Consumer Information Systems Research Articles

Defining Quality in Assisted Living: Comparing Apples, Oranges, and Broccoli

The purpose of this article is to discuss and describe various measures of quality, quality indicators, and uses of information on quality with specific reference to the role or purpose of assisted living. We reviewed a variety of major studies of assisted living quality. We elaborated models of assisted living based on differing goals or claims made for it by providers and policy makers. We then searched for available quality measures that might indicate whether assisted living was meeting those goals or living up to those claims. Any meaningful concept of "quality" must embrace a variety of dimensions, including quality of care, quality of life, the physical environment, and resident rights. The ability to use a multidimensional concept of quality is complicated by the lack of consensus, confusion, and disagreement among consumers, providers, and regulators about the role of assisted living. This disagreement significantly confounds the task of comparing quality among assisted living settings and between assisted living and other types of long-term care. We propose ways that researchers may compare quality along dimensions claimed to be intrinsic to assisted living as part of an effort to inform consumer information systems, quality monitoring and assurance systems, and policy-relevant research. Such comparisons would vary, depending on the intended use of the indicators and role defined for assisted living. However, all uses contain structural, process, and outcome quality indicators, including direct feedback from interviews with residents that go beyond satisfaction measures.

Comparing Staffing Levels in the Online Survey Certification and Reporting (OSCAR) System With the Medicaid Cost Report Data: Are Differences Systematic?

This study had two goals: (a) to assess the validity of the Online Survey Certification and Reporting (OSCAR) staffing data by comparing them to staffing measures from audited Medicaid Cost Reports and (b) to identify systematic differences between facilities that over-report or underreport staffing in the OSCAR. We merged the 2002 Texas Nursing Facility Cost Report, the OSCAR for Texas facilities surveyed in 2002, and the 2003 Area Resource File. We eliminated outliers in the OSCAR using three decision rules, resulting in a final sample size of 941 of the total of 1,017 non-hospital-based facilities. We compared OSCAR and Medicaid Cost Report staffing measures for three staff types. We examined differences between facilities that over-reported or underreported staffing levels in the OSCAR by using logistic regression. Average staffing levels were higher in the OSCAR than in the Medicaid Cost Report data. The two sets of measures exhibited correlations ranging between 0.5 and 0.6. For-profit and larger facilities consistently over-reported registered nurse staffing levels. Factors associated with increased odds of over-reporting licensed vocational nursing or certified nursing assistant staffing were lower Medicare or Medicaid censuses and less market competition. Facility characteristics associated with over-reporting were consistent across different levels of over-reporting. Underreporting was much less prevalent. Certain types of facilities consistently over-report staffing levels. These reporting errors will affect the validity of consumer information systems, regulatory activities, and health services research results, particularly research using OSCAR data to examine the relationship between staffing and quality. Results call for a more accurate reporting system.

Influencing health policy for older adults: Initiatives by the John A. Hartford Centers of Geriatric Nursing Excellence

This article examined the activities and outcomes of Health Centers for Geriatric Nursing Excellence (HCGNE) initiatives over the last 5 years in health policy designed to improve the care for older people. Qualitative data were collected from the 5 HCGNE describing their policy initiatives. The findings showed that HCGNE initiatives included a wide range of policy actions designed to improve access to appropriate geriatric nursing care, improve nursing home quality, develop new models of care delivery, improve the safety and cost effectiveness of transitions from hospital to home, and develop consumer information systems about quality. In addition, HCGNE developed educational courses and programs in health policy with research and policy analysis experiences. Faculty and students were involved in policy and leadership activities at the local, state, and national levels. The HCGNE brought gerontological research knowledge, clinical expertise, and policy experience to the policy arena that resulted in needed policy changes to improve geriatric care. Policy initiatives are key to making long-term system changes that can result in improvements in the access, quality, and costs of care for older people.

