Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov

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.

iii

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

iv

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:

1

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)

2

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

3

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

4

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.

5

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

6

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

7

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]

8

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

9

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

10

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

11

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

12

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.

13

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

14

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/

15

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

16

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

17

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/

18

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/

19

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

20

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)

21

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)

22

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)

23

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

24

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

25

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

26

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.