A Quick Look at Quality
Contents
Quality health care means doing the right thing, at
the right time, in the right way, for the right person—and having
the best possible results.
Although we would like to think that every
health plan, doctor, hospital, and other provider gives
high-quality care, this is not always so. Quality varies, for
many reasons.
Fortunately, there are scientific ways to
measure health care quality. These tools, called measures,
have mostly been used by health professionals. They use
measures to check up on and improve the quality of care they
provide.
But there is some quality information you
can use right now to help you compare your health care
choices. And more and more is becoming available all the time.
Many public and private groups are working to improve and
expand health care quality measures. The goal is to make these
measures more reliable, uniform, and helpful to consumers in
making health care choices.
What is Measured?
There are two main types of quality measures
that can help you choose quality health care:
consumer ratings
and clinical
performance measures. Both types are based on
"outcomes research."
Outcomes research measures the end results
of health care practices and treatments. For example, after
treatment, is the pain gone? Can the patient carry out his or
her daily activities? Is he/she satisfied with his or her
care?
Consumer ratings
(or "consumer satisfaction" information).
These look at health care from the consumer's point of view.
For example, do doctors in the plan communicate well? Do
members get the health services they need?
Many consumer ratings of health plans are
based on a survey called the Consumer Assessment of Health
Plans (CAHPS®) -
http://www.ahcpr.gov/qual/cahpsix.htm
and on the Health Plan Employer Data and Information Set (HEDIS)
member satisfaction survey, which includes CAHPS® questions.
Clinical performance
measures (also sometimes called "technical quality"
measures). Some widely used clinical
performance measures are included in
HEDIS. These measures look at
how well a health care organization prevents and treats
illness. For example, one HEDIS clinical performance measure
looks at whether children get the immunizations (shots) they
need when they need them.
More information on CAHPS® and HEDIS is
provided in the
Choosing a Health Plan
section.
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What Should I Look For?
Quality Reports You may be able to find consumer ratings, clinical performance
measures, or both in quality reports. Quality reports go by
different names, including performance reports and report
cards. Quality reports don't tell you which health care
choices are the best. But they can help you decide which are
best for you, based on the things that are most important to
you.
More information about quality reports is
provided in the
Choosing a Health Plan and
Choosing a Hospital sections.
Accreditation Reports
Another way to compare quality is to use information about
accreditation. Accreditation is a "seal of approval." It is
mainly used for health care organizations such as health
plans, hospitals, and nursing homes.
To earn accreditation, organizations must
meet national standards, often including clinical performance
measures. Organizations choose whether to participate in
accreditation programs. Therefore, you will not find
accreditation information on every nursing home, for example.
More information on accreditation is
provided in the
Choosing a Health Plan,
Choosing Treatments,
Choosing a Hospital, and
Choosing Long-Term Care
sections.
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