Rationing and competition in the Dutch health-care system

In this paper we examine the goals and effects of health-care policy in the Netherlands over the period 1980--2000. During this period Dutch health-care policy is marked by a peculiar combination of increasingly stringent cost-containment policies alongside a persistent pursuit of market-oriented reforms. The main goal of cost containment was to keep labour costs down under the restriction of universal equal access to health care. Supply and price control policies were quite successful in achieving cost containment, but in due course prolonged quantity rationing began to jeopardise universal physical access to health services. The main goal of market-oriented health-care reforms is to increase the system's efficiency and its responsiveness to patient's needs, while maintaining equal access. The feasibility of the reforms crucially hinges on the realisation of adequate methods of risk adjustment, product classification and quality measurement, an appropriate consumer information system and an effective competition policy. Realising these preconditions requires a lengthy and cautious implementation process. Although considerable progress has been made in setting the appropriate stage for regulated competition in Dutch health care, the role of the market is still limited.

Case Study: Development of and Stakeholder Responses to a Nursing Home Consumer Information System

California Nursing Home Search (www.calnhs.org), launched in October 2002, provides information about nursing home quality to a broad range of stakeholders. This case study discusses the process of developing a consumer-oriented nursing home Web site and presents an analysis of postlaunch responses from a number of sources (i.e., media, outreach, Web site use, correspondence, meetings, interviews) to determine the impact of the site and how it can be improved and used as an example. Consumers found the Web site valuable, but some needed clarification on navigation. Providers had complaints about the use of quality ratings and concerns about public availability of the data. Most discharge planners and care managers do not use Internet resources to find facilities. Feedback, modifications, updates, and outreach are needed on a continuous basis to ensure the site is a helpful tool for all stakeholders.

Consumer satisfaction in long-term care: state initiatives in nursing homes and assisted living facilities.

We report the results of a survey of state initiatives that measure resident satisfaction in nursing homes and assisted living facilities, and we describe several model programs for legislators and public administrators contemplating the initiation of their own state programs. Data on state initiatives and programs were collected during March and April 2000 through a mailed questionnaire and follow-up telephone interviews and were current as of September 2002. Of the 50 states surveyed, 50 responses were received (response rate = 100%); 12 states (24%) reported the use of consumer satisfaction measures, and 7 (Florida, Iowa, Ohio, Oregon, Texas, Vermont, and Wisconsin) reported using resident satisfaction data within their consumer information systems for nursing homes or assisted living facilities. Additionally, 2 states (Iowa and Wisconsin) use resident satisfaction data for facility licensing and recertification. The design of the instruments and collection methods vary in these states, as do the reported response rates, per-resident cost, and the purpose for satisfaction data collection. State satisfaction efforts are in an early stage of development. Well-produced, easily understandable reports on nursing home and assisted living quality could provide information and guidance for patients and families contemplating the utilization of long-term care services. Dissemination of quality information may also facilitate sustained quality and efficiency improvements in long-term care facilities and thus enhance the quality of care for and quality of life of long-term care residents.

HIN7/440: Evidence-based Consumer Health Information - The need for unbiased risk communication

Online consumer health information is rapidly growing. At the same time an active part of patients and consumers in decision making about preventive or therapeutic interventions is increasingly demanded. The basis for informed consumer choice is the communication of evidence-based scientific data in a format that is clearly understood by most lay persons. The way study results are presented influence decisions by health care providers and patients or consumers alike. The impact of framing of outcome data as either relative or absolute differences is well recognized. Outcome data should be reported as absolute numbers, absolute risk reductions or numbers needed to treat or to screen rather than as relative risk reductions. Beyond the question of whether relative or absolute differences are used, outcome data can be framed by either emphasising achievable benefits or the lack of such benefits. Presentation of data as the proportion of patients who remain free of a target outcome rather than the proportion of patients who benefit from a certain intervention could substantially influence decision making. So far, studies evaluating the communication of treatment results to patients were focussed on the benefits of the respective interventions. Such an approach is incompatible with unbiased informed decision making by the patient, client or consumer. In order to communicate outcome data in an objective manner the whole possible spectrum of data presentation should be considered. Both, the proportion of persons who are likely to benefit as well as the proportion of persons who are unlikely to benefit or likely to be harmed should be presented with equal emphasis. Instruments to judge the quality of printed or online consumer health information do not include rating the framing of outcome data (e.g. http:/www.discern.org.uk).In order to establish an online system of evidence-based consumer health information that provides unbiased evidence-based communication of outcome data mammography screening was used as a model. After screening the literature according to evidence-based medicine criteria the information on benefits and risks of mammography screening has been compiled. Results are communicated as simple self explaining illustrations as well as original numbers equally emphasising the various aspects of the outcome. In addition, unbiased information is provided on the test efficacy of mammography screening (false positive, false negative results), on other potential side effects or other beneficial effects of mammography screening such as the number of diagnostic surgical interventions following mammography or the psychological sequaele thereof, data on total mortality and precision or lack of precision of results. The described mammography screening consumer information system is being evaluated with experts and the target consumer population with the final goal of an online evidence-based consumer health information

