Measuring Success

Overview

Until recently, consumers and health care purchasers have had a hard time finding reliable, objective information about the quality of health care. But now, consumer groups, government agencies, large employers and others have joined forces to find ways to measure and report information about the quality of health care.

Assessing quality is complex, of course. Studies consistently show health care quality in the United States varies widely. For years, even doctors had no way of knowing whether the treatments they prescribed were consistently effective.

In fact, as Michael Millenson, author of “Demanding Medical Excellence – Doctors and Accountability in the Information Age” (University of Chicago Press, 1997) says in his book, “A surprising 85 percent of everyday medical treatments have never been scientifically validated.”1

Though treatments that have not been validated may be effective, Millenson notes that the gap between research and practice has real consequences. “In the absence of reliable information, physicians' decisions fluctuate wildly,” Millenson writes.

For example, two towns with similar populations that are 30 miles apart may have vastly different surgical rates for hysterectomies, cesarean sections or prostate surgery with no difference in outcomes.

So, what is health care quality? As the Foundation for Accountability (FACCT), a non-profit organization dedicated to helping consumers make better health care decisions, says:

“To put it simply, health care quality means that health plans, doctors and other professionals do the right things at the right time in the right amount for the right people – and the things they do get good results. With high-quality care, people can function better and enjoy a better quality of life.”

For FACCT, one key to improving the quality of health care is information. To do that, consumers must be informed and empowered to help shape the system, hold it accountable and act as partners in improving health care, FACCT says.

1. Office of Technology Assessment of the Congress of the United States, The Impact of Randomized Clinical Trials on Health Policy and Medical Practice , Background Paper OTA-BP-H-22 (Washington, D.C.: U.S. Government Printing Office, August, 1983.

General Principles

  • Develop consumer-focused quality measures
  • Involve patients and families in defining quality
  • State clearly what is being measured
  • Measure success by both outcomes and processes
  • Include measures of functionality, such as Can this child go to school? Can this older person live alone?
  • Reward positive outcomes with appropriate fiscal incentives
  • Support public education about health care quality
  • Encourage health policies that inform and empower patients and their families

Conference Breakout Session Poster:

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Key web sites

  • Foundation for Accountability – A nonprofit coalition of consumers, employers and government agencies that seeks to improve America's health care system by helping Americans make better health care decisions.
  • National Committee on Quality Assurance -- A not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans. Governed by a board of directors that includes employers, consumer and labor representatives, health plans, quality experts, policy makers, and representatives from organized medicine. NCQA provides information that enables purchasers and consumers of managed health care to distinguish among plans based on quality. This will encourage plans to compete on quality and value, rather than price and provider network alone.
  • Demanding Medical Excellence -- An interview with Michael Millenson, author of Demanding Medical Excellence.
  • Understanding Patient Experience -- This is a joint effort by the American Hospital Association and The Picker Institute to gather information about patients' experiences and to disseminate models for improvement.
  • Patient-Centered Care Performance Improvement Project -- A website run by the New Hampshire Hospital Association, this page explains the patient-centered care projects.