Quality report cards market your services
What should be included for public consumption?
By Patrice Spath, ART
Forest Grove, OR
For several years, purchasers of health care have focused their quality measurement activities on health plans. However, there is a growing demand for provider-specific data.
More than half of the 1,011 U.S. households that participated in the December 1996 national survey commissioned by the National Coalition on Health Care said they would like to be better informed about the quality of medical care.1 Hospitals have a new audience for their quality measurements: the public. However, the average consumer is ill-prepared to interpret much of the clinical outcome data now collected by hospitals. To meet the needs of this new audience, hospitals should identify consumer-friendly performance measures and present them in report card formats that can be understood by the general public.
Four issues must be considered when designing provider-specific report cards for the public:
• The performance measures reported to the public should be "good measures."
• The measures included on the report card should help the average citizen distinguish between high-quality and poor-quality providers.
• The measurement data should be displayed in a manner that allows ease of interpretation.
• The data must be available to consumers when they want it.
What your public wants to know
Selecting the most appropriate measures of hospital performance to include in your hospital’s report card requires an understanding of how the public judges the quality of a health care provider. The service aspects of health care tend to be what hospitals share with consumers. However, including overall satisfaction scores on your report card may be confusing for consumers. It is difficult for the public to judge whether a high "satisfaction rating" indicates people’s feelings about costs or quality. Consi der narrowing the focus of your satisfaction measures. In addition to sharing data about overall patient satisfaction, concentrate on specific patient care activities. For example, your hospital’s report card could include satisfaction ratings for educational services, billing processes, how attentive caregivers are to patients’ personal needs, and other aspects of care that consumers view as important.
Research by the Foundation for Accountability (FACCT), a nonprofit organization involved in identifying consumer-focused quality measures, has shown that people confuse service quality (convenience, friendliness) with clinical quality (the outcomes of their care). For this reason, data about achievement of patient outcomes that caregivers find useful for measuring performance may not be the right information to include on your consumer-oriented report card.
Consumers are expressing concerns about staffing reductions in hospitals, and for this reason measures of professional staff-patient ratios and total nursing care hours provided per patient day might be informative data to include in your hospital report card. Consumers also have indicated that the recommendations of their regular physician greatly influence their choice of hospitals. Therefore, a measure of physicians’ satisfaction with hospital services could be a worthwhile addition to your consumer-oriented report card.
Planning is an important first step in determining what information will be included in your hospital’s public report card. During the planning phase, carefully consider the purpose for the report card:
· Who is the target audience for this report?
· What do you want them to learn?
· What actions, if any, do you expect them to take after gaining this new knowledge?
The answers to these questions will influence what information is included. (Examples of hospital performance measures that are meaningful for various consumer groups are listed in the chart at left.)
The manner in which the data are presented to the public is likely to vary significantly from the format used for intrafacility reporting. Consumer-oriented hospital report cards must be simplified to allow for better interpretation by the public. Even if report cards include important measures of quality, consumers will dismiss the information if they do not understand it.
Focus groups provided guidance
One group involved in designing and disseminating a health plan report card is the Oregon Consumer Scorecard Consortium. The purpose of this scorecard initiative is to aid consumers in choosing a health plan that best meets their individual needs and preferences for how health care services are delivered. The project focuses primarily on design of a scorecard that could be used by clients selecting coverage under the Oregon Health Plan (Medicaid population), although the study results have implications for hospital-specific report card projects. The focus group meetings that were held with Medicaid recipients throughout Oregon revealed several important issues relevant to report card style and dissemination, such as:
• While multiple media presentations (computer kiosks, videos, and telephone back-up) are useful, written information should always be available.
• It is helpful if consumers have access to a live person (for example, by phone) to answer their questions about the performance measurement data.
• The amount of data presented on report cards should be limited to keep from overwhelming the consumers’ ability to assimilate the information.
• When clinical outcome data are made available to consumers, they should be accompanied by explanatory information.
A well-designed health plan report card can be found at the Web site of Group Health Cooperative of Puget Sound in Seattle (http://www.ghc.org). Viewers are provided with multiple pages of information about the performance of health plan providers, including satisfaction ratings and clinical outcomes. When clinically related measures are presented, there is an accompanying explanatory note. For example, providers’ rates of childhood immunization are reported with this statement: "Childhood immunization rates are a prime example of how preventive care improves health status while decreasing cost. A congressional study found that for every dollar spent on vaccinations, $10 in treatment costs are saved." Similar types of information should accompany clinical outcome data presented on hospital report cards.
Hospitals put report cards on the Web
Many individual providers have begun to distribute their performance measurement data to consumers. For example, since 1993, Community General Hospital in Syracuse, NY, has released a Quality Report Card. This report card contains a variety of performance measurement results, including patient and physician satisfaction scores for the facility’s nursing services. In 1996, Community General made the report card available on its Web site: (http://www.cgh.org/execsumm.htm).
In 1996, Mercy Hospital Medical Center in Des Moines, IA, distributed its first Quality Care Report to the public. This report is now available on the facility’s Web site (http://www. mercydesmoines.org). Using bar graphs, Mercy Hospital shows consumers how the hospital’s performance in various categories compares to that of other hospitals in Iowa. Performance measures include average charges, patient volume, length of stay, results of new treatment procedures, and patient satisfaction.
Many technical aspects of health care decision making and service delivery cannot adequately be evaluated by the public. For this reason, satisfaction as well as other service-related quality measurement data will likely be the focus of your hospital’s public report card. However, clinical outcome data can be understood by the public if they are accompanied by very elementary explanatory remarks.
Consumer advocate groups are working closely with health service researchers to create the "perfect" provider report card; however, this goal may never be fully realized. Don’t wait until these groups finish their work. Start now to design and disseminate your own public- oriented performance measurement report. You’ll gather a better appreciation of what your community wants to know about your organization and how quality data can be used to market your services.
1. National Coalition on Health Care. How Americans Perceive the Health Care System: A Report on a National Survey Conducted for the National Coalition on Health Care. Washington, DC; January 1997. URL: http://www.nchc.org/perceive.html.
Agency for Health Care Policy and Research (AHCPR) Center for Health Information Dissemination. AHCPR and Kaiser examine consumers’ use of quality information. Research Activities 1996; 12:10-11.
McIntosh T. Empathy: Why patients recommend hospitals. Healthcare Benchmarks 1997; 4:39.
Oregon Consumer Scorecard Consortium. Oregon Consumer Scorecard Project (NTIS Publication No. PB97-117758). Springfield, VA: National Technical Information Service; 1997.