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Health Background
Consumer and Community
Health: Choosing Quality
Health care quality varies in the United States. Some health plans and doctors do a better job than others. Although most people want and value quality health care, they often don't know how to choose it.
Fortunately, more tools are available than ever before to help consumers select quality health care. Researchers and health policy specialists have learned how to define and measure health care quality, and have begun reporting their findings to the public to help people do a better job of choosing health plans, doctors, and hospitals.
There are two major types of quality measures: consumer ratings and clinical performance measures. Both are based on "outcomes research," i.e., measurements of the end results of health care practices and treatments.
Consumer ratings look at health care from the consumer's point of view. Sometimes these are also called "consumer satisfaction" ratings. They ask questions like: Do the doctors in a health plan communicate well? Do members get the health services they need?
Many of these consumer ratings are based on a survey known as the Consumer Assessment of Health Plans (CAHPS) and on the Health Plan Employer Data and Information Set (HEDIS) membership satisfaction survey, which includes questions from the CAHPS.
Clinical performance measures examine how well a health care organization prevents and treats illness, e.g., whether children get the immunizations they need when they need them. Clinical performance measures are sometimes called "technical quality" measures.
Consumer ratings and clinical performance measures are published in quality reports, also known as "performance reports" and "report cards." These don't tell you which health care choices are best, but they do provide guidance to help you choose care based on what's most important to you.
Accreditation information is another tool to help you compare the quality of health care organizations, like health plans, hospitals, and nursing homes.. To earn accreditation, an organization must meet national standards that may include clinical performance measures.
Here are some sources for finding out about the quality of health care plans and organizations:
The National Committee for Quality Assurance (NCQA) evaluates and rates managed care plans using more than 50 standards. These standards address topics such as the doctors' credentials; plan's efforts to continuously improve quality of care; members' rights and responsibilities; preventive health services; and whether appropriate health care services are provided. To generate a report card on one of hundreds of health plans, go to www.ncqa.org.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) evaluates and accredits all types of health care organizations, focusing on patient-related areas that it believes most closely relate to improving health outcomes. JCAHO standards cover: rights, responsibilities, and ethics; continuity of care; education and communication; health promotion and disease prevention; leadership; management of personnel and health information; and continuous quality improvement. Information on accredited organizations is available at www.jcaho.org.
The American Accreditation HealthCare Commission/URAC develops accreditation standards and programs for managed care. Its Network Standards address five general areas: network management, utilization management (checking to see if health care resources are used appropriately), quality management, credentialing, and member participation and protection. To obtain a directory of accredited organizations, visit www.urac.org.
Your Guide to Choosing Quality Health Care is a publication from the Agency for Healthcare Research and Quality (AHRQ) that provides step-by-step directions for using quality ratings to select health plans, doctors, treatments, hospitals, and long-term care.
Reference
Agency for Healthcare Research and Quality. Your Guide to Choosing Quality Health Care
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