Final Report
Model Public Report Elements: A Sampler
Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov
Prepared by:
R. Adams Dudley, M.D., M.B.A., University of California, San Francisco Judith Hibbard, Dr.P.H., University of Oregon Dale Shaller, M.P.A., Shaller Consulting Group Shoshanna Sofaer, Dr.P.H., Baruch College With assistance from:
Michelle Ferrari, M.P.H., Shaller Consulting Group Jennifer Kuo, M.H.S., The Lewin Group Dana Stelmokas, The Lewin Group Edie Wade, Ph.D., University of California, San Francisco
AHRQ Publication No. 10-0088 August 2010 (updated November 2011)
The views expressed in this report are those of the authors. No official endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services is intended or should be inferred.
ii
Acknowledgments
The authors gratefully acknowledge the valuable comments provided by the following CVE
representatives, who generously contributed their time and expertise to the development and
review of this report.
Jim Chase Minnesota Community Measurement
Minnesota Healthcare Value Exchange
Scott Cleary
SMC Partners, LLC
Connecticut – eHealthConnecticut, Inc.
Cathy Davis Kansas/Missouri – Kansas City Quality
Improvement Consortium
Jerome Frankel Oakland Southfield Physicians, PC
Michigan – Greater Detroit Area Health
Council
Marge Ginsburg Center for Healthcare Decisions
California Chartered Value Exchange
Judy Hirsh
Procter & Gamble
Ohio – Health Improvement Collaborative of
Greater Cincinnati and HealthBridge
Thomas James
Humana, Inc.
Kentucky – Greater Louisville Value
Exchange Partnership
Donna Marshall
Colorado Business Group on Health
Colorado Value Exchange
Ted Rooney Maine Health Management Coalition
Maine Chartered Value Exchange Alliance
Ron Smith St. Mary’s Regional Medical Center
Nevada Partnership for Value-driven Health
Care
Diane Stollenwerk
Stollenwerk & Associates
Formerly of Washington – Puget Sound
Health Alliance
Ted Zimmer Consumer Health Coalition
Pennsylvania – Pittsburgh Regional Health
Initiative
Sampler Report Workgroup Facilitators
Larry Bartlett
Independent Consultant
Margaret Trinity
Project Director
AHRQ CVE Learning Network
This document is in the public domain and may be used and reprinted without permission. AHRQ appreciates
citation as to source. The suggested format follows:
Dudley RA, Hibbard JH, Shaller D, Sofaer S. Model Public Report Elements: A Sampler. Rockville, MD: Agency
for Healthcare Research and Quality; 2010. AHRQ Publication No. 10-0088.
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Contents
Acknowledgments…………………………………………………………………………………………………………… ii
Invitation to Readers of Sampler To Suggest Additional Model Report Elements ………………….. iv
Introduction and Purpose …………………………………………………………………………………………………..1
Who Is the Audience? …………………………………………………………………………………………………1
What Kinds of Web Sites Are We Highlighting? ……………………………………………………………1
What Is Meant by a Sampler? ………………………………………………………………………………………1
What Other Tools Related to Public Reporting Are Available From AHRQ? …………………….1
I. Early Strategic Decisions: Options and Examples ……………………………………………………………4
A. Types Of Providers and Measures ………………………………………………………………………….4
B. Separate Information for Consumer vs. Provider ……………………………………………………..7
II. Five Basic Elements (Web Pages) of a Public Report: Options and Examples …………………..12
A. Landing Page or Information Accessible From Landing Page …………………………………12
1. Motivating use of the information and defining the benefits ……………………………..12
2. Explaining possible uses of the data ………………………………………………………………12
3. Communicating about a shared responsibility …………………………………………………14
4. Defining quality of care and providing consumers with a framework for
understanding quality …………………………………………………………………………………..16
5. Describing the collaborative membership ……………………………………………………….17
6. Explaining rules concerning use of information by other organizations ……………..20
7. Providing legal notices and disclaimers ………………………………………………………….23
B. Presentation of Measure Ratings ………………………………………………………………………….26
1. Displaying measures so that consumers can understand them ……………………………32
2. Using consumer-friendly language for measures ……………………………………………..38
3. Presenting comparative information on costs and resource use ………………………….39
4. Encouraging providers to report accurate and complete data …………………………….41
5. Noting in a report that ―sample sizes are too small‖ …………………………………………47
6. Using consumer-friendly phrases to replace clinical and technical terms ……………48
C. Consumer Engagement Tools ………………………………………………………………………………48
1. Evaluating and selecting a high-quality provider ……………………………………………..49
2. Preparing for a visit to a doctor or hospital ……………………………………………………..52
3. Partnering with doctors to manage a chronic disease ……………………………………….57
D. Place for Consumer Input on Web Site Design ………………………………………………………61
1. Place for consumers to to ask questions or share suggestions ……………………………61
2. Consumer survey to provide information on how data were used ………………………64
E. Other Resources …………………………………………………………………………………………………67
1. Links/tools/libraries (national and community resources) …………………………………67
2. Links to provider Web pages ………………………………………………………………………..68
III. Functionality and Layout ……………………………………………………………………………………………69
A. Capacity To Narrow Selection of Providers Based on Consumer Preferences ……………69
B. Capacity To Sort Providers Based on Performance ………………………………………………..71
C. E-Mail Capability ………………………………………………………………………………………………73
D. Web Page Layout ………………………………………………………………………………………………75
References ……………………………………………………………………………………………………………….79
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Invitation to Readers of Sampler To Suggest Additional Model Report Elements
The state of the art and science of public report design is rapidly evolving. We invite readers of
this Sampler to e-mail us with other model report elements, which we will post in this section of
the Sampler. E-mail model elements you come across to Jan De La Mare at
Jan.DeLaMare@ahrq.hhs.gov, including the following information:
Name of Public Report:
URL of specific report Web page that features the model element:
Check the relevant report element or functionality being featured:
__Landing page
__Presentation of measure ratings
__Consumer engagement tools
__Place for consumer input on Web site design
__Functionality (e.g., capacity to narrow selection, sort providers, e-mail
content)
__Layout
__Other:__________________________
Discussion of why you like this specific element:
Your name:
Your e-mail address:
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Introduction and Purpose
The purpose of this guide, Model Public Report Elements: A Sampler (Sampler), is to provide an
illustrative menu of public report elements from health care provider performance reports from
around the country. The example Web pages highlighted in the Sampler span five core Web
pages (landing page, presentation of measure ratings, consumer engagement tools, place for
consumer input on Web site design, and other resources) that constitute a public report and are
present on nearly all public reporting Web sites. Additional examples illustrate functional
possibilities of Web sites (such as sorting by performance) and demonstrate how to facilitate use
by consumers and how to engage consumers in their care.
Who Is the Audience?
Community quality collaboratives—such as Chartered Value Exchanges (CVEs)—and
organizations hosting or beginning development of a public report on health care provider
performance.
What Kinds of Web Sites Are We Highlighting?
