Patient-centered care and healthcare consumerism are dominant models of the patient-provider relationship. Positioning theory was applied to examine consumers' and physicians' positions on patient-centered care and healthcare consumerism, along with their attitudes toward direct-to-consumer healthcare service advertising and trust in the medical profession. Surveys were conducted with a convenience sample of consumers and physicians respectively. Patient-centered care was the only theoretical construct that both consumers and physicians unequivocally embraced. Both groups were either ambivalent or skeptical of the other three concepts. Between the two groups, physicians exhibited a stronger endorsement of patient-centered care and more negative attitudes toward advertising than consumers. When the relationships among the theoretical constructs were examined, a negative correlation between patient-centered care and consumerism was found among consumers. Also, patient-centered care and trust were negatively correlated in both groups. Implications of these findings are discussed for strategic communication, consumer and physician education, and future research.

Purpose With the increasing dependence on market-based distribution of health-care resources in the USA, spending on health-care service advertisements directly targeting consumers has also increased. Previous research has shown that the ads fail to deliver information deemed essential by regulators. Nevertheless, the attitude of consumers toward health-care service advertising has been more positive than negative. The purpose of this study is to create a taxonomy of advertising information features to better describe the relationships between information features in the advertisements and consumer attitudes toward them. Design/methodology/approach A cross-sectional survey was conducted with 128 health-care consumers in a western state in the USA. Findings Factor analysis generated seven groups of information features. Among them, information features about access, cost and quality of care were rated as most helpful, whereas providers’ clinical qualifications and communication were rated least helpful. The advertising attitude measure was validated to contain two subscales, one regarding health-care service advertising and the other regarding physicians who advertise. People who highly rated the consumerism features had more positive attitudes toward health-care service advertising and people who highly rated provider clinical qualification features had more negative attitudes toward advertising physicians. Originality/value This study made methodological improvements in health-care service advertising research that would be crucial for its theoretical development. It also shed light on consumer characteristics and perceptions about information features that could influence their attitudes toward health-care service advertising.

Direct-to-consumer advertisements for healthcare services constitute a rare channel of public communication where consumers see and hear directly from their local providers and healthcare organizations. Although spending on these advertisements has increased drastically during the past decades, research on their content and effects remains rare. To fill this gap, we analyzed primetime television advertisements for healthcare services directly targeting consumers. The advertisements were collected from the two largest media markets in Nevada for one month. In total, 795 advertisements were identified, and 106 of them were non-duplicates. Analysis revealed that the advertisements focused on patients' good health outcomes by showing them smiling, going out and about, having fun with others, and enjoying rigorous physical activities. On the other hand, the advertisements focused less on the providers. Although the advertisements often showed providers in clinical settings, basic information about their professional degrees was often missing. Mentions of providers' other qualifications and professional experiences were even scarcer. Also, a substantial number of advertisements failed to show providers interacting with patients. Additional analysis of patient and provider characteristics revealed under-representation of racial or ethnic minority and older adult patients. Representation of women and minorities as providers was even more uncommon. We discussed the implications of these findings from the perspective of patient expectation and made suggestions to help providers improve their direct-to-consumer advertisements.

Patient-centered care and healthcare consumerism are the two most dominant ideas about the relationship between patients and providers in the United States. To identify providers’ positions between the two perspectives, we analyzed the content of direct-to-consumer healthcare service advertisements. The advertisements were collected in the state of Nevada ( N = 323) and their landing pages were analyzed for provider attributes, patient experience features, and terms referring to patients and providers. The results showed that the advertisements fully embraced the notion of patient-centeredness by commonly claiming patient-centered care and frequently using the term “patient.” The advertisements also contained multiple indicators of healthcare consumerism, although they avoided using the terms “consumer/customer/client” closely associated with consumerism. Contrary to the prominence of patient experience features, provider attributes were not common. An additional analysis of inter-specialty differences in advertising features confirmed the strong consumerism position of cosmetic surgery providers. Application of the healthcare service advertising analytic scheme developed for this study could help providers and healthcare administrators recognize how their advertising messages may reflect their values.

