Consumers are unable to make clear distinctions about the healthcare providers best suited for them because they lack adequate knowledge of the relative cost and degree of effectiveness of healthcare services, so they cannot select providers based on the quality (value) of their care.

Solution: Increase Consumer Knowledge and Awareness

Informing consumers about providers’ involvement in quality improvement programs dealing with their particular health problems, and the benefits consumers gain when treated by these providers, would give those providers competitive advantage and drive quality improvement initiatives.

Moves to inform the public of hospital performance has already begun. For example, the New York State Department of Health launched a Web site[1] in January 2006 that compares the performance of hospital regional hospitals by region using process and risk-adjusted outcome measures[2] for common health conditions, as well as the number of common medical and surgical procedures performed annually. These “report cards” are designed, according to State officials, to raise quality by applying competitive market pressures.[3] And in February, the Massachusetts Health Quality Partners group, a coalition of 150 medical groups, posted efficacy data on its web site — measuring the reliability with which patients receive tests and treatments known to improve outcomes — in order to encourage consumers to search for high-quality providers and guide physicians looking to improve their performance.[4]

While these report cards push hospitals to focus on quality improvement, the data are open to misinterpretation, very limited in scope, and may not help providers improve their care quality. This is because the quality measures in use today tend to be based on immature, imprecise, static practice guidelines, and patient satisfaction scores[5], instead of the valid, precise, evolving quality metrics and evidence-based practice guideline outcomes that can only come from the kind of wide-spread, collaborative, interdisciplinary quality improvement efforts recommended by the Quality though Knowledge model.

Providers who are proactive in developing and using guidelines in a way that shows the public they are learning organizations truly dedicated to delivering the ever-increasing care quality are the ones most likely to gain competitive advantage.

Next: Conclusion

Footnotes and References

[1] New York State Hospital Profile is located at
[2] Outcomes data are risk-adjusted to account for the differences between patients treated by different providers so the outcomes data can be used to compare the performance of providers. This is necessary since some providers treat patient who are older or sicker than the patients of other providers. The risk factors include patient demographics (e.g., gender and age) and clinical characteristics (e.g., type of illness, severity of symptoms, and coexisting problems) that might influence the outcome care.
[3] Mahony, J. (Jan 20, 2006). Hospital data posted on Net. New York Daily News.
[4] Foubister, V. and Anne-Marie Audet, A. (February 2006). Quality Matters: Public Reporting of Physician Group Quality Data. The Commonwealth Fund; vol. 16. Available at
[5] Connolly, C. (February 16, 2006) Vital Evidence: Taking Patients' Word May Be Ill-Advised. Available at

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