most important factors
Dammen et al., 2012 / Discrete-choice experiment / 1,303 cataract and total knee replacement patients / For both surgeries, the most significant factors for patients were distance, waiting times, and complication concerns (p = .000)
de Groot et al., 2011 / Questionnaire / 337 new surgical patients / Patients use own experiences and experiences of others more than public information when choosing hospitals for surgery
Djis-Elsinga et al., 2010 / Questionnaire / 2,122 patients who underwent 1 of 6 elective surgeries from 2005-2006 / Hospital reputation and hospital atmosphere were the most important factors in choosing hospital for surgical care. Patients will use more information for future choices than they used for past choices
Donelan et al., 2011 / Questionnaire / 337 individuals from general population / 82% of respondents indicated QI would be very useful in choosing a surgeon. Only 6.4% of patients were always able to find the surgeon with the lowest risk mortality when presented with four different QI displays
Dusch, O'Sullivan, and Ascher, 2014 / Survey / 436 general medicine patients / Patients did not show significant preference for a particular surgeon gender. Preferred surgeon demeanor may vary by type of surgery
Edgman-Levitan and Cleary, 1996 / Review and interviews / Available medical literature and health plan managers / Patients, especially Medicare recipients, need more objective information to assist them in making educated healthcare decisions
Ejaz et al., 2014 / Best-worst scaling survey / 214 cancer patients seeking surgery at Johns Hopkins Hospital / Surgeon caseload, training, and experience and hospital reputation were the most important factors
Epstein, 2000 / Commentary / Information on performance data use / Distribution of QI alone will not have an effect. QI must be composed of easily understood quality indicators
Faber et al., 2009 / Review / Available medical literature / Patients value and use QI to choose better healthcare plans
Fast et al., 2012 / Cross-sectional study / Web-based pediatric urology information / Information on the Internet is of poor quality. Physicians should be able to guide patients to more credible sources of information to be used in decision-making
Fiala, 2012 / Review / Available medical literature / Patients value empathy, compassion, and communication in surgeons and may use these attributes to infer about a surgeon's technical competence
Finks, Osborne, and Birkmeyer, 2009 / Chi-squared and regressions / >3.2 million patients for eight high-risk surgeries between 1999-2008 / Operative mortality fell for all procedures from 8%-36%. Higher hospital volume explained much of this decline for three of the eight surgeries
Finlayson et al., 1999 / Questionnaire / 100 patients awaiting elective surgery / All else equal, patients prefer local care. If local hospitals offered twice the mortality rate of regional hospitals, 45% of patients would still opt for local surgery. 18% of patients would prefer local care even if the local mortality rate were 18%
Fraval et al., 2012 / Survey / 400 patients from surgical clinics / 65% of patients used the Internet to research their condition. 36% of patients used the Internet to research their surgeon. More credible Internet information is needed
Galanis et al., 2013 / Questionnaire / 96 individuals chosen from nonsurgical clinics / Surgeon reputation and certification were most important of 8 factors. Surgeon training only moderately important
Goslin and Elhassan, 2013 / DISCERN evaluation / Web-based ear, nose, and throat surgery information / The mean quality of web information was "poor" and over 50% of websites were rated "poor" or "very poor." Only 13% of websites were rated "good" or "excellent"
Gu et al., 2009 / Time trade-off method / 50 outpatient patients and 16 orthopedic surgeons / Patients were significantly less likely than surgeons to trade off years of life for a reduction in "constant severe pain" (p < .05)
Hanauer et al., 2014 / Survey / 2,137 individuals from general public / 59% of people consider physician rating websites to be very important or somewhat important. 65% of patients were aware of such rating sites. 43% of the patients who have not sought out physician rating sites expressed not trusting the information on those sites
Hansrani et al., 2014 / Questionnaire / 581 patients at an elective orthopedic center / Almost 50% of patients chose to delay surgery due to work commitments. Nearly 16% of patients could not accept an operation within 6 weeks of consultation
Harris, 2002 / Survey / 206 adults in West Lost Angeles / Patients are willing to increase restrictions on healthcare access in exchange for higher quality healthcare. Consumers also would benefit from QI sources
Harris, 2003 / Survey / 1,541 adults from general population / Patients are often passive healthcare consumers. Improvements in QI could help patients make better choices
Hibbard, Sofaer, and Jewett, 1996 / Survey and focus groups / 72 randomly selected adults / General healthcare consumers find QI to be relevant and useful
Hibbard et al., 2012 / Survey / 1,421 healthcare consumers / Easily understood QI and cost data could help patients make better-informed healthcare decisions
Holt et al., 2010 / Questionnaire / 258 patients screened for abdominal aortic aneurysms / 92% of patients were willing to travel >1 hour beyond the nearest hospital to access a surgeon with a 5% lower mortality rate, 2% lower amputation or stroke rate, a higher caseload, or routine use of endovascular repair
Katz et al., 2007 / Survey / 1,844 women who had undergone breast cancer surgery / Most patients referred to surgeon by another physician. Surgeon reputation was most commonly used factor for patients who selected their surgeon
Kurup et al., 2012 / Survey / 877 surgical patients / 41% of patients used the Internet to research their condition. 37% researched their surgery, 32% researched their surgeon, and 19% researched the hospital
Landau et al., 2013 / Survey / 67 abdominal aortic aneurysm patients / All else equal, patients prefer local care. If mortality risks were increased at the local hospital, 9% still would prefer local surgery
Liu et al., 2006 / Multivariate analysis / 719,608 patients who received 1 of 10 surgeries from 2000-2004 / Patients who were non-white, on Medicaid, or uninsured were less likely to have surgery at a high volume hospital and more likely to have surgery at a low volume hospital (p < .05). There are disparities in patients treated at high volume centers
Llewelly-Thomas et al., 1998 / Time trade-off method / 124 patients waiting for hip or knee replacement surgery / 57% of patients initially chose to delay surgery for 6 months to access a surgeon with a 1% mortality risk. Maximal wait times ranged from 1-26 months with a median of 7 months.
