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Other Issues Related to Quality Ty Borders, Ph.D. And James Rohrer, Ph.D.

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Other Issues Related to Quality Ty Borders, Ph.D. And James Rohrer, Ph.D. Objectives for today Define and describe the concept of quality Review a few managerial ... – PowerPoint PPT presentation

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Title: Other Issues Related to Quality Ty Borders, Ph.D. And James Rohrer, Ph.D.


1
Other Issues Related to Quality Ty
Borders, Ph.D. And James Rohrer, Ph.D.
2
Objectives for today
  • Define and describe the concept of quality
  • Review a few managerial approaches to quality
    assurance

3
Technical vs. Interpersonal Care
  • Technical care (Donabedian)
  • Application of science, technology of medicine
    (and other health sciences) to the management of
    personal health
  • Interpersonal care
  • Management of the social and psychological
    interaction between client and practitioner

4
Access and quality
  • When care is needed but not received
  • An issue of access and quality
  • The non-receipt of needed care in itself is poor
    quality
  • Gaps in treatment are also poor quality
  • When care is not needed but is received
  • Inappropriate access is poor quality
  • Potential harm an individual
  • Lost opportunities (spending on other services,
    commodities, etc.)

5
Benefits and risks
  • At first, more services translate intro more
    benefits
  • Benefits of services begins to decline as risks
    increase
  • Benefits and risks determined by patient
    characteristics, effectiveness of treatment

6
Benefits, utility, risk, and cost (Donabedian,
Vol. I).
Benefits
Utility of benefits
Risks
Monetary costs
Volume of services
7
Benefits or utility minus risks or risks plus
costs
Benefits minus risks
Benefits minus (riskscosts)
Utility of benefits minus (riskscosts)
Volume of services
8
Small Area Variation
  • Developed by John Wennberg
  • Compares utilization rates in populations from
    specified geographic areas
  • Geographic market areas based on where most
    people go for care

9
CABGs
per 100,000 non-HMO Medicare enrollees
10
Back surgeries per 100,000 non-HMO Medicare
enrollees
11
Radical prostatectomies per 100,000 non-HMO
Medicare enrollees
12
Level and scope of concern
  • Different perspectives of quality
  • Provider vs. health care organization vs.
    health plan
  • Patient vs. person
  • Physical vs. psychological vs. social functioning

13
Plan, institution, system
Organized team
Several practitioners
Individual practitioner
Phys. function
Psych. function
Social function
Individual
Case load
Individual Population
Patient
Person
14
Administrative structures
  • Accreditation
  • for hospitals (JCAHO)
  • for health plans (NCQA)
  • Licensing, certification
  • Legal approaches Malpractice

15
Management approaches
  • TQM (total quality management)
  • CQI (continuous quality improvement)
  • Reengineering

16
TQM / CQI philosophy
  • TQM a strategic, customer-oriented approach to
    improving care
  • CQI Similar to TQM, but focuses more on process
    improvement

17
Reengineering
  • Definition
  • Recreation of task interdependencies
  • Changing of how tasks connect to each other to
    improve efficiency and effectiveness
  • Examples
  • Patient reaggregation clustering of similar
    patients into patient units
  • Reduction of medical staff committees

18
Economic approaches
  • Second opinion
  • Preadmission certification (used more for
    utilization management)
  • Utilization review (also used more for
    utilization management)

19
Structure (eg staffing ratios) Process (eg
guidelines) Outcome measures
  • HEDIS measures
  • Health status
  • Patient satisfaction
  • Well talk more about these in the epidemiology
    section

