3 Key "Do's" of Public Reporting (Text Version)

On September 27, 2010, R. Adams Dudley made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (1.4 MB).

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Slide 1

3 Key "Do's" of Public Reporting

R. Adams Dudley, MD, MBA
Professor of Medicine and Health Policy

Support: Agency for Healthcare Research and Quality, Robert Wood Johnson Foundation, California Health Care Foundation, California Hospital Assessment and Reporting Taskforce

Disclosures: None

Slide 2

"If you only do 3 things, please be sure to..."

1. Know your customer: survey users and analyze click patterns!
2. Choose measures that matter to those customers: even if you have to develop them yourself!
3. Make sure they get the message: present the data so people can understand!

Slide 3

Tip #1: Know your customer: survey users and analyze click patterns!

Slide 4

A Burning Question for Public Reporting Collaboratives: How Can Our Reporting Activities Be Sustainable?

• To answer this, you need to know:
  • If your target users are coming to your site,
  • What information they use (among what is there) and
  • What information they seek but do not find.

Slide 5

How might public reporting improve performance?

• Inducing providers to improve
  (target user = providers)

  OR

• Changing where patients go:
  • Change consumers' choices by education, engagement (target user = consumers)
  • By network or benefits design (target user = employers, labor unions, or health plans)

Slide 6

AHRQ Is Creating Tools To Help Know Your Users

• Team at University of California, San Francisco and University of Oregon
  • Creating survey tool.
  • Writing software to analyze click patterns.

Slide 7

Approach

• Multi-Web site survey of users.
• Multi-Web site analysis of click pattern data.
• Work with as many sites as volunteer.

Slide 8

What can we learn from surveys? Some examples:

• Who are you? (e.g., age, education, patient/friend of patient vs. provider)
• Why are you here? (e.g., select doctor).
• Did you find the information you wanted?
• Did it affect your behavior? (e.g. your choice of doctor)
• What would have improved your experience?

Slide 9

What can we learn from click patterns?

For Example:

• Which diseases get the most clicks?
• What search key words do they use?
• How long do people spend on the Web site?
• Where do people leave the site most commonly?

Slide 10

Comparing Sites

• Do the answers to surveys/click analyses depend on how you set up your site?
  • We should be able to help participants increase traffic, impact, sustainability.

Slide 11

Interested?

• For Web site survey/click analysis participation, contact:
  • Naomi Bardach and Adams Dudley at UCSF (nbardach@peds.ucsf.edu and adams.dudley@ucsf.edu)

Slide 12

Tip #2: Choose measures that matter to your customers, even if you have to develop them yourself!

Slide 13

The Existence of NQF Has Not Eliminated Controversy About What to Measure

• E.g., in pediatrics, there are so few measures that CHIPRA now requires AHRQ to find or build new pediatrics measures:
  • If pediatrics measures are important to your group's sustainability, what can you do?

Slide 14

Readmissions: An Example

• Health plans partially fund the California Hospital Assessment and Reporting Taskforce. They were concerned about preventable readmissions:
  • No measures available that tell hospitals how readmissions might be prevented.

Slide 15

2 Questions Added to CAHPS Hospital Survey

28. Did someone on the hospital staff explain the purpose of the medicines you were to take at home in a way you could understand?

• ___ Not at all
• ___ Somewhat
• ___ For the most part
• ___ Definitely
• ___ Did not need explanation
• ___ No medicines at home

29. Did they tell you what danger signals about your illness or operation to watch for after you went home?

• ___ Not at all
• ___ Somewhat
• ___ For the most part
• ___ Definitely

Slide 16

Value of Added Discharge Preparation Questions

• Answers to discharge preparation questions are associated with readmission-Hospitals that do worse have higher risk-adjusted readmission rates.
• The questions also suggest what hospitals could do to improve (inform about meds, warning signs).
• Low cost to implement, important to customers.

Slide 17

Tip #3: Make sure they get the message: present the data so people can understand!

Slide 18

Using a Framework to Communicate about Health Care Quality

Source: Judith Hibbard
University of Oregon

Slide 19

Why a Framework?

• Consumers do not understand quality in the way it is measured and reported.
• Providing a conceptual framework will help (just don't call it that!)

Slide 20

What are the Criteria for a Quality Framework?

• Must communicate what quality of care is.
• Must be no more than 3-4 categories.
• Must be consistent with how the health care industry conceptualizes quality.

Slide 21

The best quality medical care is when the doctor does things that are:

• Effective = proven to work.
• Safe = protects from medical errors.
• Patient Focused = responsive to patients' needs and preferences.

Slide 22

Un-translated and No Framework

Doctors	Percent of patients with diabetes who had hbA1c test	Percent of women receiving breast cancer screening	Provider uses electronic prescribing to prevent medication errors	Provider who uses a computer system to prevent lab results from getting lost	Patients report that provider explains information, listens and shows respect to patients	Patients report that provider spends enough time with patients
Dr. Allard	Average	Average	Better	Better	Average	Average
Dr. French	Below	Average	Better	Average	Below	Below
Dr. Cain	Average	Average	Below	Below	Better	Average
Dr. Emory	Better	Better	Average	Average	Average	Average
Dr. Castle	Average	Average	Average	Average	Better	Better

Legend:

• Better =scored above average
• Average = scored average
• Below = scored below average

Slide 23

Translated in Plain Language and No Framework

Doctors	Uses best practices for treating chronic illness	Uses best practices for screening for diseases	Has procedures to prevent medication errors	Has a system to prevent lab results from getting lost	Communicates well with patients	Spends enough time with patients
Dr. Allard	Average	Average	Better	Better	Average	Average
Dr. French	Below	Average	Better	Average	Below	Below
Dr. Cain	Average	Average	Below	Below	Better	Average
Dr. Emory	Better	Better	Average	Average	Average	Average
Dr. Castle	Average	Average	Average	Average	Better	Better

Legend:

• Better =scored above average
• Average = scored average
• Below = scored below average

Slide 24

Framework and Translated into Plain Language

Doctors	Effective		Safe		Patient Focused
	Uses best practices for treating chronic illness	Uses best practices for screening for diseases	Has procedures to prevent medication errors	Has a system to prevent lab results from getting lost	Communicates well with patients	Spends enough time with patients
Dr. Allard	Average	Average	Better	Better	Average	Average
Dr. French	Below	Average	Better	Average	Below	Below
Dr. Cain	Average	Average	Below	Below	Better	Average
Dr. Emory	Better	Better	Average	Average	Average	Average
Dr. Castle	Average	Average	Average	Average	Better	Better

Legend:

• Better =scored above average
• Average = scored average
• Below = scored below average

Slide 25

Comprehension of Hospital Quality Concepts Index

	Percent Correct
Framework	77
Translated	60
Untranslated	40

Statistically significant at p<.05 when comparing all three versions from each other

Slide 26

Conclusions

• For any organization, sustainability depends on:
  • Knowing your customers/users.
  • Providing services that matter to them.
  • Making sure they receive and understand the service.
• AHRQ is providing tools that will help you understand how to accomplish these 3 things in public reporting.

Slide 27

Conclusions

• For Web site survey/click analysis participation, contact::
  • Naomi Bardach and Adams Dudley at UCSF (nbardach@peds.ucsf.edu and adams.dudley@ucsf.edu)
• To learn more about frameworks see Model Public Report Elements: A Sampler:
  • https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/pubrptsampler/index.html