How consumers evaluate health care quality: Part III

This article is the third and final article in a series which examines the way in which consumers assess information regarding the quality of health care services. The previous article focused on consumers' perceptions of health care plans and health insurance companies. This article examines the views of health care consumers regarding hospitals and doctors.     

Using Web sites on quality health care for teaching consumers in public libraries

More and more consumers are searching the Internet for health information. Health Web sites vary in quality, though, and not all consumers are aware of the need to evaluate the information they find on the Web. Nurses and other health providers involved in patient education can evaluate Web sites and suggest quality sites for patients to use. This article describes a project we implemented in 2 public libraries to educate consumers about quality health care and patient safety using Web sites that we had evaluated earlier. Participants (n = 103) completed resources on health care quality, questions patients should ask about their diagnoses and treatment options, changes in Medicare and Medicare options or ways to make their health benefits work for them, and tips to help prevent medical errors. Most consumers were highly satisfied with the Web sites and the information they learned on quality care from these resources. Many participants did not have Internet access at home or work and instead used the library to search the Web. Information about the Web sites used in this project and other sites on quality care can be made available in libraries and community settings and as part of patient education resources in hospitals. The Web provides easy access for consumers to information about patient safety initiatives and health care quality in general.     

Development of a Quality Ranking Model for Home Health Care Providers

This research aims to increase transparency and simplify consumer decision-making regarding the selection of a home health care provider. Currently, quality information on home health care providers is fragmented and difficult to interpret. In this study, a quality-ranking model is developed by selecting multidimensional quality indicators across multiple sources and respective weights using expert judgment. Given the weights and providers' performance on each quality indicator, a composite score is calculated that summarizes a home health care provider's overall quality level. This quality information empowers consumers to narrow their search and select the best-performing, most efficient providers.     

The impact of the Internet on quality measurement

Consumers are eager for information about health. However, their use of such data has been limited to date. When consumers do consider data in making health care choices, they rely more on word-of-mouth reputation than on traditional quality measures, although this information has not necessarily been readily accessible. The Internet changes the exercise of quality measurement in several ways. First, quality information--including reputation--will be more readily available. Second, consumers will increasingly use it. Third, the Internet provides a low-cost, standard platform that will make it vastly easier for providers to collect quality information and pass it on to others. However, major barriers still stand in the way of public access to quality information on the Internet as well as of having that access actually improve patients' care.     

An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care

Advocates of health reform continue to pursue policies and tools that will make information about comparative costs and resource use available to consumers. Reformers expect that consumers will use the data to choose high-value providers-those who offer higher quality and lower prices-and thus contribute to the broader goal of controlling national health care spending. However, communicating this information effectively is more challenging than it might first appear. For example, consumers are more interested in the quality of health care than in its cost, and many perceive a low-cost provider to be substandard. In this study of 1,421 employees, we examined how different presentations of information affect the likelihood that consumers will make high-value choices. We found that a substantial minority of the respondents shied away from low-cost providers, and even consumers who pay a larger share of their health care costs themselves were likely to equate high cost with high quality. At the same time, we found that presenting cost data alongside easy-to-interpret quality information and highlighting high-value options improved the likelihood that consumers would choose those options. Reporting strategies that follow such a format will help consumers understand that a doctor who provides higher-quality care than other doctors does not necessarily cost more.     

Improving the quality of long-term care with better information

Publicly reporting information stimulates providers' efforts to improve the quality of health care. The availability of mandated, uniform clinical data in all nursing homes and home health agencies has facilitated the public reporting of comparative quality data. This article reviews the conceptual and technical challenges of applying information about the quality of long-term care providers and the evidence for the impact of information-based quality improvement. Quality "tools" have been used despite questions about the validity of the measures and their use in selecting providers or offering them bonus payments. Although the industry now realizes the importance of quality, research still is needed on how consumers use this information to select providers and monitor their performance and whether these efforts actually improve the outcomes of care.     

Do consumers respond to publicly reported quality information? Evidence from nursing homes

Public reporting of quality information is designed to address information asymmetry in health care markets. Without public reporting, consumers may have little information to help them differentiate quality among providers, giving providers little incentive to compete on quality. Public reporting enables consumers to choose highly ranked providers. Using a four-year (2000-2003) panel dataset, we examine the relationship between report card scores and patient choice of nursing home after the Centers for Medicare and Medicaid Services began publicly reporting nursing home quality information on post-acute care in 2002. We find that the relationship between reported quality and nursing home choice is positive and statistically significant suggesting that patients were more likely to choose facilities with higher reported post-acute care quality after public reporting was initiated. However, the magnitude of the effect was small. We conclude that there has been minimal consumer response to information in the post-acute care market.     

