Do Quality Measures Help Patients Make Better Decisions?

July 26, 2013 9:27 am
Posted By: Jenny Jin


I have been researching quality measures over the last 2 weeks to support potential integration into a mobile app that may help with selection of medical services.  An interesting question is how do patients select which hospitals to use. Do they pick the hospital they have experience with? Do they go to the closest one? And, with the availability of increasing amounts of information about quality, how is this affecting their choices? These are all questions that researchers are trying to answer. Unfortunately, there is still no single “correct” answer.

Without making effective use of healthcare quality measures, patients are unable to make a rational choice. Studies have summarized some of the reasons that consumers use to choose a hospital: (1) they prefer hospitals that they have experience with or that their friends have experience with, feeling that they can get more trusted treatments; (2) the distance to the hospital is also a common reason. A large number of patients simply pick the closest hospital while few will make a trade-off between quality and distance; and, (3) Patient’s own previous experience with the medical provider can affect their choice of a hospital.  Policy makers hope that by publishing information on healthcare quality, such as CMS does with the Hospital Compare website, patients can make more informed decisions. However, some surveys have shown that a limited amount of people use hospital quality information or find it relevant, while a larger portion of people are not even aware of the availability of this kind of information.

Although people say they prefer to have as much information as they can, researchers have found that the availability of large amounts of data does not help consumers make better decisions. Patients are easily confused when they encounter too much information. They need guidance to understand the data in order to use this information in their decision-making process. Also, the guidance must be put in a relevant context for patients. Using a combination of surveys and focus groups, researchers have shown that patients poorly understood many quality indicators, and patients found little utility in these measures. However, if provided with the right context, patients can better understand the quality indicators. Another reason for consumers not making full use of available quality measures is that the available information is not the information they want. However, when asked about their preferences for information on quality, patients’ answers are consistent and can vary significantly based on how the question is asked or what information lead to it. Thus, we need to develop better approaches to seek the preferences of consumers and match that to quality indicators.

This harkens to my own experience searching for quality measures. There are lots of quality measures, such as those at Medicare.gov, AHRQ’s Quality Measures Clearinghouse, and NCQA among others. Without appropriate guidance or a full understanding of the healthcare context, I had difficulty translating these quality measures into useful inputs for a patient decision-making mobile application we are exploring. Many of the technical terms were unfamiliar. Nevertheless, I now have a much better picture of the quality measure landscape and after discussing specific contextual examples with an expert, it was much more clear. It is important for the publishers of quality measures, especially the quality measures meant for patient consumption, to present quality measures in ways that patients can make the best use of them.