Those that convey provider-specific quality scores to an audience of consumers, although certain
collaboratives may want to reach multiple audiences, including consumers, providers, health
plans, and employers and other purchasers, such as labor unions.
What Is Meant by a Sampler?
The Sampler addresses important topics in creating a public reporting Web site, with the goal of
facilitating Web site design or improvement by community quality collaboratives or other report
sponsors. It should be noted that examples included are ―better practices‖ or ―common
practices.‖ It is not yet possible to delineate best practices in the area of public reporting. Such
programs are relatively novel and evaluative data regarding both their impact and our
understanding of how to maximize this practice are still evolving. Any Web site included in the
Sampler may have some features that are good and other features that could be improved. The
red arrows on the screenshots identify the specific better practice elements being featured.
Without definitive evidence about best practices, it is likely that the most effective public
reporting Web sites will be those that are, at least for a while, continually in a state of growth.
These are sites that are actively reevaluating, refining, and enhancing their offerings.
What Other Tools Related to Public Reporting Are Available From AHRQ?
In addition to this Sampler, AHRQ has seven other resources related to public report design:
1. Selecting Quality and Resource Use Measures: A Decision Guide for Community Quality Collaboratives: Expert answers to 26 questions posed by community quality
collaboratives on data and measures (quality and efficiency) selection issues. The
resource includes examples from community quality collaboratives.
• Lead author: Patrick Romano • How to access: www.ahrq.gov/qual/perfmeasguide/ or AHRQ Clearinghouse
(Publication No. 09(10)-0073)
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2. White Paper: Methodological Considerations in Generating Provider Performance Scores for Use in Public Reporting: A set of 20 key methodological decisions
associated with producing provider (e.g., hospital, physician, physician group)
performance scores for use in public reporting. It includes an explanation of the practical
importance of each decision, a review of alternative decision paths, and a discussion of
the pros and cons of each option. The resource includes examples from community
quality collaboratives.
• Lead authors: Cheryl Damberg and Mark Friedberg • How to access: www.ahrq.gov/qual/value/perfscoresmethods/
3. TalkingQuality Web site (rerelease): A comprehensive, interactive Web site to guide planning, producing, and evaluating a comparative report on health care quality for
consumers. The Web site includes the Report Card Compendium, which provides links
to more than 200 consumer reports.
• Lead investigator: Lise Rybowski • How to access: www.TalkingQuality.ahrq.gov
4. Public Report Design: A Decision Guide for Community Quality Collaboratives: Expert answers to 25-30 questions posed by community quality collaboratives on public report
design and sustainability. The resource includes examples from community quality
collaboratives.
• Lead author: Adams Dudley • Expected: 2012 • How to access: CVE and AHRQ Web sites and AHRQ Clearinghouse
5. Best Practices in Public Reporting No. 1: How To Effectively Present Health Care Performance Data to Consumers: A report that provides practical strategies to
designing public reports that make health care performance information clear,
meaningful, and usable by consumers. The report focuses on the challenges involved in
designing a public report card so that the performance information is easily understood
by consumers. It also describes strategies to make it easier for consumers to understand
and use comparative health care quality reports.
• Lead authors: Shoshanna Sofaer and Judith Hibbard • How to access: http://www.ahrq.gov/qual/pubrptguide1.htm
6. Best Practices in Public Reporting No. 2: Maximizing Consumer Understanding of Public Comparative Quality Reports: Effective Use of Explanatory Information: A
report that provides practical strategies to designing public reports that make health care
performance information clear, meaningful, and usable by consumers. The report focuses
on the explanatory information in public reports, beyond the performance data, that helps
to accurately communicate quality ratings to consumers and motivate them to use the
ratings in making informed health care decisions.
• Lead authors: Shoshanna Sofaer and Judith Hibbard • How to access: http://www.ahrq.gov/qual/pubrptguide2.htm
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7. Best Practices in Public Reporting No. 3: How To Maximize Public Awareness and Use of Comparative Quality Reports Through Effective Promotion and Dissemination
Strategies: A report that provides practical strategies to designing public reports that make
health care performance information clear, meaningful, and usable by consumers. The report
applies social marketing and other principles to explore how to target reports to specific
audiences, develop messages to promote the report with key audiences, engage consumer
advocacy and community groups in promoting reports and helping people use them,
disseminate reports through trusted channels, and ensure that consumers see and use
comparative quality reports.
• Lead authors: Shoshanna Sofaer and Judith Hibbard • How to access: http://www.ahrq.gov/qual/pubrptguide3.htm
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I. Early Strategic Decisions: Options and Examples
A. Types of Providers and Measures
In developing public reports, it is important to make some decisions early. For example:
• Will your report feature quality ratings for more than one type of provider, such as hospitals and physician organizations?
• Will you start with condition-specific reports and expand to other conditions, procedures, and/or populations from there?
• Will your report group individual measures into categories of quality, such as patient experience and provider safety?
If you are currently reporting on or plan to report on multiple types of providers, it is optimal to
have all provider categories on one site. It is typically easier for the consumer to navigate if you
use a similar format and approach for displaying comparative data for each type of provider.
Similarly, if your report begins with one condition and then later expands to other conditions, it
is preferable to have all the condition-specific information available on one site. Because
families may be coping with multiple conditions within the same household or same individual
family member, integrating the information will make it easier to use.
Organizing individual quality measures into categories that represent dimensions of quality also
helps consumers learn that quality is multidimensional. Refer to Sections II A and B.
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This example shows how to report performance data on two provider types at one site.
Tool: MyCareCompare.Org
Sponsor: Greater Detroit Area Health Council
URL: http://www.mycarecompare.org/site
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This example lets the user choose condition-specific quality indicators.
Tool: Partner for Quality Care
Sponsor: Oregon Health Care Quality Corp
URL: http://www.partnerforqualitycare.org/selection.php
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B. Separate Information for Consumer vs. Provider
The data needs of consumers, on the one hand, and providers on the other, are different, as is
their ability to interpret technical, clinical, and statistical details. In particular, research shows
that consumers may not understand clinical terms such as ―hemoglobin A1C‖ or statistical
concepts such as confidence intervals. Community quality collaboratives might consider having
different reporting formats and reporting sources for consumers versus providers.
In the example below, the Puget Sound Health Alliance uses a report for medical groups that
includes many clinical and statistical terms. However, they also have a Web site targeting
consumers that uses more everyday language and provides less clinical detail (shown in the
second screenshot below). The report is available to participating providers through a password-
restricted Web site. It provides performance rates with 95 percent confidence intervals and
sample sizes on a variety of process measures, allowing the groups to benchmark themselves
against regional averages.
Tool: Blinded Medical Group and County Comparison Reports—All Payers
Sponsor: Puget Sound Health Alliance
URL: http://www.wacommunitycheckup.org/
[URL is for community site; this page is an example from the restricted access site]
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This consumer-oriented report presents a simple three-tiered rating system for level of diabetes
care (above, at, or below regional average), although more details are available.