CIS: A NEW FRONTIER FOR MIS

The era of customer service is seeing the development of a new branch of management information systems — consumer information systems (CIS). The CIS is fast becoming the source of intelligence on all consumer issues in customer-oriented firms. The authors outline the main characteristics of CIS, and relate them to the development of the consumer affairs role in business. Technological aspects of the CIS are also discussed.

Beyond physician referral: consumer information and referral systems as a marketing strategy for hospitals.

Beyond physician referral: consumer information and referral systems as a marketing strategy for hospitals.

Local Consumer Information Systems for Services: A Test

This paper reports on a survey of consumers' experiences with local services firms that was conducted by the Montgomery County, Maryland Office of Consumer Affairs and supported by an FTC grant. Over 1,200 individuals evaluated auto repair, heating and air conditioning, home remodeling, roofing, and insulation contracting firms on three dimensions: satisfaction with work performed, price in relation to quality, and strength of recommendation. Results for the heating and air conditioning category were published and widely disseminated.

Certification and product testing. Some problems in consumer information systems

Well-known problems in technical product testing are lack of reproducibility of test methods and performance differences between “identical” products (also referred to as the sampling problem). The Dutch certification institute IVHA has incorporated these phenomena in its consumer information system in such a way that they can be dealt with adequately. A number of principles in the IVHA approach are also applicable to comparative testing and informative labelling. An active dialogue with suppliers is an important element in the IVHA approach.

CONSUMER INFORMATION SYSTEMS IN VIDEOTEX: DESIGN AND ACCEPTANCE

Comprehensive information about complex products with frequent product changes is delineated as an area where consumer information systems in videotex could be most promising. Four psychological principles for the design of such systems are presented and applied to construct an information system to support automobile purchases. Results from an empirical study show very favourable evaluations of this information system by videotex users. Several possible determinants of acceptance are discussed.

Bringing consumer information systems down to earth. Experiences from a Swedish experiment

How is it possible to provide consumers with necessary information to make well informed choices in today's markets where there is a growing supply of complex and ever changing products and services? The information is in the main commercial. Its role is to persuade as well as to inform. Therefore, its usefulness for the consumers is questionable. To bridge this information gap policymakers have initiated programmes to provide useful information for consumers. In this context, Sweden has tried something new, by requiring by law that enterprises supply information in their advertising which is of special significance for the consumers.

Implications of Consumer Information Processing Research for the Design of Consumer Information Systems

The commercial success of computerized consumer information systems will depend heavily on the extent to which they help consumers make choices. A system's usefulness will be a function of both the information it contains and the capabilities it offers to process this information. These capabilities will be incorporated in the system's access “language.” This paper reviews research on how consumers process information to make choices, and discusses the implications of this research for the design of consumer information system languages. A hypothetical example is presented and contrasted briefly with available access languages.

Information Seekers and Information Systems: A Policy Perspective

Consumer information systems in general, and independent consumer information programs in particular, are seen as indispensable elements of consumer policy, both private and public. In open market democracies, information has inherent merit relative to consumer protection by direct regulation. Policy conclusions are based on large-scale research concisely summarized.

