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Public health and health policy, with commentary.
Sunday, May 02, 2004
How much do consumers care about quality health care?
When the IOM noted that as many as 40,000 people die per year from medical errors, it provoked a firestorm of outrage and provided new impetus for quality of care research and quality improvement initiatives, led by employers and consumers, such as the Leapfrog Group. Some have even said that the health care crisis is not about increased costs, but decreased value: consumers are willing to pay current health care prices, or even more, but are outraged that prices are so high for low-quality care.
The movement for quality improvement (QI) has been misinterpreted as being critical of individual physicians or even all physicians or as highlighting rare isolated mistakes. In fact, QI is aimed at improving the systemic flaws in the health care system, which currently relies overly much on human memory, error correction, and multi-tasking, is fragmented and disjointed, and is not designed to ensure that patients understand their doctors' instructions. Rather than casting aspersions on the skills, compassion, or abilities of physicians, QI tries to direct these towards patient care rather than extraneous issues.
Anecdotal reports don't teach us about prevalence, but they do give examples of the types of medical errors that can occur in hospitals.
At the same time that the public seems to be at least moderately concerned with health care quality, the leading source of information for consumers about their health care is still friends and family, rather than any of the many surveys of quality available, such as the federally sponsored national surveys of health care quality in specific health plans.
The National Committee for Quality Assurance presents a several summary measures, each of which summarizes dozens of measures. They check some of the quality indicators that are not visible to patients, such as compliance with professional care guidelines (e.g. eye and foot exams for diabetics, follow-up visit within a month after mental hospital stay, postpartum visits within 8 wks of delivery, flu shots for the elderly), measures of patients' abilities to understand their doctor's instructions, etc.
For California a ratings site uses the same data, but displays more details about the summary measures.
The movement for quality improvement (QI) has been misinterpreted as being critical of individual physicians or even all physicians or as highlighting rare isolated mistakes. In fact, QI is aimed at improving the systemic flaws in the health care system, which currently relies overly much on human memory, error correction, and multi-tasking, is fragmented and disjointed, and is not designed to ensure that patients understand their doctors' instructions. Rather than casting aspersions on the skills, compassion, or abilities of physicians, QI tries to direct these towards patient care rather than extraneous issues.
Anecdotal reports don't teach us about prevalence, but they do give examples of the types of medical errors that can occur in hospitals.
At the same time that the public seems to be at least moderately concerned with health care quality, the leading source of information for consumers about their health care is still friends and family, rather than any of the many surveys of quality available, such as the federally sponsored national surveys of health care quality in specific health plans.
The National Committee for Quality Assurance presents a several summary measures, each of which summarizes dozens of measures. They check some of the quality indicators that are not visible to patients, such as compliance with professional care guidelines (e.g. eye and foot exams for diabetics, follow-up visit within a month after mental hospital stay, postpartum visits within 8 wks of delivery, flu shots for the elderly), measures of patients' abilities to understand their doctor's instructions, etc.
For California a ratings site uses the same data, but displays more details about the summary measures.
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