Tool: Health Alliance Community Checkup
Sponsor: Puget Sound Health Alliance
URL:
http://www.wacommunitycheckup.org/?p=viewreports&orgname=all&county=All+Counties
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This is another example of a report specifically targeted to providers, allowing them to look at
their performance at the patient level. Access to this type of information—data reports and
patient-level detail—requires secure sign-in to protect patient confidentiality.
Tool: Partner for Quality Care for Practitioners
Sponsor: Oregon Health Care Quality Corporation
URL: http://www.partnerforqualitycareforpractitioners.org/practitioners.php
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Another option is to provide a common portal and public access, but to separate consumer reports
from provider reports. The data presentation may be the same, but the tips, tools, resources, and
advice on using the site can be tailored to each audience.
The report below is designed for both consumers and providers. However, the Patient Guide differs
from the Practitioner Guide in its tips, tools, resources, and advice.
Tool: Maryland Hospital Performance Evaluation Guide
Sponsor: Maryland Health Care Commission
URL: http://mhcc.maryland.gov/consumerinfo/hospitalguide/index.htm
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Below is an example where the data available for selection are simplified for the consumer and more
detailed for the professional or researcher. This report is intended for consumers and providers.
However, selecting the ―researchers and professionals‖ link allows the user to access much more
detailed information. For example, on the researchers and professionals portal for hospital inpatient
data, the user can search by International Classification of Diseases, Ninth Revision, Clinical
Modification (ICD-9-CM) Principal Diagnosis Code and then select the desired demographics,
including race, sex, county, payer type, admission source, and admission type. A link is also
provided to download administrative data. By contrast, on the consumer portal for hospital inpatient
data, the user can select only the age group, subgroup of hospitals to compare, and a general
condition category such as asthma.
Tool: FloridaHealthFinder.gov
Sponsor: Florida Agency for Health Care Administration
URL: http://www.floridahealthfinder.gov/about-ahca/Sitemap.shtml
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II. Five Basic Elements (Web Pages) of a Public Report: Options and Examples
A. Landing Page or Information Accessible From Landing Page
The landing page—the first view of the Web site—is key and can either invite users in or drive
them away. It can motivate use of the information, help consumers understand the benefits of
comparative performance data, and help consumers understand how to apply the information to
their choices.
Because using comparative information on provider quality is new to most health care
consumers, they need to understand what the information means, how it may help them, and
what they can do to improve their chances for excellent care and improved health outcomes.
Assume that your target audience of consumers has a limited understanding of the concept of
health care quality. You have an opportunity to provide a definition of quality to consumers
when they are eager to learn about it, given that they have initiated access to the site. Being clear
about what is meant by ―health care quality‖and explaining that it is now possible to measure and
compare health care providers on their quality of care will help set the context for using the
information.
1. Motivating use of the information and defining the benefits
It is important to help consumers see how they can use comparative quality information to select
a provider or engage providers in a discussion of quality. Making links between consumer
concerns and comparative data is one way to achieve this goal. Consumers also may be more
motivated to use comparative data if the degree of variability in quality is made explicit and the
dangers of receiving poor quality care are clear.
2. Explaining possible uses of the data
Provider quality ratings are new to most consumers, so the report offers an opportunity to help
them understand the different ways they can use the information to their benefit.
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This site highlights for consumers both how to use the information (top) and the benefits of
doing so (bottom excerpt).
Tool: Clinical Quality in Primary Care
Sponsor: Massachusetts Healthcare Quality Partners
URL: http://www.mhqp.org/quality/whatisquality.asp?nav=030000\
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3. Communicating about a shared responsibility
Consumers do not always understand what their role is in the care process or that their active
participation can increase their chances of a good health outcome. Explicitly communicating
that care is a shared responsibility between patients and providers is an important way to
reinforce this behavior.
These next examples show strategies for communicating about the different ways consumers can
use and benefit from information. The following example uses video to discuss the shared
responsibility that patients and providers have in determining quality.
Tool: Doctor Ratings
Sponsor: Maine Health Management Coalition
URL: http://www.mhmc.info/interviews/
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Here is an example of a disease-specific report that speaks to the importance of the patient’s role
in the care process.
Tool: D5
Sponsor: Minnesota Community Measurement
URL: http://www.thed5.org/index.php?p=about_the_d5
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4. Defining quality of care and providing consumers with a framework for understanding quality
Research shows that when consumers have a better understanding of the larger concept of quality
and the elements that make up good quality care, they also tend to have a better understanding of
individual quality indicators and view comparative information as more useful.
The example below provides a brief description of what high quality care is, which is referred to
as ―care that works best.‖
Tool: Partner for Quality Care
Sponsor: Oregon Health Care Quality Corporation
URL: www.partnerforqualitycare.org/getcare.php
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5. Describing the collaborative membership
Some visitors will be interested in who funds, designs, and produces the report. Some sources
are more trusted than others. Having an ―About Us‖ section showing multistakeholder input
may help establish credibility. Below are three examples.
The About Us page on the Maine Health Management Coalition (MHMC) site below includes a
comprehensive list of ―the employers, doctors, health plans, and hospitals who are members of
MHMC.‖
Tool: Maine Doctor Ratings, Maine Hospital Ratings, Major Surgery Ratings
Sponsor: Maine Health Management Coalition (MHMC)
URL: http://www.mhmc.info/about/
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This ―About‖ page allows the user to find out about the membership, activities, and goals of the
organization.
Tool: Performance & Progress Report
Sponsor: The Wisconsin Collaborative for Healthcare Quality
URL: http://www.wchq.org/about/
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This page provides clearly categorized links to each stakeholder organization. The Board of
Directors page provides additional details on represented organizations.
Tool: Virginia Health Information: From Numbers to Knowledge
Sponsor: Virginia Health Information (VHI)
URL: http://www.vhi.org/about_stakeholders.asp
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6. Explaining rules concerning use of information by other organizations
Some collaboratives have developed ―Rules of Use‖ for other organizations that may be
interested in using some or all of the information. For example, others may be interested in
using the data for other public reports, provider advertisements, or provider negotiations. Rules
of Use statements may include restrictions about the business use of the data, changes in how the
data are presented, ways to cite the data, and steps to get approval of use of a collaborative’s data
or logo.
The following three examples illustrate Rules of Use with varying levels of detail and emphasis.
The following example includes a brief statement on the intended uses of publicly reported data.
Tool: Take Charge for Better Health, Using Information To Get Good Care
Sponsor: Healthy Memphis Common Table
URL: http://www.healthymemphis.org/ (organization) and
http://www.healthymemphis.org/assets/docs/Reports/HMCT%20report%202%20111609R.pdf
(document)
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The guidelines below provide recommendations for acknowledging data limitations, using
publicly reported performance results for marketing, and using results for financial and business
purposes. Specific examples of what is and is not appropriate are also provided.
Tool: Partner for Quality Care, Guidelines for Using Performance Results
Sponsor: Oregon Health Care Quality Corp
URL: http://www.partnerforqualitycare.org/index.php (organization) and
http://www.partnerforqualitycare.org/pdf/guidelines_performance.pdf (document)
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The file available from the Rules of Use link below includes four pages describing optimal uses
of the results; restrictions on use during report development; a guide to interpretation of results;
directions for submission for review before use; specific guidelines for citations and logo use;
prohibition on composite measures; and insistence that reporting conventions be upheld.