20
Highlights and Chartpack

The Kaiser Family Foundation/Agency for Health
Care Research and Quality
National Survey on
Americans as Health Care Consumers
An Update on The Role of Quality
Information
December 2000
21
Chart 1
What is Important in Choosing a Health Plan
1996
2000
Percent saying very important in a health plan
When forced to choose, the percent saying most
important
Having a health plan that provides a high quality
of health care Having a wide range of
benefits or a particular benefit you
need Keeping costs of coverage low
Having a plan that offers a
wide choice of doctors
Dont know not shown
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
22
Chart 2
Differences in Quality
Percent who say there are big differences in
the quality of care among...
1996
2000
Health plans that offer coverage
in your area Local hospitals where you
live Local nursing homes where you live Doctors
in your area who are specialists, such as
orthopedists, allergists and those who treat
heart problems Family doctors, general
practitioners and other primary care doctors in
your area
N/A
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
23
Chart 3
What is Important in Quality of Care Open-Ended
Responses
Percent naming each as most important in
determining the quality of health care patients
receive
Qualifications of a doctor Ability to choose
your own doctor Patient/provider
relationship Insurance coverage of care and
procedures Affordability/cost Availability of
appointments
Responses mentioned by less than 5 are not
shown.
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
24
Chart 4
Doctor Quality
Percent saying each would tell them a lot about
the quality of a doctor
How many malpractice suits a doctor has had filed
against him or her How many times a doctor has
done a specific medical procedure Whether a
doctor is board certified How patients surveyed
rate how well the doctor communicates Whether a
doctor has admission privileges to send patients
to a particular local hospital Whether a doctor
attended a well-known medical school or training
program Whether a doctor has been highly rated
by a government or independent agency Whether a
doctor has been rated the best by a local
newspaper or magazine Whether a
doctor charges more than others do
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
25
Chart 5
Hospital Quality
Percent who say each tells a lot about the
quality of hospitals
Reports of medical errors or mistakes
that lead to harm for patients How much
experience the hospital has in performing a
particular test or surgery The
number of doctors at the hospital who are board
certified How many
patients die after having surgery The
number of patients who do not get standard
recommended treatments, such as aspirin after a
heart attack How patients
surveyed rate the quality of care Whether
the hospital has passed an independent review and
been accredited Whether it is a teaching
hospital Whether it has been rated the best
by a local newspaper or magazine
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
26
Chart 6
Health Plan Quality Resonates Most
Percent who say each of the following tells them
a lot about the quality of health plans
The number of medical errors or
mistakes by the plans doctors and hospitals
The percentage of doctors in the plan who have
had a complaint filed against them or lost
malpractice suits Whether the plan has programs
to help people with chronic illnesses How easy
it is for plan members to see specialists The
number of complaints flied by plan members
against the health plan How quickly patients can
get to be seen by a doctor The percentage of
plan members who get preventive care Whether the
plan will help you find the care you need, such
as the best place to get a particular surgery done
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
27
Chart 7
Other Indicators of Health Plan Quality
(Continued)
Percent who say each of the following tells them
a lot about the quality of health plans
How easy it is for plan members to get
the laboratory tests they need The range of
health benefits What patients surveyed say
about how well the plans doctors
communicate How patients surveyed rate the
quality of care Turnover rates from doctors in
the plan How much the health plan costs Whether
the plan has passed a review and been accredited
by an independent organization What health
improvement programs the plan offers or pays for
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
28
Chart 8
Concerns About Experiencing an Error
In the past 12 months, have you personally
suffered personal injury or harm that you feel
resulted from a medical error?
Percent who are very concerned about an error
resulting in injury happening to them or their
family
When receiving health care
in general When going
to a hospital for care When
going to a doctors office for care
When filling a prescription at a pharmacy
When flying on U.S. commercial
airliners When eating food purchased at
the supermarket
No
Dont know/ Refused
Yes
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
29
Chart 9
Confidence In Having Enough Information to Make
the Right Choices
Percent who say they were very or somewhat
confident that they had enough information to
make the right choices the last time they were
Somewhat confident
Very confident
Choosing a doctor Choosing a hospital Making
decisions about treatment options or thinking
about having a particular test or
procedure Making decisions about a prescription
medicine that youd never taken before Choosing
a health plan
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
30
Chart 10
Influences on Doctor Choice
If they had to choose a new doctor, the percent
saying that ratings or recommendations from each
would have a lot of influence on their choice
1996
2000
Friends or family members Regular doctor or
other individual doctors Patients surveyed about
the quality of care Employer Groups of
doctors Consumer groups Government
agencies Newspapers or magazines
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
31
Chart 11
Influences on Hospital Choice
If they had to choose a hospital, the percent
saying that ratings or recommendations from each
would have a lot of influence on their choice
1996
2000
Regular doctor or other individual
doctors Friends or family members Patients
surveyed about the quality of care Groups of
doctors like state medical societies
Employer Consumer groups Government
agencies Newspapers or magazines
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
32
Chart 12
Influences on Health Plan Choice
If they had to choose a new health plan, the
percent saying that ratings or recommendations
from each would have a lot of influence on
their choice
1996
2000
Regular doctor or other individual
doctors Friends or family members
Patients surveyed about the quality of
care Employer Groups of
doctors Consumer groups Government
agencies Newspapers or magazines
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
33
Chart 13
Finding Quality Information
Percent who say they would be very likely to do
each to try to find information about quality
Ask friends, family members, or co-workers Ask a
doctor, nurse or other health professional
Contact someone at or refer to materials from
someone at your health plan Go online Order a
printed booklet Contact a state agency Call a
toll-free number to hear recorded
information Refer to a section of a newspaper or
magazine
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
34
Chart 14
Familiarity vs. Ratings
Supposed you HAD TO CHOOSE between two surgeons
Suppose you HAD TO CHOOSE between two different
hospitals
1996
2000
Surgeon seen before, but not as well rated
Hospital that is familiar
Surgeon not seen before, but rated higher
Hospital that is rated higher
Question wording was slightly different in 1996.
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)

