Publicly Reporting Quality Indicators: Complexity and Challenges

By Natalie Truesdell, JSI consultant

Accountability and transparency in healthcare are principles leading a variety of initiatives to publicly report quality data to patients and consumers of healthcare. In Massachusetts, the state has recently launched a new site "My Health Care Options" to publicize the cost and quality of Massachusetts hospitals.¹ This is one of many examples happening across the country and being driven by employers, health plans, and state governments.

This movement is built on the idea that historically cost and quality have been "hidden" from patients through both challenges in measuring data and the complexity of the reimbursement system. In an effort to both engage patients in their care and to encourage patients to make choices about where they seek care based on quality and cost a number of such websites and tools have been developed. The principles behind these developments are worthy. Too often consumers must put trust in their providers with no objective measures of quality. Cost, seemingly more straightforward than measuring quality, proves as difficult for consumers to assess when comparing provider options.

Yet, in attempting to tackle the paucity of information on cost and quality the developers of quality indicators face a number of challenges. In choosing measures, there are a number data quality concerns such as: Appropriate volume or number of patients for data to be valid, identifying measures that represent the quality outcomes of interest, and risk adjusting the data across providers with wide variations in patient populations.

Beyond the methodological challenges, the foremost consideration is that data must be presented in a way that consumers can understand. Complex charts and statistical qualifications are not sensitive to a broad range of literacy skills and are time consuming to understand. The information presented to consumers must be digestible. Too many measures will cause analysis paralysis for the consumer. Yet limiting the quality measures may give a one dimensional view of the provider that does not represent the full quality of their services, as a provider may have strengths in some areas of care and not in others.

These are only some of the challenges, and the ultimate concern is: Will people use the data once it is made available? To reach the ultimate goal of using quality data to engage consumers a great deal of testing has to be done with consumers in the development of measures, and determining the best way to present it. They must be involved in the process at the outset and testing through focus groups, interviews, and advisory panels.

JSI has engaged in this process most recently in the project "Prevention and Control of Hospital Acquired Infections." The task of the project was to guide the process of public reporting of hospital infection data. A critical component of their work was to engage consumers on their thoughts of public reporting in general and then to test specific measures of infection control. Interviews iteratively tested measures for reporting and provided feedback on the format for data released to the public.

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To use the "My Health Care Options" site, you pop in your zipcode, check off a list of proximate hospitals, and then can see a variety of ratings of these hospitals in areas ranging quality ratings of patient safety and heart failure to ratings of costs of vaginal delivery.