Measuring the quality of chiropractic alternative care in a managed care environment

Today's health care environment is more consumer driven with regard to quality issues, and consumers want open access to alternative care, which includes chiropractic care. Given the growing demand for quality, the majority of the top health care plans are requiring their providers to participate in a credentialing process and an on-site office review. These standards allow managed care organizations to make an informed, objective decision regarding the network selection process of chiropractic providers.     

Providing Access to Multilingual Patient Education Materials

Access to reliable yet readable health information is key for consumers making health decisions and participating in the management of their care. This presents a particular challenge for patients whose first language is not English. The language barrier makes it difficult for them to understand the counsel and direction of care providers or educational materials only available in English. Online reliable sources in their own language may be difficult to locate, particularly for those with additional literacy or technological barriers. This article will highlight a pilot project to collate online patient education materials in languages other than English for use by providers in primary care.     

Holding health providers in developing countries accountable to consumers: a synthesis of relevant scholarship

Health care providers in low-income countries often treat consumers poorly. Many providers do not consider it their responsibility to listen carefully to consumer preferences, to facilitate access to care, to offer detailed information, or to treat patients with respect. A lack of provider accountability to health consumers may have adverse effects on the quality of health care they provide, and ultimately on health outcomes. This paper synthesizes relevant research on health provision in low-, middle- and high-income countries with the aim of identifying factors that shape health provider accountability to consumers, and discerning promising interventions to enhance responsiveness. Drawing on this scholarship, we develop a framework that classifies factors into two categories: those concerning the health system and those that pertain to social influences. Among the health systems factors that may shape provider accountability are oversight mechanisms, revenue sources, and the nature of competition in the health sector-all influences that may lead providers to be accountable to entities other than consumers, such as governments and donors. Among the social factors we explore are consumer power, especially information levels, and provider beliefs surrounding accountability. Evidence on factors and interventions shaping health provider accountability is thin. For this reason, it is not possible to draw firm conclusions on what works to enhance accountability. This being said, research does suggest four mechanisms that may improve provider responsiveness: 1. Creating official community participation mechanisms in the context of health service decentralization; 2. Enhancing the quality of health information that consumers receive; 3. Establishing community groups that empower consumers to take action; 4. Including non-governmental organizations in efforts to expand access to care. This synthesis reviews evidence on these and other interventions, and points to future research needs to build knowledge on how to enhance health provider accountability to consumers.     

Making the grade: a status report on hospital report cards

Hospital report cards that document patients' medical outcomes are attracting increasing attention for their role in guiding health care decisions by employers, consumers and providers. Significant questions remain, however, regarding the validity and utility of this information. This Issue Brief is based on a seminar held by the Center for Studying Health System Change at which two expert panels discussed whether report cards make the grade. The first panel approached this subject through a Socratic dialogue that focused on the release of a hypothetical community hospital report card. The second panel weighed in on two research presentations related to report cards. The panelists agreed that efforts to collect and report clinical outcomes data are flawed. Even so, release of the data can help improve clinical quality and foster an environment in which health care quality information ultimately has an impact on health care decision making.     

Consumer Attitudes and Perceptions on mHealth Privacy and Security: Findings From a Mixed-Methods Study

This study examined consumers’ attitudes and perceptions regarding mobile health (mHealth) technology use in health care. Twenty-four focus groups with 256 participants were conducted in 5 geographically diverse locations. Participants were also diverse in age, education, race/ethnicity, gender, and rural versus urban settings. Several key themes emerged from the focus groups. Findings suggest that consumer attitudes regarding mHealth privacy/security are highly contextualized, with concerns depending on the type of information being communicated, where and when the information is being accessed, who is accessing or seeing the information, and for what reasons. Consumers frequently considered the tradeoffs between the privacy/security of using mHealth technologies and the potential benefits. Having control over mHealth privacy/security features and trust in providers were important issues for consumers. Overall, this study found significant diversity in attitudes regarding mHealth privacy/security both within and between traditional demographic groups. Thus, to address consumers’ concerns regarding mHealth privacy and security, a one-size-fits-all approach may not be adequate. Health care providers and technology developers should consider tailoring mHealth technology according to how various types of information are communicated in the health care setting, as well as according to the comfort, skills, and concerns individuals may have with mHealth technology.     