Tool: Community Checkup Report
Sponsor: Puget Sound Health Alliance
URL: http://www.pugetsoundhealthalliance.org/ (organization) and
www.pugetsoundhealthalliance.org/resources/documents/RulesforUse_2009.pdf (document)
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7. Providing legal notices and disclaimers
Some collaboratives add a legal disclaimer when allowing users to access data. Most often, such
disclaimers state that the collaborative cannot be liable for the accuracy of the data. In some
cases, the user is required to go to the disclaimer before accessing provider scores. In other
cases, the disclaimer is simply available on the Web site.
The following three examples illustrate a disclaimer that is just available as a link, a disclaimer that
asks users to accept certain terms of use when they select the search button, and a disclaimer that
appears in a popup box that with an Accept button that users must select before any data are
displayed.
The legal disclaimer below can be found by selecting the ―Disclaimer‖ link at the top of the NH
QualityCare Web site.
Tool: NH QualityCare
Sponsor: Foundation for Healthy Communities and Northeast Health Care Quality Foundation.
URL: http://www.nhqualitycare.org/disclaimer.php
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The search page below links to terms of use, which consumers are asked to accept in order to
search by ZIP Code for patient experience data.
Tool: What Patients Say About Their Doctors
Sponsor: Consumers’ CHECKBOOK/Center for the Study of Services (CHECKBOOK/CSS),
in collaboration with the Kansas City Quality Improvement Consortium and health plans
URL: http://www.checkbook.org/patientcentral/?cb=kcqic&ref=xxx
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This popup box appears with Terms of Use and an Accept button that users must select in order to access the data. The Terms of Use include a detailed legal disclaimer.
Tool: CalHospitalCompare.org
Sponsors: California Hospital Assessment and Reporting Taskforce, the California HealthCare
Foundation, and the University of California, San Francisco
URL: http://www.calhospitalcompare.org/profile.aspx?h=147
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B. Presentation of Measure Ratings
An effective presentation of measure ratings is based on the following principles:
• Consumers do not define or understand quality in the same way that it is typically measured and reported.
• A framework can help consumers understand the larger concept of quality, as well as better comprehend the individual quality indicators.
• A framework may enable consumers to more effectively participate in the quality discussion.
• If a consistent framework is used in all reports, consumers will expect to see performance ratings in all categories of the framework.
A few existing quality frameworks might be considered as an organizing concept for individual
measures within a quality report:
• The Institute of Medicine (IOM) developed a framework consisting of six categories: Effective, safe, patient centered, timely, equitable, and efficient.
1
• The IOM also developed these three categories: overuse, underuse, and misuse.2 • Donabedian developed a framework consisting of three categories: structure, process,
and outcome. 3
A framework to communicate about health care quality should:
• Indicate clearly what quality of care is; • Contain no more than three or four categories; and • Be consistent with how quality is measured and conceptualized within the policy and
industry arenas (that is, the major categories that are used to define quality by experts and
the industry should be reflected in some way in the framework provided to consumers).
27
The following examples use a framework in communicating what quality of care means.
Tool: Health Matters
Sponsor: Colorado Business Group on Health
URL: http://www.cbghealth.org/cbgh/index.cfm?LinkServID=E0FEA580-D721-5B0E-
DA115CC5582742B9&showMeta=0 (PDF; page 2)
28
Tool: Community Checkup Report
Sponsor: Puget Sound Health Alliance
URL: http://www.wacommunitycheckup.org/editable/files/CommunityCheckup_Nov2008/FAQs_About
QualityHealthCare_Nov2008.pdf
29
This next example, which is not from an existing Web report, shows an abbreviated IOM
framework for communicating what quality is, which has the advantages of using only three
categories and having undergone cognitive testing. With this kind of framework, quality
indicators can be displayed within each of the three categories of performance. This approach
can make each quality indicator easier to understand while also conveying that ―quality‖
incorporates three different but important dimensions.
Source: Study funded by the Robert Wood Johnson Foundation on Giving Consumers a
Framework for Understanding Quality.
Reference: Hibbard JH, Greene J, Daniel D. What is quality anyway? Performance reports
which clearly communicate the meaning of quality of care. Med Care Res Rev 2010; 67:275;
originally published online January 21, 2010.
30
As noted above, the most effective way to use a framework is to actually show the quality
indicators arrayed under the main categories of the framework, as in the example below. The
framework categories tell the user what the individual indicators mean.
Source: Study funded by the Robert Wood Johnson Foundation on Giving Consumers a
Framework for Understanding Quality.
Reference: Hibbard JH, Greene J, Daniel D. What is quality anyway? Performance reports
which clearly communicate the meaning of quality of care. Med Care Res Rev 2010; 67:275;
originally published online January 21, 2010.
31
How does one select quality indicators for each element of a framework? The decision to use a
framework implies making some early choices about the types of performance measures to
include in your report. The table below shows examples of indicators to include if using the
Structure, Process, and Outcome framework; the IOM framework of six domains; or the
Hibbard-abbreviated IOM framework.
Reference: Romano PS, Hussey P, Ritley D. Selecting Quality and Resource Use Measures: A
Decision Guide for Community Quality Collaboratives. Rockville, MD: Agency for Healthcare
Research and Quality; May 2010. AHRQ Publication No. 09(10)-0073.
Matrix of Quality Measure Typologies With Examples
32
1. Displaying measures so that consumers can understand them
Using comparative data to make a choice can be cognitively burdensome. People are are more
likely to use data if the information is easy to understand and process. Making it easier actually
increases the individual’s motivation to use the data. There are multiple ways to make the data
more evaluable (that is, easier for the user to quickly see better and worse options without much
effort).
Strategies to make comparative data more evaluable and less cognitively burdensome include:
• Use data display approaches that do not require users to hold information in their mind as they look from page to page or at different points on the same page:
Make relevant choices visible on one screen.
Use symbols instead of numbers (many people have limited numeric skills).
Use symbols that do not require a legend to understand what they mean.
Use language and terms that consumers understand (avoid language that requires the
user to look up the definition).
Do not assume people will understand advanced statistical concepts, such as using
confidence intervals in data displays. Consumers do not understand them, and they
introduce ambiguity that can result in consumers being less likely to rely on or trust
the data.
• Do some of the cognitive work for the user:
Summarize information. Providing an overall summary measure of all the other
measures helps the end users by doing some of the work for them.
Order by performance (or have a function that allows this). This makes it easy to
quickly see top and bottom performers.
Use affective labels (e.g., excellent, good, fair, poor) that interpret the information for
the user.
Highlight high performers.
33
Here is an example of using symbols instead of numbers. These symbols use color and have
words embedded in the symbol to make them easy to use without consulting a legend.
