Report Cards for Health Care: Is Anyone Checking Them.

摘要

Changes in health care organization and financing in the United States have increased consumers' concerns about the quality of the health care they receive. Among national efforts to improve the quality of health care, perhaps none has been as prominent as the movement to evaluate health care quality and to disclose the results of that evaluation publicly, usually in the form of 'report cards', 'provider profiles', or 'consumer reports', sometimes communicated via the World Wide Web. The purpose of public disclosure of information on quality is twofold: to facilitate informed choice and to stimulate quality improvement. Researchers at RAND, who have been among those involved in designing health plan performance evaluation and reporting systems for several of the nation's largest employers, have begun evaluating the effects of those systems. While it was generally assumed by health policy planners that consumers would welcome access to these report cards, the existing research seems to suggest that this is not the case. In order to learn why those faced with health care decisions fail to use comparative performance information and what can be done to increase its use, we have examined how information for report cards is gathered and organized; who uses them and who does not why people don't use report cards; and what might be done to make them more user friendly Health care report cards are constructed from information gathered from several national surveys of health care quality. Contrary to expectations, these report cards appear to affect the health care decisionmaking of large health care providers more than that of individual consumers. We have learned through our own experience and that of others that the way report cards organize and present their evaluations strongly influences whether the report cards are used. Moreover, a few simple techniques of effective communication can improve their usability.