35
Chart 15
Friends and Family vs. Expert Ratings
1996
2000
If the two plans cost the same, which would you
be more likely to choose?
Which comes closer to your view?
The opinions of friends and family are a good
source of information about health
plans Friends and family dont have enough
knowledge and experience to provide good
information about health plans
Plan recommended by friends and family
Plan more highly rated by experts
Dont know not shown
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
36
Chart 16
Employers as a Source of Information on Quality
Which comes closer to your view
1996
2000
Employers are not a good source because their
main concern is saving the company money on
health benefits Employers are a good source of
information about the quality of different health
plans because employers examine plans closely
when deciding which ones to offer
Dont know not shown
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
37
Chart 17
Used Quality Information
Percent who say theyd use the information they
saw comparing quality among
1996
2000
Total Used Any Health
Plans Hospitals Doctors
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
38
Chart 18
Saw Information Comparing Quality in the Past Year
1996
2000
Specifically saw information comparing quality
among
Saw any information comparing quality
Health Insurance Plans
Didnt see any information
Hospitals
Saw any information
Doctors
Dont know not shown
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
39
Chart 19
Choice of Plans
Percent who say
Employer offers only one plan
Had choice
Dont know/Refused
Based on those with employer-based health
coverage
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
40
Chart 20
Why People Didnt Use Quality Information
Percent who say each is a reason they didnt use
the information they saw about
Hospitals
Doctors
Health Plans
You didnt need to make any
decisions at the time The information you
saw about the quality wasnt specific to your
personal health conditions or concerns
Factors other than quality, such as
location or cost, were more important in your
decision-making The information you saw didnt
cover the specifics you need to know about The
information you saw about the quality was
confusing or difficult to understand
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
41
Chart 21
Would Information Comparing Quality Be Useful?
Percent who say the information they saw
comparing quality would be useful to someone
making decisions about...
1996
2000
Health Insurance Plans Doctors Hospitals
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
42
Chart 22
Government Involvement in Ensuring Quality
Yes - 63
No Opinion
No
Penalize providers that fail to meet standards
Work directly with providers to improve quality
Other/Dont know /Refused
Just make sure information is available
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
43
Chart 23
Medical Errors
Which comes closer to your views on how medical
errors that result in serious injury or harm
should be handled?
The government should REQUIRE health care
providers to report all serious medical errors to
make sure this information is publicly available
Reporting of serious medical errors should be
done on a VOLUNTARY basis to ensure the personal
privacy of patients/staff involved
Dont know/Refused
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
44
Chart 24
Quality Information and The Internet
  • People who have seen quality information over
    the Internet
  • Say they would be very likely to go online
    to get quality information

7 28
Trust Trust health websites to provide accurate
information about prescription drugs
A lot 9
Somewhat 31
Not too much 13
Not at all 32
Dont know not shown
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
45
Chart 25
Trust in Sources of Information About
Prescription Drugs
Percent who say they trust each of the following
sources a lot to provide accurate information
about prescription drugs
Your doctor Your pharmacist The
printed information included in the packages of
prescription medicine Government agencies
Health websites on the Internet Advertisemen
ts for prescription medicines
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
46
Chart 26
Seniors
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
47
Chart 27
People With a Chronic Disease or Disability
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
48
Chart 28
People Who Have Had Difficulty Communicating with
a Provider
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
49
Chart 29
Racial and Ethnic Minorities
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An Update
on The Role of Quality Information, December 2000
(Conducted July 31-Oct. 13, 2000)
50
The Henry J. Kaiser Family Foundation 2400
Sand Hill Road Menlo Park, CA 94025 650-854-9400
Facsimile 650-854-4800 Washington Office 1450
G Street N.W., Suite 250 Washington, DC
20005 http//www.kff.org Agency for
Healthcare Research and Quality 2101 E. Jefferson
Street, Suite 501 Rockville, MD
20852 301-594-1364 http//www.ahrq.gov Additiona
l free copies of this publication (3093) are
available on the Foundations website at
www.kff.org or by calling the Kaiser Family
Foundations Publication Request Line at
1-800-656-4533.
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