Tool: CalHospitalCompare
Sponsors: California Hospital Assessment and Reporting Taskforce, California HealthCare
Foundation, and University of California, San Francisco
URL: www.calhospitalcompare.org/comparison.aspx?c=&h=210&h=218&h=155&h=146&h=256
34
Here is another example that uses symbols instead of numbers. In this example, the symbols use a
color, a shape, and a word embedded in the symbol. Average scores are faded so that the higher and
lower performers ―pop‖ out more. Thus, users can discern a pattern in the data. The use of colors
and shapes helps the user easily see patterns in the data. The embedded words in the symbols mean
that the user does not need to rely as much on a legend. The embedded words also help the user by
interpreting the information for them (e.g., better, worse).
Source: Study funded by the Robert Wood Johnson Foundation on Giving Consumers a
Framework for Understanding Quality.
Reference: Hibbard JH, Greene J, Daniel D. What is quality anyway? Performance reports
which clearly communicate the meaning of quality of care. Med Care Res Rev 2010; 67:275;
originally published online January 21, 2010.
35
The next example shows a report format that helps the user by providing two overall summary
measures: one based on clinical standards and the other based on patient ratings. This approach
greatly reduces the cognitive burden of using multiple data points to compare multiple options.
Tool: Medical Group Ratings
Source: California Office of the Patient Advocate
URL: http://www.opa.ca.gov/report_card/medicalgrouprating.aspx?County=KERN
36
Here is an example of a report that uses symbols that have inherent meaning. Words are
embedded in the symbol to make it less necessary to use a legend.
Tool: Partner for Quality Care – Quality of Care Ratings
Sponsor: Oregon Health Care Quality Corp
URL: http://www.partnerforqualitycare.org/selection.php
37
The next example uses a summary measure and orders hospitals by performance, with highest
quality providers listed first. Ordering is a powerful way of helping the user quickly discern
better and worse options.
Tool: Partner for Quality Care – Quality of Care Ratings
Sponsor: Oregon Health Care Quality Corp
URL: http://www.partnerforqualitycare.org/care.php?region_name=portland_metro
Highest quality
providers are listed first.
38
2. Using consumer-friendly language for measures
Using everyday language and terms familiar to consumers is key to making public reports
understandable and usable. Using technical terms and expecting consumers to look them up
(even if the definition is only a click away) will discourage use. Writing at a 6 th
grade level will
make the information accessible to a wider audience.
Here are some examples of translating technical labels into plain language.
Source: AHRQ Model Quality Reports (available at
http://www.qualityindicators.ahrq.gov/Downloads/Modules_Non_Software/QI%20Reporting/M
odel%20Report%20Health%20Topics.pdf)
39
In the next example, the original ―untranslated ― technical version of the ambulatory care quality
performance indicators is shown, as well as the plain language translation of those technical
labels.
Source: Study funded by the Robert Wood Johnson Foundation on Giving Consumers a
Framework for Understanding Quality.
Reference: Hibbard JH, Greene J, Daniel D. What is quality anyway? Performance reports
which clearly communicate the meaning of quality of care. Med Care Res Rev 2010;67:275;
originally published online January 21, 2010.
Untranslated Percent of patients with diabetes who had A1c test
Percent of women receiving breast cancer screening
Provider uses electronic prescribing to prevent medication errors
Translated Diabetes patients receive recommended tests
Women receive recommended cancer screenings
Has procedures to prevent medication errors
3. Presenting comparative information on costs and resource use
Consumers have had very little access to comparative information on costs and resource use, and
until recently, we have known very little about how to present this information effectively. A 2011
AHRQ-funded study led by Judith Hibbard of the University of Oregon and Shoshanna Sofaer of
Baruch College used focus groups, cognitive tests, and a randomized laboratory study to identify:
Cost/resource use measures that resonated with the public; and
Displays of such measures that were most accurately understood, led to ―high value‖ choices, and gave people the most confidence in their choices.
An overarching recommendation of this study is to present cost information in displays that include a
strong quality signal (easy to understand and use quality information). In addition, displays work
better if they help consumers understand the meaning of the measures by using labels and other
strategies that interpret the information for consumers. We present three sample displays with
specific recommended features.
40
Presenting Comparative Costs for Doctor’s Office Visit
Recommended features:
Present cost data in the same display as quality data.
Present exact cost information.
Use a ―word icon‖ for quality, which is highly ―evaluable‖ and thus represents a strong quality signal.
Presenting Comparative Hospital Cost, Quality, and Value Information
Recommended features:
Combine information on quality, cost, and value in the same display.
Call out value using a familiar signal (checkmark), which is present only for those with high quality and low cost.
41
Use a ―word icon‖ for quality, which is highly ―evaluable‖ and thus represents a strong quality signal.
Use dollar signs to represent comparative costs.
Presenting Comparative Information About Resource Use (Imaging)
Recommended features:
Use labels and symbols to characterize use of imaging, rather than giving numeric levels.
Use labels that interpret numeric imaging scores so that consumers do not need to determine for themselves which provider is providing more appropriate care.
Whenever possible, merge resource use and quality into one highly interpretable score.
4. Encouraging providers to report accurate and complete data
In some cases, significant effort is required by providers to collect, clean, and submit the
required data. In these instances, collaboratives may choose to recognize that effort specifically.
In the underlined text and blue box below, Colorado Business Group on Health helps the visitor
recognize the commitment made by participating hospitals.
42
Tool: Health Matters 2009
Sponsor: Colorado Business Group on Health
URL: http://www.cbghealth.org/cbgh/index.cfm?LinkServID=E049392D-D33F-F20A-
D2ED70858A72E914&showMeta=0
In most cases, those providers who choose to participate in public reporting will have to invest
significant resources just in collecting and sharing the data and making sure it is accurate; they
will have made a significant commitment to transparency. However, if the program is voluntary,
other providers may elect not to provide the data. To recognize the additional contributions of
those providers who share accurate data about their performance, some community
collaboratives have instituted penalties for nonparticipation or incomplete or inaccurate data
submission.
43
Medical Center^ 299 2.00 (0.86, 3.93)
^ Facility refused to sign-off on its data
The following examples illustrate ways to denote or call attention to a lack of transparency,
effort, or completeness. The report below specifically notes the facility’s refusal to sign off on
the accuracy of the data submitted.
Tool: Hospital Performance Report
Sponsor: State of New Jersey Department of Health and Senior Services
URL: Sample screen shown no longer available online.
44
This report describes levels of participation both in terms of the data submitted and actual level
of performance.
Tool: Clinical Outcomes Assessment Program
Sponsor: Foundation for Health Care Quality
URL: Sample screen shown no longer available online.
45
Hospital
A
B
C
D
E
F
G
H
Hospital
A
B
C
D
E
F
G
H
In this report, ―NR‖ (measure not reported) is distinguished from nonparticipation as a whole.
Tool: Focus on Hospitals
Sponsor: Missouri Hospital Association
URL: No longer available online
46
In this report, a notation is made when data are presented for only some patients with a given
condition, but not all.
