Your Guide to Choosing Quality Healthcare

Healthcare Quality Varies a Lot

Healthcare quality varies in this country—a lot. For example, some health plans and doctors simply do a better job than others of helping you stay healthy and getting you better if you are ill. Research shows that Americans want and value quality healthcare. And that's a good thing. Because when you make healthcare choices that offer the best possible care, you are most likely to get the best possible results.

So when it comes to making major healthcare decisions—about health plans, doctors, treatments, hospitals, and long-term care—how can you tell which choices offer quality healthcare, and which do not?

Fortunately, more and more public and private groups are working on ways to measure and report on the quality of healthcare. This means there is more and more information to help you make choices that improve the quality of your own care.

The goal of this guide is to help you find and use such information to choose quality healthcare. It can also help you measure quality for yourself according to what is most important to you. You can trust the information in this guide because it is based on research about what people want and need in order to make quality healthcare choices.

Here are some important things to remember as you make such choices:

• Quality matters. It can be measured, and it can be improved. Take part in every decision about your health.
• See yourself and your doctor as a team. You need to work together to get the best care.
• Ask questions, and make sure you understand the answers. The only "bad" question is the one you wish you had asked.
• Remember that "more" is not always "better." It is always a good idea to find out why a test or treatment is needed and how it can help you.
• Find and use reliable healthcare information. Ask your doctor or nurse, use your library, explore the Internet.... This guide has many resources for you to try.

I urge you to keep and use this guide. It can help you and your family answer many of the healthcare questions you will have.

Make quality healthcare choices. Your good health, and your family's, depends on it.

High-quality health care is something we all want. But research shows that many people do not have the information they need to make informed health care choices. The first step is to understand what quality means and how it is measured.

A Quick Look at Quality

• What is Measured?
• What Should I Look For?

Quality health care means doing the right thing, at the right time, in the right way, for the right person—and having the best possible results.

Although we would like to think that every health plan, doctor, hospital, and other provider gives high-quality care, this is not always so. Quality varies, for many reasons.

Fortunately, there are scientific ways to measure health care quality. These tools, called measures, have mostly been used by health professionals. They use measures to check up on and improve the quality of care they provide.

But there is some quality information you can use right now to help you compare your health care choices. And more and more is becoming available all the time. Many public and private groups are working to improve and expand health care quality measures. The goal is to make these measures more reliable, uniform, and helpful to consumers in making health care choices.

There are two main types of quality measures that can help you choose quality health care: consumer ratings and clinical performance measures. Both types are based on "outcomes research."

Outcomes research measures the end results of health care practices and treatments. For example, after treatment, is the pain gone? Can the patient carry out his or her daily activities? Is he/she satisfied with his or her care?

These look at health care from the consumer's point of view. For example, do doctors in the plan communicate well? Do members get the health services they need?

Many consumer ratings of health plans are based on a survey called the Consumer Assessment of Health Plans (CAHPS®) and on the Health Plan Employer Data and Information Set (HEDIS) member satisfaction survey, which includes CAHPS® questions.

Some widely used clinical performance measures are included in HEDIS. These measures look at how well a health care organization prevents and treats illness. For example, one HEDIS clinical performance measure looks at whether children get the immunizations (shots) they need when they need them.

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Quality Reports

You may be able to find consumer ratings, clinical performance measures, or both in quality reports. Quality reports go by different names, including performance reports and report cards. Quality reports don't tell you which health care choices are the best. But they can help you decide which are best for you, based on the things that are most important to you.

More information about quality reports is provided in the Choosing a Health Plan and Choosing a Hospital sections.

Accreditation Reports

Another way to compare quality is to use information about accreditation. Accreditation is a "seal of approval." It is mainly used for health care organizations such as health plans, hospitals, and nursing homes.

To earn accreditation, organizations must meet national standards, often including clinical performance measures. Organizations choose whether to participate in accreditation programs. Therefore, you will not find accreditation information on every nursing home, for example.