The results of the study highlighted that public reporting may mislead the choice of hospital for patients with AMI to select a hospital with a good rating than the nearest hospital. Before providing clinical information and public reporting of AMI to the respondents, most respondents answered that they would go to the nearest hospital after the onset of AMI symptoms. Despite the fact that most respondents had little knowledge about AMI, majority of the respondents chose the nearest hospital as their choice. This is crucial, as appropriate timing of treatment for AMI is essential to have better outcomes. However, after providing the information about the HIRA's public reporting and clinical information of AMI, the number of respondents who chose hospitals with good rating significantly increased. Although HIRA publicly discloses both the hospital ratings and information on the available hospitals for AMI care , we found these information did not affect the respondent’s choice of hospital because they were not aware of it. This is consistent with previous studies [4, 23, 24].
Unlike chronic diseases such as cancer, it is of importance to visit the nearest hospital where the appropriate treatment is available as soon as the onset of AMI symptom occurs, since early treatment is critical for the prognosis of AMI . According to the report, the time taken to arrive at tertiary hospitals after the onset of AMI is an average of 30 minutes later than the time taken to arrive at general hospitals in Korea .
Prehospital delays for AMI treatment increase the risk of mortality. Patients with AMI, who tend to choose hospitals based on the hospital ratings, are often at risk of missing the ‘golden time’ for proper treatment while looking for hospitals with a good rating. In addition, outside the metropolitan area in Korea, 80% of patients with AMI die because of missing the ‘golden time’ for treatment while being transferred to the emergency room after the onset of AMI symptoms .
The fact that hospital ratings are considered more when selecting hospitals for cancer treatment than AMI treatment indicates that there are differences in the factors to consider when choosing a hospital for acute (AMI) and chronic disease (cancer). In ranking the hospitals, it is necessary to interpret the data appropriately, but the public reporting offer no guidance as to the relative benefit of specific measures. For example, for choosing hospital for medical care for patient with pneumonia, the guidance in different factors including appropriate timing for antibiotics (i.e., within four hours) or what the correct antibiotics should be given, is more important . Although there are few studies evaluating the effect of severity of illness or insurance type on hospital choice [29, 30], the evidence for hospital choice according to disease type remains limited.
Despite a small proportion of respondents (9.9%) who considered hospital ratings as the most useful information for AMI treatment, more than half (57.3%) of respondents selected ‘Good rates’ as the most important factor for their future hospital choice for AMI treatment. This can be interpreted in the respondents’ belief that the hospital with a good rating for AMI care quality is the best hospital with great doctors’ expertise.
Another interesting finding is the association between education level and the choice of hospital. In our study, additional information about the clinical characteristics of the disease or hospital rating had no effect on the respondents’ choice of hospital by education level (Supplementary Table 1). In Tayyari's study , however, there was a significant relationship between education level and the choice of highly specialized hospital. Thus, additional study is needed to investigate various factors that may influence the choice of hospitals.
The strength of this study is that we used mobile devices and social media platforms to collect the data for our survey. This way of collecting data is cost-effective, enables access to large and diverse individuals quickly, and takes less time than traditional methods to obtain data for analysis. In addition, this research is easily replicable using the standardization of data collection process.
The limitation of this study is that the results are not generalizable to the entire Korean population as the snowball sampling method was used to select the study population. Most respondents were young ages less than 40s as the mobile and social media platform is more popular in this age group [32, 33], and were concentrated in the metropolitan area.
When providing clinical information and public reporting of AMI in the survey to observe change in hospital choice for AMI treatment before and after information acquisition, we did not indicate that when someone has onset of AMI symptom, he or she should go to the nearest hospital as soon as possible because this might lead respondents to choose the ‘close hospitals’ for the question of hospital choice. In addition, the definition of ‘good rate’ was not specifically presented in the survey questions, but we assumed that the respondents considered the first and second grades out of five as good.