Plaintalk Blog: Quality Matters – How Do You Know if The Health Care You’re Getting is Good?

Deciding where to get health care is a pretty big deal. But, unlike most other big-deal purchases, today’s industry doesn’t allow us to comparison shop.

When you’re getting ready to buy a new car, the price point is only one of the things you take into consideration. You likely research the safety ratings of the vehicle, how many miles per gallon it gets, the size of the engine, how much horsepower it has, and whether the cup holders are big enough to secure your coffee mug. All of these factors combine to help you to determine the quality of the car and decide how to spend your money.

Determining quality in health care isn’t so simple. In 2001, the Institute of Medicine published a report called Crossing the Quality Chasm, where they defined – for the first time – :

• Safety: avoiding injuries to patients from the care that is intended to help them.
• Effectiveness: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.
• Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.
• Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.
• Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy.
• Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

Great. These are definitely things that make up good health care…but how do we know if they are being done? Measuring patient safety isn’t exactly the same as measuring miles per gallon.

The Agency for Healthcare Research and Quality (AHRQ) identifies three types of quality measures:

• Structural Measures – the tools used to provide care
  • Whether the health care organization uses electronic medical records or medication order entry systems.
  • The number or proportion of board-certified physicians.
  • The ratio of providers to patients.
• Process Measures – the ways care is provided
  • The percentage of people receiving preventive services (such as mammograms or immunizations).
  • The percentage of people with diabetes who had their blood sugar tested and controlled.
• Outcome Measures – the impact of care provided
  • The percentage of patients who died as a result of surgery (surgical mortality rates).
  • The rate of surgical complications or hospital-acquired infections.

Even better! These examples could be really helpful when trying to decide where to get treatment. Yet, here’s the catch: most of these measures are not readily available for folks on the street trying to get health care. According to AHRQ, industry professionals use these measures in four ways:

• Program Management – Overseeing key functions to ensure that program goals are met and resources are used efficiently.
• Accountability – Demonstrating achievement of identified goals.
• Quality Improvement – Devising and tracking the impact of targeted interventions designed to improve health services.
• Reporting Results – Reporting to a variety of stakeholders and other audiences.

Bummer. While all of these are valuable ways to use quality information, there are many out there who would love to use these measures to help choose the place to spend their health care dollar.

But, there’s hope! Organizations across the nation are working to make public-facing quality reporting a reality. CIVHC, and others like us, are developing ways to show quality information next to cost data so regular folks are empowered to choose high value care and take charge of their health care journey.