Okologie. Ein Lehrbuch.

Information Systems Education.- The Practical Relevance of IT Education: Skill Requirements and Education Expectations of Practitioners.- Challenges of Professionalization: Bridging Research and Practice through a Body of Knowledge for IT Specialists.- Mapping Research Questions to Research Methods.- Keynote.- Reflections on 50 Years of Computing: Impact of Professionalism on Teaching, Practice and Research.- New Perspectives on Information Systems Development.- Advances in Information Systems Development: From Discipline and Predictability to Agility and Improvisation.- The Emergence of Partnership Networks in the Enterprise Application Development Industry: A Global Corporation Perspective.- Challenges of Consumer Information Systems Development: The Case of Interactive Television Services.- Defining, Modeling and Diffusing IS Projects.- Improving diffusion of Information Technology in communities in a developing world context.- 'Driving' IS projects.- Bridging the Gap Between Service-Oriented and Object-Oriented Architectures in Information Systems Development.- Keynote.- The IFIP International Professional Practice Partnership.- Knowledge Management and Business Intelligence.- Requirements Elicitation in Data Mining for Business Intelligence Projects.- Social Networks and KMS Use in US IT Services.- Realizing the Value of Business Intelligence.- Applications and Emerging Technologies.- An RFID Adoption Framework: A Container Supply Chain Analysis.- Adoption of Service Oriented Computing from the IT Professionals' Perspective: An e-Government Case Study.- of a Public Sector e-Procurement Solution: Lessons Learned from Disappointing Adoption.

Information Seekers and Information Systems: A Policy Perspective

Consumer information systems in general, and independent consumer information programs in particular, are seen as indispensable elements of consumer policy, both private and public. In open market democracies, information has inherent merit relative to consumer protection by direct regulation. Policy conclusions are based on large-scale research concisely summarized.

BOOK REVIEWS

Books reviewed in this article:DeSalvo, Louis J., Consumer Finance.Ewen, Stuart, Captains of Consciousness: Advertising and the Social Roots of the Consumer Culture.Leibenstein, Harvey. Beyond Economic Man: A New Foundation for Microeconomics.Gordon, Leland J. and Stewart M. Lee, Economics for Consumers, seventh edition.Reynolds, Fred D. and William D. Wells, Consumer Behavior.Thorelli, Hans B. and Sarah V. Thorelli, Consumer Information Systems and Consumer Policy.Warmke, Roman F. and Eugene D. Wyllie, Consumer Economic Problems.

The Local Consumer Information System: An Institution‐To‐Be?

This paper makes the case for the creation, testing and perfection of a new economic institution–a local consumer information system. The heart of the system would be a data bank to which the consumer could address questions and receive answers repeatedly regarding the local market. The purpose of the system would be to deliver relevant consumer information more efficiently. For the individual consumer this new institution would help identify his best buy variety of a product, quickly and at low cost. It would also tell him, again quickly and at low cost, from what local retailers and at what local prices this best buy variety might be purchased. This new institution would serve all consumers in a given community by lowering many prices, quality constant. By reproducing itself in different locales, as the product testing organizations have, it might be expected to multiply and serve consumers in many communities. The paper discusses the types of information to be provided, methods of information collection and dissemination, means of insuring accuracy and fairness and how it might be financed.

Cable Communications Policy Issues: An Overview

Three perspectives-need-oriented, value-oriented, and technology-oriented-were used to develop an overview of cable comminications policy issues. A need-oriented perspective shed light on the specific policy issues in the five service areas of the community information system, consumer information system, teleshopping/telebanking, teleeducation, and telemedicine, and in the social experimentation of these services. A value-oriented perspective identified programming diversity as a more important social policy issue than economic efficiency in cablecasting. A corresponding research agenda is presented for policy and institutional changes to increase ideological and stylistic diversity in television programming. From a technology-oriented perspective, the most important development impinging on cable communication is that of fiber optics. The policy issues here are so far-reaching that research should be started now, along the direction of a specific research agenda, to study policy options dealing with the convergence of telephone systems and cable systems.