Search

Abstract Background Quality of care public reporting provides structural, process and outcome information to facilitate hospital choice and strengthen quality competition. Yet, evidence indicates that patients rarely use this information in their decision-making, due to limited awareness of the data and complex and conflicting information. While there is enthusiasm among policy makers for public reporting, clinicians and researchers doubt its overall impact. Almost no study has analyzed how users behave on public reporting portals, which information they seek out and when they abort their search. Methods This study employs web-usage mining techniques on server log data of 17 million user actions from Germany’s premier provider transparency portal Weisse-Liste.de (WL.de) between 2012 and 2015. Postal code and ICD search requests facilitate identification of geographical and treatment area usage patterns. User clustering helps to identify user types based on parameters like session length, referrer and page topic visited. First-level markov chains illustrate common click paths and premature exits. Results In 2015, the WL.de Hospital Search portal had 2,750 daily users, with 25% mobile traffic, a bounce rate of 38% and 48% of users examining hospital quality information. From 2013 to 2015, user traffic grew at 38% annually. On average users spent 7 min on the portal, with 7.4 clicks and 54 s between clicks. Users request information for many oncologic and orthopedic conditions, for which no process or outcome quality indicators are available. Ten distinct user types, with particular usage patterns and interests, are identified. In particular, the different types of professional and non-professional users need to be addressed differently to avoid high premature exit rates at several key steps in the information search and view process. Of all users, 37% enter hospital information correctly upon entry, while 47% require support in their hospital search. Conclusions Several onsite and offsite improvement options are identified. Public reporting needs to be directed at the interests of its users, with more outcome quality information for oncology and orthopedics. Customized reporting can cater to the different needs and skill levels of professional and non-professional users. Search engine optimization and hospital quality advocacy can increase website traffic.

Abstract A joint analysis of five paternal half-sib Holstein families that were part of two different granddaughter designs (ADR- or Inra-design) was carried out for five milk production traits and somatic cell score in order to conduct a QTL confirmation study and to increase the experimental power. Data were exchanged in a coded and standardised form. The combined data set (JOINT-design) consisted of on average 231 sires per grandsire. Genetic maps were calculated for 133 markers distributed over nine chromosomes. QTL analyses were performed separately for each design and each trait. The results revealed QTL for milk production on chromosome 14, for milk yield on chromosome 5, and for fat content on chromosome 19 in both the ADR- and the Inra-design (confirmed within this study). Some QTL could only be mapped in either the ADR- or in the Inra-design (not confirmed within this study). Additional QTL previously undetected in the single designs were mapped in the JOINT-design for fat yield (chromosome 19 and 26), protein yield (chromosome 26), protein content (chromosome 5), and somatic cell score (chromosome 2 and 19) with genomewide significance. This study demonstrated the potential benefits of a combined analysis of data from different granddaughter designs.