Psst! Do you wanna know a secret?
Psst! Do you wanna know a secret?
Consumers care about quality, too!
Sometimes it may seem that the home care regulations regarding quality are onerous and inane. But a recent group of public and consumer forums on health care quality sponsored by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) showed that consumers had specific ideas and concerns on the issue.
Nine focus groups — some involving consumers and others, featuring invited representatives from the media, healthcare groups, and consumer organizations — were held last December and January in Chicago, Washington, DC, and Los Angeles. Information from those and any subsequent forums will be used to determine how to make information about health care quality available to the public.
Concerns are varied
Topics covered at the meetings included:
• Categories of health care quality. What role should outcomes of patient care, such as mortality rates, complications, and patient satisfaction play in evaluating quality? What about errors in treatment, patient rights, cleanliness of a facility, speed of treatment and choices of health care providers?
• Quality oversight. To whom should health care providers be accountable?
• Public access to health care information. Should comparisons be made between health care organizations? Should information about health care quality be available on the Internet or in the newspaper?
The groups were asked — with some prompting — to define the dimensions of quality health care (see box, p. 60). The most important, they said, were outcomes of care, the care process, diagnostic accuracy, and significant errors.
Here’s what participants told JCAHO:
• Consumers think that every category of provider, including home care agencies, should be responsible for all categories of quality, although distinctions could be made in some cases. For instance, it might be hard to hold hospitals accountable for population measures of disease prevention and wellness, but they would be accountable for providing preventive care and wellness services.
• Information on quality should come from a variety of sources, with an emphasis on patient and former patient surveys and interviews that are conducted confidentially, perhaps through an independent organization. Staff interviews should also be done in complete confidence, and participants who know about JCAHO procedures feel a change in this area is needed. Even taking the staff members off site for interviews could reduce the chance that an employee could be subject to punitive action by the provider organization if he or she gives unfavorable information. Patient records should be randomly selected for review, but should not be the sole method of measuring quality. Lastly, consumers feel that there should be some direct observation of the care process as part of the quality measure.
• Consumers feel that most, if not all, visits should be unannounced. This is particularly important, according to some of the invited forum participants, in light of the role of accreditation in deemed status for licensure and reimbursement. That 27% of those getting unannounced follow-up surveys receive Type 1 recommendations are viewed as further indication that more of these are needed. Consumers also think that the commission should notify interest groups about announced and unannounced surveys of area providers. The commission Web site might be used for this purpose.
Easier is better
• Quality data should be collected at least every six months, particularly if surveys only occur every three years.
• Significant errors and patterns of such mistakes should be factored into accreditation decisions. Forum participants feel a toll-free number devoted to complaints could ease concerns about confidentiality. Error rates and significant errors should be part of the accreditation report.
• Consumers want an easy way to make comparisons among providers, and urge that a core set of common quality measurements be developed as soon as possible.
• Accreditation results should be made available to the public, say consumers — through publication in local print media, availability from providers, and through the Internet. Included in those publicly available reports should be information on what areas the commission thinks a particular organization needs to improve. Consumers would also like to have some information that the agency acted upon the recommendations and with what success.
Future forums possible
While participants of the open discussions and forums agreed that some quality measurement system was vital, they questioned whether accreditation was meaningful at all when so many of the organizations surveyed achieve scores between 90 and 100. Some participants argued that the commission must "seriously consider its role as a peer review organization vs. one that has greater accountability to the public."
Whether any or all of these suggestions are taken on board by JCAHO remains to be seen. The report on the initial set of public forums was presented to the JCAHO board in late March. Currently, JCAHO is deciding whether and when to have more such forums, perhaps some solely for provider organizations.
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