Tool: New York State Hospital Profile
Sponsor: New York State Department of Health
URL: http://hospitals.nyhealth.gov/measure.php?measure_id=103
47
5. Noting in a report that “sample sizes are too small”
Sometimes a provider has too few patients with a particular condition or undergoing a specific
procedure to calculate a quality measure. In such cases, a performance label should not be
assigned. It is important, however, to let the consumer know that the lack of a measure or
performance label does not reflect poorly on the provider’s quality of care.
Some sites simply indicate that there are ―too few cases.‖
In the example below, the site provides a warning to the reader, ―* Too few patients (<160) with
condition of interest to meaningfully report for this clinic.‖
Tool: Health Alliance Community Checkup
Sponsor: Puget Sound Health Alliance
URL: http://www.wacommunitycheckup.org/index.php?p=viewreports&orgname=all&county=All+Co
unties
48
6. Using consumer-friendly phrases to replace clinical and technical terms
It is better to use consumer-friendly language (that has undergone cognitive testing), rather than
technical terms even if they are linked to a glossary.
The following glossaries may serve as a starting place for report sponsors who seek lay
definitions of technical terms. Use of terms that are found in one or more glossaries is not a
substitute for cognitive testing.
• http://www.wchq.org/utility/glossary.php
• http://mhcc.maryland.gov/consumerinfo/hospitalguide/patients/consumer_help/glossary.html
• http://info.kyha.com/qualitydata/FAQ.htm#Glossary_
• http://web.doh.state.nj.us/apps2/hpr/mortalityfacts.shtml
• http://www.mihospitalinform.org/Definition.aspx
C. Consumer Engagement Tools
An important focus of any public report should be to help consumers become more engaged in
managing their health and health care. Consumers can become more educated and active
participants in their care when they have concrete tools and tips to help them effectively use
information and navigate the health care system.
The range of behaviors expected of consumers has grown dramatically in recent years. For
example, advances in medical technology and pharmaceuticals make it possible for people with
chronic conditions to live longer and better lives, but only if they can effectively manage the
demands of complex medication and lifestyle regimens. The increasing specialization of care
and expanding number of tests and treatments have led to significant improvements in care but
have increased the burden on patients for coordinating services from multiple providers and
keeping track of complicated information about their medical history.
Public reports cannot possibly meet all the growing demands on consumers to become more
knowledgeable and engaged in managing their health and medical care. But by even partially
addressing the need for practical guidance and tools for engagement, sponsors of public reports
can play an important educational role. They also can make their Web sites more relevant to the
needs and concerns of their target audience.
This section identifies tools and other engagement strategies that public report sponsors can use
to help consumers in three key areas:
1. Evaluating and selecting a high-quality provider,
2. Preparing for a visit to a doctor or hospital, and
3. Partnering with doctors to manage a chronic disease.
For each of these engagement areas, specific examples are provided that illustrate approaches or
provide resources and tools that the authors consider to be effective and consistent with good
public reporting practice.
49
1. Evaluating and selecting a high-quality provider
Public report sponsors focused on a consumer audience need to understand that simply
publishing quality data is not enough to engage consumers in using information to make health
care decisions. Quality information is only one of many considerations, and perhaps not the
primary one, entering into a consumer’s choice of a provider. Therefore, public reports should
help consumers easily access and use the information most relevant to them and should present
the information in terms that resonate with their concerns and preferences. In this sense, reports
should aim to meet consumers where they are, which may require sponsors to segment their
audiences so that they can target different groups with different needs.
Another important consideration in providing guidance on selecting providers is that most
consumers, when asked, would prefer comparative performance information on individual
practitioners. However, most report sponsors do not have access to physician-level information
and instead are limited to information about hospitals or medical groups. In the absence of
physician-specific performance information, reports can still provide guidance on steps that
consumers can take to gather available information and make good decisions.
The following examples demonstrate tools and strategies to help consumers evaluate and select a
high-quality provider.
50
Below is an example of a guide that helps consumers make health care decisions using
information about quality. The guide is based on research about the information people want and
need when choosing health plans, doctors, treatments, hospitals, and long-term care providers. It
shows how consumers can use information about quality to improve the health care services they
and their families receive. It also describes quality measures, including consumer ratings,
clinical performance measures, and accreditation—what they are, where to find them, and how to
use them. In addition, the guide has checklists, questions, charts, and other tools to help users
make appropriate health care decisions. The ―Choosing a Doctor‖ section features a step-by-step
worksheet to walk through the process of selecting a doctor.
Title: Your Guide to Choosing Quality Health Care
Sponsor: Agency for Healthcare Research and Quality
URL: http://www.ahrq.gov/consumer/qnt/qntdr.htm
51
The following example is a step-by-step guide to choosing a doctor. This guide encourages
patients to take several steps in researching their physician options, starting with seeking a
referral from a trusted source and checking physician qualifications. The tool also emphasizes
the importance of patients learning more about their specific medical issues.
Tool: How To Choose a Doctor
Sponsor: Consumer Reports
URL: http://www.consumerreports.org/health/doctors-hospitals/your-doctor-relationship/how-
to-choose-a-doctor/getting-started/getting-started.htm
52
Below is a an example of a guide designed to help consumers understand the birth process,
review comparative information on hospitals and physicians, and promote an open dialogue
about their wishes with their physician and other care providers. Information is included on all
Virginia hospitals providing obstetric services and includes rates of cesarean delivery and
episiotomy, as well as descriptions of hospital obstetric programs, services available, and quality
practices. Similar information on close to 600 physicians includes their performance rates,
education, location, foreign languages spoken, and other information. The guide is endorsed by
the National Partnership for Women and Families and the Virginia Section of the American
College of Obstetrics and Gynecology.
Title: Obstetrical Services: A Consumer’s Guide
Sponsor: Virginia Health Information
URL: http://vhi.org/ob_guide/ob_intro.asp
2. Preparing for a visit to a doctor or hospital
A central part of engaging consumers to be active participants in their health care is emphasizing
the importance of preparing for medical encounters. Consumers need to know that taking charge
of their care, planning what they would like to achieve, and asking questions of their provider is
not only acceptable, but also critical to achieving good health care outcomes. In helping to make
these behaviors normative, it is important to provide tools that will assist consumers in planning
for their medical encounter in an easy-to-use, step-by-step fashion.
The following examples demonstrate tools and strategies to encourage consumers to prepare for
their medical encounters.
53
The following is an example of a patient education campaign featuring television public service
announcements (PSAs) developed by the Ad Council to encourage patients to ask their providers
questions. The campaign highlights a list of 10 key questions for patients to ask and provides an
online tool for patients to build a customized list of questions to bring to their medical visit.
Additional tips are provided for patients getting medical tests, planning for surgery, and getting
prescriptions. Report sponsors may want to embed the PSA in their Web-based report.
Tool: Questions Are the Answer
Sponsor: Agency for Healthcare Research and Quality
URL: http://www.ahrq.gov/questionsaretheanswer/
54
Below is a Web site that advises patients on three basic questions to ask every time they talk with
a doctor, nurse, or pharmacist. The questions are: (1) What is my main problem? (2) What do I
need to do? (3) Why is it important for me to do this? The Web site also includes brief tips on
communicating clearly with a provider.
