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Richard Hamblin Center for Health Studies Group Health Cooperative of Puget Sound. Informing for Improvement Report cards, performance measures and quality indicators – why bother?. Why publish report cards?. - PowerPoint PPT Presentation
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Informing for ImprovementReport cards, performance measures and quality indicators – why bother?
Richard HamblinCenter for Health Studies
Group Health Cooperative of Puget Sound
Why publish report cards?
• How do we encourage consumerism? Well, one thing you do is you make sure people understand their options…– G.W Bush, Minneapolis, August 22, 2006
• Our choice information pages …help you make a choice that best suits you.”– UK Department of Health choice website
But…
• “when this information is published only a minority are aware of it; of those, most do not understand it, trust it or use it…” – Gwyn Bevan 2005
My objectives
• Understand this contradiction
• Group health provides a unique population– Chronic conditions– My Group Health
• What is the likely use of such information?
• What does this imply about presentation and dissemination?
More enthusiastic users?}
How might it work
• Pressure on providers
• Patients as consumers – choosing the best providers
• Informed and empowered patients – getting the best from their providers
• Which of these two is most likely to work?
Survey
• Written survey tool mailed to 600 respondents
My GH non-userno chronic condition n = 150
My GH userno chronic condition n = 150
My GH userdiabetesn = 150
My GH non-userdiabetesn = 150
My GH non-usern = 300
My GH usern = 300
Diabetesn = 300
no chronic condition n = 300
Survey
• 22 written questions to test pre-determined hypotheses– Patients with long-term conditions are more interested
– My Group Health users are more interested
– Less satisfied patients are more interested
– Information more likely to be used for boosting confidence than changing provider
• Data collection February to April 2007
Responses
• Ethnicity similar across groups
• MyGH users wealthier and better educated
• Diabetics generally lower income
0%
10%
20%
30%
40%
50%
To
tal
MyG
H
NM
yGH
Dia
bet
es
No
CC
Response rates
Lots of interest
• 11 point scale (0-10) used to report interest
Mean Median
Weighted total 7.7 8
My Group Health User 7.9 8
My Group Health Non User
7.4 9
Diabetes 7.4 9
No chronic condition 7.9 9
But little prior knowledge or use
No meaningful differences between the groups
0%5%
10%15%20%25%30%
To
tal
MyG
H
NM
yGH
Dia
bet
es
NL
TC
Percentage respondents who knew of various report cards HEDIS
US News
Health Grades
Use of any
What do I do with this then?the continuum of potential use
Active and immediateNone
None Passive/uncertain Prospective
Active Consumerist
Active informed patient
“I would not use”
“Understand better how my doctor rates”
“Choose doctor when entering health plan”
“Boost confidence to discuss things I don’t understand or agree with.”
“Change doctor inside current plan”
Proportion of respondents citing different uses for data (forced choice of
one use)
0%
20%
40%
60%
80%
100%
Total
MyG
H
NMyG
H
Diabet
es
No CC
would not use
understand better
choose doctor (newplan)
change doctor(existing plan)
boost confidence
For all groups “understand better” is a significantly greater proportion than any other
Use versus self-reported interest does not vary (except for the would not use group)
Active users only
• Surprising result – expected a greater proportion in the active section
• Active uses only – significant results (p<0.05)
• “Boost confidence” a more common response, but very small numbers
922Diabetes*821MyGH*
Change doctorBoost confidencen
Key result
• Just because people are interested in the information doesn't mean that they are going to use it to make choices tomorrow
How do patients want data presented?
• Individual measures vs an overall service rating• Individual physicians vs hospital/practice• Benchmarks/expected performance vs rankings
• * (p<0.01)
76.1%*57.8%45.9%Total
BenchmarksIndividual physicians
Individual measures
% of responders
How does satisfaction affect interest?
• Are satisfied patients less interested in having information about quality?
• Test 1: Correlation of interest scale with CAHPS satisfaction scale
0.001No CC0.001Diabetes0.011NMyGH0.002MyGH0.000Total
r2
Correlation between interest and satisfaction ratings
How does satisfaction affect interest?
• Test 2: Comparison of interest scale with specific CAHPS attributes of patient-focused care
Mean interest scores by regularity of CAHPS attributes
7.97.5Time
7.57.7Respects
7.77.6Listens
7.77.7Explains
Not alwaysAlways
CONCLUSIONS
• Many prior expectations were wrong
• Interest in performance information uniformly high
• Prior knowledge and use of report cards uniformly low
• Contrary to expectations, little difference between groups
• No relationship between satisfaction with doctor and desire for information about quality
CONCLUSIONS
• The importance of “better understand”
• Doesn't have to be “used” to be “useful”
• Possible interpretations– Information as a resource
• Reassurance• Accountability
– Understanding as a precursor of action
CONCLUSIONS
• Large majority in all groups favoured comparisons with benchmarks rather than ranked performance
• Consistent with the “use” finding
Policy implications – consumerisms’ weaknesses and an alternative approach
• Publishing information about quality will not necessarily encourage choice
• Not because the data are badly presented but because most patients don’t prioritise choice
• A different goal of trust and understanding of quality of service
Policy implications – unresolved next steps
• Balancing measurement of different things: – Clinical process – outcome – experience
• How to set external benchmarks? (e.g. NQF process)
• How to determine the “normal range”? (e.g. outliers, composites)