Your Guide to Choosing Quality Health Care
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®) 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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