Losina et al., 2005 / Survey / 932 Medicare patients who underwent a total knee replacement / Surgeon reputation was most frequently cited factor for choosing location for surgery. Patients with lack of choice of surgeon more likely to be dissatisfied with care
Lubalin and Harris-Kojetin / Review / Available medical literature / Patients may act as irrational consumers of medical care. Clearer and more informative health information can assist consumers in making better choices
Luft et al., 1990 / Multivariate analysis / 39,645 patients who underwent 1 of 7 surgeries in 1983 in California / For 5 of 7 surgeries, hospitals with poorer outcomes saw fewer admissions
Luft, Hunt, and Maerki, 1987 / Simultaneous equation model / >1 million patients for 17 different surgeries in 1972 / Multiple possible explanations are possible for the lower mortality associated with higher-volume hospitals
Marang-van de Mheen, et al., 2010 / Questionnaire / 2,122 elective aorta reconstruction patients / Patients who had in-hospital adverse outcomes were more likely to use information on mortality, complications, and hospital stay if choosing a hospital for a subsequent surgery
Marang-van de Mheen, et al., 2011 / Questionnaire / 665 former surgical patients / Surgery-specific and quality of care information are the most important to patients when choosing between hospitals
Marshall and McLoughlin, 2010 / Commentary / Information on QI use / More QI may not necessarily lead patients towards viewing healthcare as anything but a commodity. QI may not directly lead to healthcare improvements
Marshall et al., 2000 / Review / Available medical literature / QI is an important aspect of quality improvement, yet there is uncertainty about its merits and risks. QI disclosure should be developed to minimize risks and maximize benefits
Mavis et al., 2005 / Questionnaire / 1,059 patients visiting OB/GYN clinic / Surgeon interpersonal skills, compassion, and expertise were most important factors
McGlone, Butler, and McGlone, 2002 / Survey / 222 individuals, mostly from physician offices / Physician professional attributes were most important factors for choosing a primary care physician
Mennemeyer, Morrisey, and Howard, 1997 / Multivariate regression / The effect of the Health Care Financing Administration QI released from 1986-1992 / HCFA QI had essentially no effect on hospital discharges. QI measures must be easily understood by the public to be effective
Modi et al., 2013 / Questionnaire / 384 patients undergoing surgical consults for shoulder or elbow conditions / Lower income and living alone were negative indicators of willingness to get surgery (p ≤ .015). Greater optimism of success and competency in English were positive predictors of willingness to get surgery (p ≤ .002)
Moser et al., 2010 / Interviews and focus group meetings / 18 patients who had undergone a hip or knee replacement / Patient decision-making based on variable interplay of physician and hospital attributes
Moser et al., 2010 / Interview / 18 hip or knee replacement patients / Consumers could understand QI, but often had problems incorporating it into their decision-making. Information from peers is considered very important in surgical planning
Mukamel and Mushlin, 1998 / Multivariate analysis / Information from New York State Cardiac Surgery Reports / Hospitals and physicians with better outcomes saw increased market shares. This correlation varied geographically and declined over time
Rini et al., 2011 / Cross-sectional study / 91 patients receiving surgery for inflammatory bowel disease / Close others have a large influence on surgical patients. Close other influence was associated with a greater likelihood of surgery (OR=1.97)
Romano and Zhou, 2004 / Time-series analysis / Patients admitted to hospitals classified as outliers for cardiac surgery morbidity and mortality / In New York, low-mortality outlier hospitals transiently experienced a significant increase in case volume
Salkeld et al., 2005 / Discrete-choice questionnaire / 103 patients who had undergone surgery for colorectal cancer / Surgeon training, surgeon communication, and type of hospital were important, statistically significant factors as determined by logistic regression (p<.001)
Schneider and Epstein, 1996 / Survey / 612 cardiologists and 85 cardiac surgeons in Pennsylvania / Pennsylvania's QI Consumer Guide was known by 82% of physicians. Only 10% viewed the Guide as important in assessing a cardiothoracic surgeon. The Guide held limited sway among cardiovascular specialists.
