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Quality of Care

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Consumers need help in understanding health care report cards

Although consumers are very interested in having access to quality-of-care information about health plans, physicians, and hospitals, many of them do not understand some of the indicators appearing in health care report cards, according to the findings of a project supported by the Agency for Health Care Policy and Research (HS08231).

Consumers are unsure what some of the quality indicators mean and are more apt to rely on patient ratings of quality than objective (clinically based) measures of quality. Moreover, many individuals do not understand how managed care plans can affect quality of care. For health care report cards to be useful, consumers need to be educated about the meaning of quality indicators and how health plans influence quality of care. These indicators should be accompanied by explanations on the report cards, explain Judith H. Hibbard, Dr.P.H., and Jacquelyn Jewett, Ph.D., of the Oregon Research Institute.

They conducted 15 focus groups (104 participants) and surveyed privately insured, publicly insured, and uninsured individuals to explore consumer understanding of health care quality indicators. The focus groups showed that consumers had little understanding about the meaning of some quality indicators, for example, that high rates of hospitalization for pediatric asthma represent poor patient management and low birthweight babies often represent poor prenatal care. Many also did not understand that plans can influence how many members have mammograms or other preventive screening tests. Uninsured and Medicaid beneficiaries tended to have lower understanding than privately insured persons.

Understanding the health plan's role in influencing quality of care and affecting the health of its enrolled populations are important concepts for consumers. Indeed, they underlie the whole rationale for report cards, according to the researchers. Plan performance measures are designed to show how well a system is caring for and maintaining the health of a defined population as opposed to individual plan members. This population-based definition of quality is a foreign concept to consumers whose experience has been largely with fee-for-service care, conclude the researchers.

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