Although genetic testing can be vastly informative, it creates a dilemma if a patient does not want to disclose an abnormal genetic test to at-risk relatives. A sample of 200 participants from Nevada (100 physicians, 100 non-physicians) completed an 11-item questionnaire asking demographic information, familiarity with genetics and genetic testing, and opinions about a physician's role in a hypothetical case in which a patient does not wish to communicate her BRCA1 mutation to her sister. Although most respondents did not think the physician should notify the sister against the patient's wishes, more non-physicians (40%) than physicians (23%) contended that the physician should do so (p = 0.0119). Most respondents from both groups agreed that the physician should not have the legal duty to notify the sister, would not be morally justified in sharing genetic test results with the sister, but should have the right to notify a patient's relatives if the disease is "serious, preventable, and treatable." More non-physicians than physicians agreed that physicians should have an educational requirement on how to communicate genetic test results to patients and their family (88% vs 65%, p = 0.0002). Most physicians (70%) reported a familiarity/strong familiarity with genetic testing compared to non-physicians (33%; p < 0.0001). Future qualitative research should assess physicians' understanding of issues surrounding familial communication of genetic test results. Educational interventions to facilitate effective communication to patients and families are needed and welcomed by most physicians. Discrepancies between the attitudes of physicians and patients or the public need to be better understood and addressed.

Background In the 1970s, the Federal Trade Commission declared that allowing medical providers to advertise directly to consumers would be “providing the public with truthful information about the price, quality or other aspects of their service.” However, our understanding of the advertising content is highly limited. Objective To assess whether direct-to-consumer medical service advertisements provide relevant information on access, quality and cost of care, a content analysis was conducted. Method Television and online advertisements for medical services directly targeting consumers were collected in two major urban centres in Nevada, USA, identifying 313 television advertisements and 200 non-duplicate online advertisements. Results Both television and online advertisements reliably conveyed information about the services provided and how to make an appointment. At the same time, less than half of the advertisements featured insurance information and hours of operation and less than a quarter of them contained information regarding the quality and price of care. The claims of quality were substantiated in even fewer advertisements. The scarcity of quality and cost information was more severe in television advertisements. Conclusion There is little evidence that medical service advertising, in its current form, would contribute to lower prices or improved quality of care by providing valuable information to consumers.

Renown Health; and Departments of Internal Medicine and Pediatrics University of Nevada School of Medicine Reno, NV Department of Pediatrics University of Nevada School of Medicine Renown Children’s Hospital Reno, NV *See also p. 2131. The authors have disclosed that they do not have any potential conflicts of interest.

Critical Care Medicine www.ccmjournal.org 2277 Over the last 40 years, outcome measurement and the prediction of outcome based on objectively available data points have evolved as a science in medicine, including critical care medicine. There is great value in better understanding outcomes because it provides an opportunity to evaluate and, where necessary, address variations in care at both the practitioner and institutional levels for the purpose of quality improvement. In this issue of Critical Care Medicine, Gupta et al (1) help to advance this dialogue by evaluating a possible association between risk-adjusted PICU mortality in children with critical illness admitted in freestanding children’s hospitals (FCHs) and those admitted in non FCHs (nFCHs). The authors performed a nonconcurrent cohort analysis using data from well over 500,000 critically ill children from 140 centers registered in the Virtual PICU Systems (VPS) database, a robust national database. A matched subset of children was used, and a propensity analysis was performed to account for covariates affecting outcome. For the children studied, they observed significantly better outcomes (ICU mortality, standardized mortality ratio, reintubation, and good neurologic outcome) for those treated in PICUs at FCHs. We appreciate the efforts of the authors in being brave enough to move this dialogue incrementally forward in content, methodology, and in their willingness to tackle a difficult and possibly sensitive conversation. Although the impact of volume on outcomes has been reported in the past, we believe that this is the first time that the issue of mortality as it relates to being treated in a freestanding versus a nonfreestanding children’s hospital is being studied. A variety of elements from a “content” perspective establish the case for the current study. Mortality is an important, well defined, and objective measure of outcome in the PICU (2). Certain aspects that affect outcome in the PICU, including structural aspects in care like team composition and leadership, have been established previously (3). In addition, practice variation, whether at the provider or institutional level, has also been demonstrated to influence outcome (4). Efforts to address and ultimately streamline processes of care including managing comorbid conditions, adverse events, such as medication errors and infections, and the presence of early warning systems all play a major role in eliminating unintended mortality and morbidity. These efforts have, in fact, been fundamental components of safety and quality programs for nearly 2 decades. We now accept that mortality, previously considered a static measurement, can be significantly improved with appropriate focus and improvement efforts that eliminate harmful variations (5). As such, the authors are supported in investigating whether the “variation” associated with freestanding versus nonfreestanding hospitals affects outcome. With all things being equal, this study suggests that for the conditions, studied children would be better off being treated in FCH PICUs. However, we agree with the authors’ statement that the results need to be interpreted with caution given the clinical significance of the results. As with many novel findings, the intriguing data presented form an invitation for confirmatory studies. Such studies may want to shed light on the observation that some nFCHs have exceptionally low PICU mortalities, while several FCHs have mortalities rates well above the mean of nFCHs (Fig. 2). This suggests that other factors besides being treated at a FCH may play an important role in PICU outcome. 14. 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