Quality Data? What Quality Data?

The American public is savvier than ever before when it comes to making healthcare choices. Everybody knows that, right? The days of the passive patient who blindly seeks care at whichever hospital his or her primary care physician recommends are fast disappearing. Today's patients are increasingly scouring Web sites for quality data before they make their choices. They're analyzing outcomes and realizing the distinction between Hospital A and Hospital B. In short, quality has become a critical differentiator, and provider organizations that don't make their data transparent to the public will soon be left wondering what happened to their patient base.

That's what I read. And hear. Constantly. Our organization is developing this online comparison tool, our hospital is reporting that new measure, our system is committed to quality transparency. And for the most part, I believe them. I believe that quality—both improving it and reporting it—is rising to the top of more and more healthcare leaders' priority lists.

So explain these figures from the Kaiser Family Foundation's 2008 Update on Consumers' Views of Patient Safety and Quality Information:

• Roughly 30% of Americans say they've seen healthcare quality comparisons of health insurance plans, hospitals, or physicians in the past year—down from 36% in 2006 and 35% in 2004.
• Roughly 14% of Americans say they've both seen and used healthcare quality comparisons in the past year—again, down from surveys in 2006 (20%) and 2004 (19%).
• Only 6% have heard of the U.S. Department of Health & Human Services Hospital Compare feature.
• Fewer people today say there are "big" differences in care quality among providers than in 2000.

The list of organizations making quality data available to the public keeps growing, yet fewer people say they've seen such data, use such data to make decisions, or even believe there's that big of a difference from hospital to hospital, anyway. How is this possible? Are provider organizations not making the strides in transparency that they think they're making? Is this notion of savvy consumers just hogwash?

No. For one thing, not everyone faces a healthcare decision that requires a quality comparison in a given year. Just because fewer people say they've seen and used quality data compared to two years ago doesn't mean the information isn't available to them. If you need the information, you look for it. If you don't, you don't. And when people say there's not that much quality difference among providers, maybe they just mean that quality in general has improved and they've perceived once-mediocre organizations to have closed the gap.

Still, this new research reinforces two significant points. First, quality data is of little use in a vacuum. The study said fewer people reported seeing information comparing quality, not seeing quality data of any kind in any context. If infection rates or Press Ganey scores or any number of indicators are made available without a sufficient frame of reference, many people will gloss right over it no matter how detailed or illuminating it might be.

And second, the industry still hasn't figured out how to make quality data useful to the average consumer or even let people know it's there in the first place. When more healthcare organizations are publishing information on myriad indicators and the government creates a Web site specifically designed to let consumers compare hospitals, yet fewer people say they're using or even seeing quality comparison data, that tells me the message is too complicated or isn't getting out there at all. Accumulating and posting information about the quality of care an organization provides is only part of the transparency equation—when it comes to actually reaching the consumer, we still have a long way to go.