Schneider and Epstein, 1998 / Survey / 474 cardiac surgery patients in Pennsylvania / Only 12% of patients knew about Pennsylvania's QI consumer guide before choosing a surgeon, and less than 1% knew the correct rating of their surgeon or hospital. 58% of patients would have changed surgeons if the guide had indicated poor performance results for that physician.
Schneider and Liberman, 2001 / Review / Available medical literature / Consumers may not use public QI. Nevertheless, QI should remain public in order to force healthcare institutions towards higher quality care
Schwartz, Woloshin, and Birkmeyer, 2005 / Telephone interview / 510 Medicare patients who had one of five elective, high risk surgeries / Hospital reputation was second most important of 6 factors, nearly equally important as the number one factor (surgeon reputation)
Shackley, Slack, and Michaels, 2001 / Conjoint analysis / 125 vascular patients / Patients strongly preferred local treatment for vascular surgery. They were willing to wait between 4 and 5.4 months for treatment and incur a 2.7-4.4% increase in mortality risk to be treated locally
Shah and Dickinson, 2009 / Questionnaire / 199 urology outpatients / Hospital cleanliness and reputation and urologist reputation were the most important factors
Sick and Abraham, 2011 / Review / Available medical literature / Cost and quality information awareness is low among patients. Information found on the Internet is usually based on anecdotes and is produced by private companies
Sofaer et al., 2005 / Survey and focus groups / 153 people who had recently been hospitalized or had a loved one hospitalized / Physician communication skills, hospital staff communication and responsiveness and hospital cleanliness were most important factors
Stewart, Long, and Tulloh, 2006 / Viewpoint / Information on travel times / High volume centers yield better results for some surgeries, yet those centers are often in urban areas. A balance should be struck so that rural patients can access quality care without unreasonable travel burdens
Thrumurthy et al., 2011 / Discrete-choice questionnaire / 81 patients who had undergone oesophagogastric cancer resection / Quality of life, cure rate, surgeon reputation, and morbidity were most important factors
Tu and Lauer, 2008 / Survey / 5,800 adults from general population / Patients mostly use advice of friends or relatives when selecting primary care physicians, but mainly use referrals from physicians to choose specialists and facilities for care
Varkevisser and van der Geest, 2007 / Multivariate analysis / 58,475 orthopedic and neurosurgery patients / Both kinds of patients are less likely to bypass the nearest hospital when travel time to the next closest hospital increases, though the coefficient is lower for neurosurgery patients. 38% of orthopedic patients and 54% of neurosurgery patients bypassed their nearest hospital in 2003
Victoor et al., 2012 / Review / Available medical literature / Patient choice is based on a complex mix of patient and provider attributes, and patients may not make rational decisions about their healthcare
Vonberg, Sander, and Gastmeier, 2008 / Telephone interview / 1000 German households / General cleanliness, low infection rate, and friendly staff were the most important factors for choosing a hospital
Waltzman, Scholz, and Evans, 2011 / Conjoint analysis / 111 plastic surgery patients / Surgeon board certification and method of referral were most important factors for patients
Wasserman et al., 2014 / Cross-sectional study / Web-based colorectal cancer surgery information / The quality of online information is variable and often incomplete. Patients cannot make well-informed decisions regarding colorectal cancer surgery based on Internet information alone
Weil et al., 2014 / DISCERN evaluation / Web-based cervical spine surgery information / 3% of websites were rated "excellent," while 50% received a rating of "poor" or "very poor." The search for useful medical information on the Internet is difficult and often fruitless
Wilson, Woloshin, and Schwartz, 2007 / Telephone interview / 500 Medicare patients who had one of five elective, high risk surgeries / 73% of patients either decided on a location for surgery with their surgeon or deferred the decision to the surgeon alone
Yeung and Mortensen, 2012 / DISCERN evaluation / Web-based diverticular disease surgery information / 37% of websites were deemed "good" or "excellent." The quality of information on the Internet was questionable and websites sponsored by private companies may be biased
Zaidi et al., 2013 / Interview / 14 patients with end-stage ankle osteoarthritis / Surgeons are key sources of information for patients. Trust in surgeon was major factor for patients' choices
Supplemental Table 1: the 86 studies included in the review