Title: Ask Me 3
Sponsor: National Patient Safety Foundation
URL: http://www.npsf.org/askme3/for_patients.php
55
The following is a guide for how to prepare for a doctor’s visit, including things to do prior to
and during the visit. Videos are featured, including physicians talking about how to make the
most of your time with your doctor (one version with an English-speaking physician and another
with a Spanish-speaking physician) and a consumer talking about being an engaged patient. A
downloadable tool to track medications also is included.
Tool: Preparing for Your Doctor’s Appointment
Sponsor: The Partnership for Healthcare Excellence
URL:
http://www.partnershipforhealthcare.org/patients_and_caregivers/preparing_for_your_doctors_a
ppointment/
56
Below is a three-step tool for consumers to create an action plan, including: (1) Prepare for your
appointment, featuring a customizable checklist of questions to print; (2) Ask questions and
understand the answers, featuring tips on how to interact with your doctor during your visit; and
(3) Follow up and follow through, featuring activity log tools and links to many other resources.
Title: Take Charge
Sponsor: Healthy Memphis Common Table
URL: http://www.healthymemphis.org/take_charge.php?s=consumers
57
Other examples of resources for preparing for a visit to a doctor or hospital Title: Making the Most of Your Medical Appointments
Sponsor: Partner for Quality Care, an initiative of Oregon Health Care Quality Corp
URL: http://www.partnerforqualitycare.org/appointments.php
Description: Tips for what to do before, during, and after a medical appointment. This downloadable brochure is consumer friendly and features two frames of a patient/doctor interaction – contrasting a scenario where the patient does not ask any questions with another modeling the patient asking questions.
Title: Quick Tips for Talking With Your Doctor
Sponsor: Puget Sound Health Alliance
URL: http://www.pugetsoundhealthalliance.org/resources/documents/QuickTipsChecklist.pdf
Description: A worksheet to assist patients in preparing for their medical visit. Includes areas to list questions and another to outline personal health goals. An area to record notes during the visit also is included.
3. Partnering with doctors to manage a chronic disease
Successful management of a chronic disease requires a daily commitment from patients to
monitor their health status and to work toward achieving health goals. A strong partnership
between patients and their providers is vital to this process. Consumers can benefit from tips and
tools that help them understand what their role is in managing their disease and how to work
with their providers to make sure their care plan is a good fit for their unique circumstances.
The following examples show tools and strategies to help patients partner effectively with their
providers in managing chronic disease. The D5 for Diabetes example further illustrates how a
report focused on addressing consumer needs for support in managing chronic disease can be
designed to effectively introduce performance information on medical groups. It presents scores
on various providers and shows how they vary in helping their patients manage this condition.
Below is a site for patients, family members, and health care providers who want to work
together to improve health, health care, and quality of life for people with chronic conditions.
The site provides support for those who want to work together, in a new health partnership, to
improve patient self-management. The site features a number of articles for patients on being
active in heath care and self-managing conditions. A recent guide for providers contains a
number of practical tips and resources for engaging patients in self-management: Partnering in
Self-Management Support: A Toolkit for Clinicians is available at
http://www.newhealthpartnerships.org/provider.aspx?id=1544.
58
Title: New Health Partnerships
Sponsor: Institute for Healthcare Improvement
URL:
http://www.newhealthpartnerships.org/PatientsPuzzlePiecePrint.aspx?id=40&linkidentifier=id&i
temid=40
The D5 Web site shown below was born out of consumer focus group findings indicating that
consumers with diabetes would be more likely to pay attention to health care quality data if they
were presented information specifically concerning their chronic condition. The D5 brand
frames Minnesota Community Measurement’s five-part diabetes quality measure as goals that
patients should be working toward in partnership with their doctor. Quality ratings are available
on an inside tab for consumers ready to use them, but the emphasis is on raising patients’
awareness of the five goals for managing their own diabetes. In addition, a catalog of free,
downloadable communications tools was added to the site to assist stakeholders in delivering this
campaign message (http://thed5.org/catalog/index.php).
59
Title: The D5 for Diabetes
Sponsor: Minnesota Community Measurement (MNCM)
URL: http://thed5.org
60
The site below features written patient story vignettes, accompanied by images of the narrator. The
videos discuss taking control and partnering with doctors when living with diabetes.
Title: Patient Stories
Sponsor: Better Health Greater Cleveland
URL: http://www.betterhealthcleveland.org/For-Patients/Diabetes/Patients–Stories.aspx
61
Another example of a resource for partnering with doctors to manage a chronic disease
Title: I Can! Challenge
Sponsor: Aligning Forces for Quality South Central Pennsylvania
URL: http://www.icanchallenge.com/home-page.html
Description: A targeted health improvement challenge for those with diabetes or heart disease in York and Adams Counties. The challenge features five citizens who were followed weekly via the local Fox station on a 12-week program to self-manage their health and is an example of modeling a popular reality TV show (i.e., The Biggest Loser). This video link tells the story of the final week: http://www.icanchallenge.com/fox43-videos/celebrating-success-during-the-final-week.html
D. Place for Consumer Input on Web Site Design
1. Place for consumers to to ask questions or share suggestions
Most consumers are just beginning to use the Web to find information about provider
performance. Therefore, they may not know how to access or interpret the data. Collaboratives
could give Web site users an opportunity to provide feedback, ask questions, or ask for help.
A simple feedback form from a New York-based site is shown below. Only the comments field
is required, so anonymous feedback can be submitted.
Tool: New York State Hospital Profile
Sponsor: New York State Department of Health
URL: http://hospitals.nyhealth.gov/feedback.php
62
For this site, an e-mail address is required, along with a security step, but not a name, to provide
comments and suggestions. Users are directed to address technical issues to a separate e-mail
address.
Tool: Illinois Hospital Report Card
Sponsor: Illinois Department of Public Health
URL: http://healthcarereportcard.illinois.gov/
Selecting ―your comments and suggestions‖ above leads the user to the following window:
63
The following Web site offers users a high level of accessibility to directors, managers, and staff.
Tool: PHC4
Sponsor: Pennsylvania Health Care Cost Containment Council
URL: http://www.phc4.org/council/contact.htm
64
2. Consumer survey to provide information on how data were used
Little is known about who uses public reporting Web sites and how they use the data. Some
collaboratives have added surveys to their sites to learn more about who their customers are and
what their needs are.
Some surveys are relatively short and simple. The following survey feature allows users who did
not find what they were looking for or did not understand the data or information presented to
provide open-ended feedback. The advantage of this approach is that users may provide
feedback about unanticipated or unrecognized issues. On the other hand, it may be difficult to
summarize and draw conclusions from this type of feedback.
Tool: Colorado Hospital Report Card
Sponsor: Colorado Hospital Association
URL: http://www.chachart.com/rptcard/ReportCardSurvey/default.asp
65
Other surveys are more specific about the response options allowed and attempt to categorize
possible answers, providing fewer opportunities for open-ended user input. This survey adds the
incentive of eligibility for a gift certificate.
