OBJECTIVES:

As diagnostic imaging demands and costs escalate, there are significant negative impacts on patient satisfaction. The objective of this study was to identify patient preferences for diagnostic imaging services and analyze how patients make trade-offs between attributes of services and compare patient preferences to value and volume-based approaches.

METHODS:

In this mixed methods study, focus groups were performed in semi-structured manner with patients in a rural health network. This preliminary work helped define key attributes and levels for a discrete choice experiment (DCE). Attributes and levels included interpreting physician specialty, primary care recommendation, cost, clinic wait time, travel time, appointment scheduling wait time, patient-rated service quality, government-rated quality score, and online scheduling availability. Two DCE's were designed to assess different aspects of the choice scenario: acute (injured ankle X-Ray), and general imaging (MRI for chronic back pain). Stated preferences data have been analyzed using random parameter mixed logit models and interaction models including participant demographics have also been constructed.

RESULTS:

We found increased cost resulted in lower probability of selection of an imaging center, while all other attributes assessed either increased or had little effect on the probability of selection. Participants placed high value on Radiologist expertise, including that of subspecialty Radiologists as well as recommendation of imaging centers by PCPs. These factors are not captured by existing quality metrics for Radiology. Participants demonstrated a strong preference for reviewing results and discussing next steps in their care with their ordering providers, while preferences for interaction with Radiologists were more heterogeneous.

CONCLUSIONS:

Patient preferences are not well aligned with value-based priorities. Value based systems will only be able to succeed if they can generate sufficient cost savings to patients to offset undesirable practice characteristics. The findings of this study are relevant to decision makers interested including patient value assessment in their healthcare reforms.