The Internet: tomorrow's portal to non-traditional health care services

It is not at all surprising that people are not enamored of hospitals, as they are almost always associated with negatives such as pain, loss of mobility, and high cost. On a less emotional level, hospitals are perceived as big businesses, and consumers are getting inured to a consistently decreasing level of caring and service, particularly from "service" businesses. Many people are going to the Internet for health information due to the belief that today's doctor-patient relationship lacks an attention to detail and personal touch that was there in the past. The Internet is empowering consumers. If it continues this way, consumers will rely on physicians less and shop for alternatives more. In this article, the author makes the following points: (1) Consumer attitudes about traditional health care providers are changing significantly as their desire for more involvement in and control over the management of their health increases. This desire increases their need for information. (2) The Internet is proving to be the information source consumers need. Anyone with a modem-equipped personal computer and a telephone line can access health care and scientific information on Web sites ranging from Medline and the Merck Manual to Ask Dr. Dean and Dr. Ruth. (3) There are alternatives to traditional providers and methods, and consumers can not only find them on the Internet, but also get information that is stated objectively and non-technically.     

Considering quality: engaging consumers to make better health care decisions

On May 19, 2005, Grantmakers In Health (GIH) convened nearly 50 grantmakers and leaders in the field of health care quality to discuss the challenges inherent in developing quality information, as well as how consumers use such information. This Issue Brief examines the potential of consumers to use information to select high-quality health services and to become drivers of quality improvement at the systems level. There are three broadly used mechanisms for connecting consumers to information: report cards on health plans and providers, decision support aides, and the Internet. Health foundations can play an important role in developing and disseminating quality information for consumers. They can support the development of quality indicators; assess the effectiveness of information technology, including the Internet; and fund advocacy efforts to ensure consumers have the information needed to make appropriate health care choices.     

Not-for-profit versus for-profit health care providers-Part I: comparing and contrasting their records

The debate over which health care providers are most capably meeting their responsibilities in serving the public's interest continues unabated, and the comparisons of not-for-profit (NFP) versus for-profit (FP) hospitals remain at the epicenter of the discussion. From the perspective of available factual information, which of the two sides to this debate is correct? This article is part I of a 2-part series on comparing and contrasting the performance records of NFP health care providers with their FP counterparts. Although it is demonstrated that both NFP and FP providers perform virtuous and selfless feats on behalf of America's public, it is also shown that both camps are involved in potentially willful clinical and administrative missteps. Part I contains the background information (eg, legal differences, perspectives on social responsibility, and types of questionable and fraudulent behavior) that is necessary to adequately understand the scope of the comparison issue. Part II offers actual comparisons of the 2 organizational structures using several disparate factors such as specific organizational behaviors, approach to the health care priorities of cost and quality, and business-focused goals of profits, efficiency, and community benefit.     

Not-for-profit versus for-profit health care providers--Part II: Comparing and contrasting their records

The debate over which health care providers are most capably meeting their responsibilities in serving the public's interest continues unabated, and the comparisons of not-for-profit (NFP) versus for-profit (FP) hospitals remain at the epicenter of the discussion. From the perspective of available factual information, which of the two sides to this debate is correct? This article is part II of a 2-part series on comparing and contrasting the performance records of NFP health care providers with their FP counterparts. Although it is demonstrated that both NFP and FP providers perform virtuous and selfless feats on behalf of America's public, it is also shown that both camps have been accused of being involved in potentially willful clinical and administrative missteps. Part I provided the background information (eg, legal differences, perspectives on social responsibility, and types of questionable and fraudulent behavior) required to adequately understand the scope of the comparison issue. Part II offers actual comparisons of the 2 organizational structures using several disparate factors such as specific organizational behaviors, approach to the health care priorities of cost and quality, and business-focused goals of profits, efficiency, and community benefit.     

Analytic Methods for Constructing Cross-Sectional Profiles of Health Care Providers

National effort is currently directed toward developing and disseminating comparative information involving both outcomes and processes of care for health care providers. Univariate provider-specific comparative indices based on posterior summaries as well as indices based on maximum likelihood estimates have been developed for use in the cross-sectional setting. A remaining issue in the dissemination of cross-sectional profiles relates to the multivariate nature of the indices: often many performance measures are used to assess quality for a particular provider. Because this information can often be contradictory and overwhelming, there is a need for measures that summarize quality at a provider level. This article proposes the use of latent variable models for comparing health care providers in the cross-sectional setting when each provider is measured on more than one dimension of care. By combining information across dimensions of care within a provider, an integrated analysis can produce a composite measure of quality and has more statistical power to detect differences among providers. As the number of individual performance measures grows over time, composite measures will become increasingly important tools to support decision making by consumers, payors, and providers.     

Consumers and quality-driven health care: a call to action

A key strategy for driving improvements in health care quality is providing comparative quality information to consumers. This strategy will not work, and could even be counterproductive, unless (1) consumers are convinced that quality problems are real and consequential and that quality can be improved; (2) purchasers and policymakers make sure that quality reporting is standardized and universal; (3) consumers are given quality information that is relevant and easy to understand and use; (4) the dissemination of quality information is improved; and (5) purchasers reward quality improvements and providers create the information and organizational infrastructure to achieve them.