Low-quality care can be both tragic and financially costly for patients and families. Measuring quality is crucial to improving quality, to paying doctors and hospitals based on patients’ health outcomes, and to steering patients toward high-value providers. But quality has many dimensions that are measured in many ways.

Public Agenda, with support from the Robert Wood Johnson Foundation, conducted nationally representative surveys of people who have experienced one of three common types of health care for which quality and costs can vary: type 2 diabetes care, joint replacement surgery and maternity care.

  • What do people think makes for high-quality care?
  • How do they view interpersonal qualities, such as doctors’ listening skills, relative to more clinical qualities, such as infection rates after surgery?
  • Do people understand that doctors and hospitals vary on specific measures of quality?
  • How, if at all, do they find out if doctors or hospitals have the qualities that are important to them?

Findings and implications are summarized below. Download a PDF of the full report here or a brief on the research findings here.

Findings in Brief

Implications

Methodology

Qualities in this Research

Findings in Brief

FINDING 1

Across all three groups, people say interpersonal and clinical qualities of doctors and hospitals are important for high-quality health care.

  • Large majorities in all three groups regard almost all interpersonal and clinical qualities as somewhat or very important for high-quality care.
  • More people recently diagnosed with type 2 diabetes and women who recently gave birth rate interpersonal qualities as very important, while fewer rate clinical qualities as very important.
  • Most people who recently had a joint replacement rate both interpersonal and clinical qualities of providers as very important.
  • The most common interpersonal quality that people across all three groups say is very important for high-quality care is that the doctor makes time for patients’ questions and concerns.



Average percent of people who say the various interpersonal or clinical qualities of doctors or hospitals are very important for high-quality care, by group.



FINDING 2

Most people across all three groups had at least some choice among doctors. But fewer people who recently had a joint replacement or gave birth had much choice among hospitals.

  • Most people across the three groups say they had some or a lot of choice among doctors.
  • The most common ways people heard about their doctors was from a friend, family member or co-worker or from another doctor or medical care provider.
  • Very few people changed doctors while receiving diabetes care, prior to their joint replacement or during their pregnancy.
  • Most people recently diagnosed with type 2 diabetes were already patients of their diabetes doctor before their diagnosis. About half of those who recently had a joint replacement or who recently gave birth were patients of their doctors prior to their surgery or childbirth.
  • About half of people who recently had a joint replacement and half of women who recently gave birth say they had only one hospital to choose from.

FINDING 3

More people spent time learning about the care they needed than about doctors or hospitals. Few people knew or tried to find out if a doctor or hospital had the clinical qualities that they think are important.

  • Most people across the three groups spent a lot of time learning about their health situation or the type of care they needed. Fewer spent a lot of time learning about doctors or hospitals.
  • More people report knowing or trying to find out whether a doctor had the interpersonal qualities they say are important. Fewer report knowing or trying to find out whether a doctor or hospital had the clinical qualities they say are important.
  • Among those who say they did not know or try to find out whether or not a doctor or hospital had the qualities they think are important, many indicate it did not occur to them to do so and that knowing this information would not have influenced their decision.
  • Among people recently diagnosed with type 2 diabetes or who recently had a joint replacement, the most common clinical qualities they know or try to find out about while deciding on a doctor are qualities that can be directly experienced by patients.
  • Fewer know or try to find out about clinical qualities related to rates of patient outcomes.
  • Across the three groups, the source most commonly used to know or try to find out about qualities of doctors and hospitals is their own doctor who provides their diabetes care or provided their joint replacement or maternity care.



Percent who say they spent a lot of time learning everything they can about their health situation or about different doctors or hospitals, by group.

FINDING 4

Few people across the three groups are aware of quality variation or price variation for doctors or for hospitals.

  • While overall few people are aware that quality varies, more people are aware that interpersonal qualities vary across doctors. Fewer are aware that clinical qualities vary across doctors or hospitals.
  • Across all three groups, more people think clinical qualities that patients can experience directly are similar across doctors. Fewer think clinical qualities related to rates of patient outcomes are similar across doctors.
  • Few people who recently had a joint replacement or women who recently gave birth are aware that hospitals vary on each of the clinical qualities.
  • Few people are aware that doctors’ prices vary or that hospitals’ prices vary for diabetes care, joint replacement or maternity care.
  • Most people across all three groups say high prices are not a sign of better-quality care.



Average percent of people in each group who say the following about two interpersonal qualities of doctors in their insurance network or area and two clinical qualities of hospitals in their insurance network or area, by group.




FINDING 5

Most people across the three groups rate the overall quality of care they received positively. But some are uncertain how their doctors and hospitals stacked up on clinical qualities.

  • Most people across the three groups rate the overall quality of care they received from their doctor or hospital as very good or excellent.
  • Most people across all three groups say that, in their experience, their doctor had the interpersonal qualities they see as important. Fewer say that, in their experience, their doctor or hospital had the clinical qualities they see as important.
  • Across all three groups, some people say that, in their experience, they do not know whether or not their doctor or hospital had clinical qualities related to rates of patient outcomes.
  • Across all three groups, few people say they spent more out of pocket to get the quality of care they wanted.
  • Across all three groups, few people chose a doctor or hospital in a less convenient location in order to get the quality of care they wanted.

FINDING 6

About half of people across all three groups say there is enough information available about quality. Fewer say there is enough information about price.

  • About half of people across all three groups say there is enough information about the quality of doctors or hospitals for their respective type of care.
  • Less than a third of people in each of the three groups say there is enough information about the prices of doctors or hospitals for their respective type of care.
  • Across all three groups, about 1 in 5 do not know whether it is reasonable to expect people to compare prices and quality across different doctors.
  • Over half of people across all three groups say insurers should be required to make public how much they pay doctors and hospitals.

Implications

There is considerable progress to be made in measuring and reporting on quality in ways that reflect what people need and want. Based on these findings, this report concludes with implications for providers, insurance companies and other payers, employers and regulators so that efforts to improve quality and efforts to make quality information more readily available and easier to understand will be informed by and responsive to the needs of people who receive care.

  1. When defining quality, understand that people value different qualities of care depending on their health needs.
  2. Continue to elevate the importance of interpersonal qualities of doctors.
  3. Explore ways to help people learn about clinical qualities of doctors and hospitals.
  4. Identify the sources people use to learn about the care they need, and use those sources to provide information about quality.
  5. Doctors are important sources of information about quality.
  6. Consider the limitations of providing people with information about quality.

Methodology

Findings are based on three nationally representative surveys: a survey of 407 adults recently diagnosed with type 2 diabetes; a survey of 406 adults who recently had a joint replacement; and a survey of 413 women ages 18 to 44 who recently gave birth at a hospital. Surveys were conducted in October 2016 in English using an online probability-based web panel that is representative of the U.S. population. For more details about the methodology, see the full report.

Qualities in this Research

Quality has many dimensions. For diabetes care, joint replacement and maternity care, we asked about several aspects of quality, including interpersonal qualities of doctors, clinical qualities of doctors and—for joint replacement surgery and maternity care—clinical qualities of hospitals. For details about how we identified and selected the interpersonal and clinical qualities that we asked about, see the full report on our findings.




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