Tool: VHI Cardiac Care
Sponsor: Virginia Health Information
URL: http://www.vhi.org/thesurvey.asp?page_Id=7&page_name=Cardiac%20Care
66
Although much of the content of this survey is similar to the one above, this site draws attention
to its survey with a prominent icon on the home page and adds questions on the site’s ease of
use.
Tool: Maryland Hospital Performance Evaluation Guide
Sponsor: Maryland Health Care Commission
URL: http://mhcc.maryland.gov/consumerinfo/hospitalguide/hospital_guide/survey/index.htm
67
E. Other Resources
1. Links/tools/libraries (national and community resources)
Some consumers may have informational needs beyond what is included in the report.
Examples—not elsewhere included in the Sampler—include additional information on health
conditions, treatment options, other health care quality organizations at the State and national
levels, and patients’ rights.
The following Web site enables consumers to select links to other organizations that provide
quality of care and cost data, patient’s rights information, and other services.
Tool: New York State Hospital Profile
Sponsor: New York State Department of Health
URL: http://hospitals.nyhealth.gov/more-quality.php
68
2. Links to provider Web pages
Some consumers come to public reporting Web sites looking for a provider, so it may help to
provide them with direct Web links. Providers also may appreciate having links to their Web
sites included. Below are examples of a provider selection page and a hospital information page.
Tool: MI Hospital Inform
Sponsor: Michigan Health & Hospital Association
URL: http://www.mihospitalinform.org/PickHospital.aspx
69
Tool: Hospital Consumer Assist
Sponsor: Arkansas Hospital Association
URL: http://www.hospitalconsumerassist.com/profile.htm?provid=040016
III. Functionality and Layout
A. Capacity To Narrow Selection of Providers Based on Consumer Preferences
Information included in a public report can be overwhelming to consumers. One strategy to
reduce the cognitive burden for consumers is to enable them to systematically reduce the fields
of information to the subset that is pertinent to them. By taking advantage of the functionalities
available in a Web-based format and letting users narrow their choices based on their preferences
and needs, you can restrict information to the data points of interest.
Report sponsors can enable consumers to narrow the fields by geography, level of quality of care
(e.g., high-quality providers), or health condition or procedure. Then consumers can focus on
the information most important to them.
The next examples show a report that allows users to narrow their search to a subset of
participating providers based on geography, as well as condition. The main search page is
shown with the location tab selected, followed by a results page showing hospitals in the selected
location and options to search further by condition.
70
Tool: CalHospitalCompare
Sponsors: California Hospital Assessment and Reporting Taskforce, the California HealthCare
Foundation, and the University of California, San Francisco
URL: http://www.calhospitalcompare.org (main page);
http://www.calhospitalcompare.org/results.aspx?l=san%20francisco&v=1 (results page)
71
B. Capacity To Sort Providers Based on Performance
In this example, a table of performance data is produced, and the user can sort hospitals based on
any of the aspects of performance reported. The site allows the user to rearrange the hospitals
presented by selecting the column headings. Doing so then sorts the hospitals by performance on
the indicator named in the column heading. The table below is sorted by mortality rating.
Tool: PHC4
Sponsors: Pennsylvania Cost Containment Council
URL: http://www.phc4.org/hpr/Results.aspx?Years=20081-
20084&CC=Septicemia&CID=0&Facilities=4610%2c0900%2c1660%2c1860%2c1610
72
Arrows under all column headings in the following example allow the user to sort in either
direction (i.e., from highest to lowest or lowest to highest cases or rates). The table below is
sorted by risk-adjusted mortality rate from lowest to highest rates.
Tool: Kentucky Hospital Association Quality Reports
Sponsor: Kentucky Hospital Association
URL: http://info.kyha.com/qualitydata/iqisite/SelectReport.asp?IndID=IQI12&TimePeriod=5&SortOrd
er=RValue&SortDir=ASC&GroupOpt=none&ACLimit
73
C. E-Mail Capability
Some consumers will want to share data with family or friends or send an excerpt of the report to
themselves for their personal file. This can be done either by permitting outgoing e-mails that link to
a particular Web page or by actually allowing the selected data to be forwarded. Report sponsors
pursuing the latter are encouraged to test this function to ensure that the graphics display properly
and that the user can select only the performance measures he or she wants to share.
The following site allows the user to send an e-mail, but the e-mail can include only the link to
the site, not any data.
Tool: Minnesota HealthScores
Sponsor: MN Community Measurement
URL: http://www.mnhealthscores.org/?p=our_reports&sf=clinic&search_phrase=&category=16&nam
e_id=&compare=
74
The site below allows selected performance data to be included in the email.
Tool: CHECKPOINT
Sponsor: Wisconsin Hospital Association
URL: http://www.wicheckpoint.org/report_topic_heartattack.aspx
75
D. Web Page Layout
The design of your Web site’s appearance matters. Many report sponsors err on the side of
inclusion and the result, unfortunately, can be a visual overload for consumers. To enhance
understanding, interest, and visual appeal, the Web site layout should have adequate white space,
that is, not too much clutter of text or pictures. A streamlined layout helps to efficiently direct
the user’s attention to what is important on the page. In addition, the search function should be
quick and easy to locate from the landing page. Below are several examples with specific
advantages.
The following search page is readily accessible from the landing page. It has plenty of white
space, a minimum of text, and a clear sequence of steps leading to an easy-to-find ―View Quality
Scores‖ box.
Tool: Partner for Quality Care
Sponsor: Oregon Health Care Quality Corporation
URL: http://www.partnerforqualitycare.org/selection.php
76
The same site maintains a balanced look on its data pages, keeping space between information
points. Also, the large, clearly-labeled tabs at the top, the same as those on the search page,
allow for quick navigation to other pages of interest.
Tool: Partner for Quality Care
Sponsor: Oregon Health Care Quality Corporation
URL: http://www.partnerforqualitycare.org/selection.php
77
The site below is an example of providing ease in starting a search and creating a customized
report by combining multiple items on a single page:
Tool: VHI Cardiac Care: Compare Hospitals
Sponsor: Virginia Health Information
URL: http://www.vhi.org/cardiac_reports.asp
78
The icons used on the page below quickly transmit important information about services
available, while the overall layout is simple and easy to understand:
Tool: New York State Hospital Profile
Sponsor: New York State Department of Health
URL: http://hospitals.nyhealth.gov/browse_view.php?id=218
79
The page below is easy to read and uses a presentation that draws the eyes to the ratings.
Tool: Get Better Maine
Sponsor: Maine Health Management Coalition
URL: http://www.mhmc.info/compare/hospitals
References 1. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC:
National Academies Press; 2001.
2. Anderson G, Brown A. Appropriateness ratings: overuse, underuse, or misuse? Lancet 2001 Nov 3;358( 9292):1475-6.
3. Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966 Jul;44(3):Suppl:166-206.
