Patient Safety and Quality

Giving consumers easy-to-understand information on health care quality and costs boosts the choice of high-value care

If something seems too cheap, many people will assume it is low quality. The same tendency is seen in health care, where some consumers assume that high-cost providers give higher quality care than low-cost providers, according to a new study. The researchers note that without looking at the provider's quality rating, consumers who link quality to cost will avoid the highest-value providers, who give high-quality care at low cost. In a study of 1,421 employed adults, researchers used a variety of ways to present quality and cost information to find a presentation that enabled consumers to readily identify high-quality, low-cost providers.
Respondents were least likely to select high-cost providers as high-value providers if the cost information was provided by a one to three-star rank in a column labeled "careful with your health care dollars" (1 star = less careful/higher costs; 2 stars = somewhat careful/average costs; 3 stars = very careful/lower costs), rather than providers with the "average cost of office visit" listed in dollars. However, the difference in selection of providers using stars and dollar amounts was much smaller than the difference between those two display methods and dollar signs ($ = low cost, $$ = medium cost, $$$ = high cost).
Also, giving a strong quality signal ("uses treatments proven to give results;" "has safeguards to protect patients from medical errors;" "is responsive to patients' needs and preferences") helped consumers identify high-value providers better than a weak quality signal ("diabetes patients tested for blood sugar [percent];" "uses electronic health record;" "patients say office staff is helpful [percent]") or no quality signal ("Saturday hours;" "driving distance [miles];" "same-day office visits"). The strong, clear quality signal also increased consumers' confidence in their choice of provider. When a hospital was specifically marked as "high value," consumers were also significantly more likely to choose that hospital.
The researchers worked with Massachusetts Health Quality Partners and two of its member employers to recruit employees for participation. The participants were randomly assigned to groups that were asked to choose the high-value physician from a list of six, with each group seeing a different presentation of the cost information along with no, weak, or strong quality signals. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00083).
More details are in "An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care," by Judith H. Hibbard, Ph.D., M.P.H., Jessica Greene, Ph.D., M.P.H., M.I.A., Shoshanna Sofaer, Dr.P.H., M.P.H., and others in the March 2012 Health Affairs 31(3), pp. 560-568.

— DIL