Relevance of quality indicators for supporting patients’ choice of hospitals: a systematic review

Abstract Background In many countries, the health systems allow patients to have free selection of the hospital where they wish to receive treatment. The market for hospital services is a competitive market, where competition not necessarily happens over costs but over the quality of care. So far, only limited information on patient preferences of hospital choice is available. Methods The aim of this study was to provide a systematic review about the relevance of the quality indicators for patients when making a choice of hospital for inpatient treatment, which we conducted according to the PRISMA guidelines. We retrieved studies from PubMed, Web of Science, and EconLit and assessed them according to predefined criteria. To be eligible for our purposes, studies needed to examine inpatient preferences for hospital choice in North America, Europe, Australia, and New Zealand. The extracted quality indicators were then sorted according to study type (quantitative or qualitative), main indication (cancer, orthopedics, gastrointestinal, cardiology, and other), and structure, process, or outcome quality following Donabedian’s framework. Study quality was assessed with the Mixed-Methods-Appraisal-Tool (MMAT). Results Fifty-one studies met inclusion criteria. We extracted 24 quality indicators (ten structure, five process, five experiences and recommendations as a sub-category of process indicators, and four outcome). The most frequently examined one was “proximity to hospital/travel distance or time” ( n = 38). Structure and process indicators were examined often, as well as experiences and recommendation indicators, while outcome indicators were examined seldom. Conclusion We found few studies conducting qualitative research and more studies examining stated preferences than revealed preferences. Structure and process quality indicators were examined frequently, while outcome quality indicators were examined seldom, potentially either because patients do not consider them important or because little information on them is available. More qualitative and mixed methods studies are needed, as well as information on additional quality indicators.