AHRQ Research Advances New Approaches to Public Reporting

Just as no two people are exactly alike, neither are their health care needs. Every hospital, nursing home, medical office, and health plan offers a unique range of prices, facilities, and services.  Likewise, every patient has unique health care needs, preferences, values, and personal circumstances. When it comes to making choices about care, there is no one-size-fits-all.

Fortunately, important progress has been made when it comes to providing meaningful information to consumers about their health care choices. Officials at our sister agency, the Centers for Medicare & Medicaid Services (CMS), have been leading the way in public reporting of health care quality information.  Nursing Home Compare became CMS’ first reporting Web site in 2002. The site provides standardized comparative information in the areas of health inspections, quality measures, and staffing for more than 15,000 nursing homes across the United States.  Nursing Home Compare introduced a 5-star summary measure in 2008 to make comparison easier for consumers.

However, even with CMS’ efforts and the work of other leading organizations,  virtually all public reports of health care quality rate nursing homes on a fixed set of measures that does not take into account consumer preferences. For instance, while CMS’ 5-star rating system was developed by an expert panel, the ratings are standard and cannot be personalized based on consumer needs.

In the April special issue of Health Affairs, four articles by AHRQ-funded researchers explore different facets of health care consumer engagement, including patient-reported outcomes, public deliberation, and public reporting. The research was conducted by research teams that put patients and consumers  front and center in their efforts to design better evidence-based measures and tools to support informed, engaged consumers. The articles are:

• Incorporating Patient-Reported Outcomes Into Health Care To Engage Patients And Enhance Care.
• Understanding An Informed Public’s Views On The Role Of Evidence In Making Health Care Decisions.
• Use Of Nursing Home Compare Website Appears Limited By Lack Of Awareness And Initial Mistrust Of The Data.
• When Patients Customize Nursing Home Ratings, Choices And Rankings Differ From The Government’s Version.

In their article, "Use of Nursing Home Compare Website Appears Limited," AHRQ grantee Tamara Konetzka, Ph.D., and colleague Marcelo Perraillon, Ph.D., explored consumers' interest in and use of CMS’ Nursing Home Compare for making decisions. Most consumers had a positive reaction to the site, but explained that their choices were often limited by nursing home location, insurance accepted, and availability of beds. They liked the information they saw, but would also have liked to see information about activities, cost, and consumer experience. Unfortunately, most of the participants were not familiar with Nursing Home Compare, suggesting the potential for additional marketing and outreach.

The article, "When Patients Customize Nursing Home Ratings," offers an excellent example of how researchers are exploring practical ways to build on CMS’ groundbreaking success to better connect consumers with Nursing Home Compare.  AHRQ grantee Dana Mukamel, Ph.D., developed a novel tablet-based application built on Nursing Home Compare data. This app—provided on a bedside tablet prior to a patient’s discharge from hospital to nursing home—offers  guided education about the quality measures and allows consumers to select and weight the measures that matter most to them. Consumers are then presented with a personalized report ranking nursing homes in their area.  

Drs. Konetzka’s and Mukamel’s studies are part of AHRQ’s  Building the Science of Public Reporting  grant initiative, co-funded with CMS.  These exciting studies, along with the other AHRQ-funded research featured in the new issue of Health Affairs, represents just some of the exciting new work being done to allow consumers to use everyday technology to make informed health care decisions.