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Guidance for sponsors of consumer reports on health care quality

The Problems With Health Care Quality

Substantial evidence indicates that the quality of health care that Americans receive is not ideal.^[1] What makes this evidence especially troublesome is how little we really know about what constitutes quality of care and who does and does not provide high-quality care, either across the board or for specific health conditions.

Moreover, while we may be aware that some health plans and some providers deliver poor-quality care, the real issue for people is much more personal:

• What about my health plan?
• How good is my doctor?
• How do I choose among the options available to me?

Here’s a summary of what we do know about health care quality:

Quality varies widely.

Health plans and providers do not always deliver services consistently or in accordance with the evidence of what works.^[2] Many procedures, tests, and therapies are used too often while others are not used often enough. In addition, few, if any, institutions or offices are free from medical errors, which can often have serious consequences for patients.^[3]

Problems are pervasive.

Studies indicate that quality is uneven throughout the industry—not only in health plans, but also in physicians’ offices, nursing homes, hospitals, and home health care agencies.^[4]

Review a list of recommended reading on the problems with health care quality.

Quality of care varies across populations.

The Agency for Healthcare Research and Quality’s National Healthcare Disparities Report points to significant disparities in the quality of care received by minority populations and other vulnerable populations.^[5] Because health care is not delivered consistently to all populations, it is critical to know not only about the overall quality of care that a provider delivers, but also whether that quality varies by race, ethnicity, or socioeconomic status.

Review a list of recommended reading on disparities in care.

^[1] Schuster MA., McGlynn EA, et al. How good is the quality of health care in the United States? Milbank Q 1998; 76(4): 517-63, 509.
^[2] McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med 2003 Jun 26;348(26):2635-45. (Also see: The Dartmouth Atlas of Health Care at http://www.dartmouthatlas.org/index.shtm for data on variations in the use of health care resources in the United States.)
^[3] Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Committee on Quality of Health care in America, Institute of Medicine. Washington DC: National Academy Press; 1999. Available at http://www.iom.edu/?id=12735.
^[4] Kohn LT, Corrigan JM, Donaldson MS, eds. Crossing the quality chasm: a new health system for the 21st century. Committee on Quality of Health care in America, Institute of Medicine. Washington DC: National Academy Press; 1999. Available at http://www.iom.edu/?id=12736.
^[5] Agency for Healthcare Research and Quality. National healthcare disparities report 2008. Washington, DC: Agency for Healthcare Research and Quality; 2009. Available at http://www.ahrq.gov/qual/qrdr08.htm.

Also in "Make the Case for Consumer Reporting"

• The Problems With Health Care Quality
• Public Information as Part of a Multipronged Strategy
• Arguments Against Consumer Reporting
• Arguments in Support of Consumer Reporting