Why Aren't Numbers and Graphs Sufficient for a Quality Report?

Quality reports need a brief and compelling explanation of the purpose and value of the information they contain, as well as the trustworthiness of the report’s sponsor. This page discusses why this is necessary.

Quality Information Is New

Someday, consumers may look at information on health care quality in the same way that they now look at data on automobile safety and gas mileage: No one needs to explain that vehicles differ or why consumers should care about those differences.

Sponsors of reports on health care quality, on the other hand, face several challenges:

  • Low level of awareness. Most consumers aren’t familiar with quality information. The 2008 survey by the Kaiser Family Foundation found that only about 30 percent of the public has heard of any kind of comparative quality report being available.[1]
  • Low level of familiarity. Of the 30 percent of people who were aware of this kind of information, only half of them had looked at it.
  • Limited understanding of the benefits. Many consumers don't fully appreciate how objective, comparative information on health care quality can help them make better decisions for themselves and their families. Rather, they are accustomed to getting the information they think they need from people they trust, including family members, friends, and physicians. The job of report sponsors is not to replace these trusted sources, but to add new information to the decision-making mix.
  • Skepticism. Many consumers are skeptical about the source of this kind of information, wondering whether it is just another form of advertising.

Quality Varies and Can Be Poor

While many Americans are aware of problems in health care, more tend to focus on concerns about the costs of insurance and services, and difficulties in accessing care, rather than issues of quality and safety. Many continue to believe that we have “the best health care in the world.” Few are aware that nearly half the time, people don’t get the care that evidence indicates is best for their condition[2] or that safety problems are so pervasive.[3]

This false optimism limits the motivation to look at quality reports. If everyone is doing a great job, why bother? Sadly, not everyone is doing a great job, and there are potentially serious consequences when people choose hospitals, physicians and other providers who are not. You need to highlight the variation in quality in order to encourage people to actually look at your report.

Quality Information Is Complex

Even in its simplest form, health care quality information is hard to comprehend and even harder to use. When you present quality data, you are asking readers to:

  • Interpret a measure (often a numerical formula like a rate).
  • Understand what it says about a health care organization.
  • Recognize how it relates to quality.
  • Appreciate what it implies about the quality of care they may receive at a particular facility.

Then they must repeat that stream of tasks for multiple measures across multiple organizations and make accurate comparisons across organizations. This is not easy to do—and it's even harder in the absence of material that offers a context for what they are doing.

Part of the problem is that the “mental model” that many consumers and patients have about quality is different from the “mental model” of health professionals. For example, while it is easy for the public to recognize the link between provider-patient communication and the quality of their experience of health care, it is hard for them to recognize the importance of using evidence-based clinical process measures as an aspect of quality that influences the outcomes they are likely to experience.

Integrating and Applying Quality Information Can Be Difficult

Even if someone understands each of your data displays, putting the scores from multiple measures together is a daunting cognitive task. This step requires recognizing patterns in the data: Who does best overall? Who does best on the things I care about most? These patterns are often hard to see, even by report sponsors and health care organizations.

Yet, this step is critical to making a choice. You have to help report users make decisions based on the information you provide or it is unlikely to be used even if it is understood.

[1] Kaiser Family Foundation. 2008 update on consumers' views of patient safety and quality information. 2008 October 15. Available at: http://www.kff.org/kaiserpolls/posr101508pkg.cfm.
[2] McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003 Jun 26;348(26):2635-45.
[3] Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Committee on Quality of Health Care in America, Institute of Medicine. Washington DC: National Academy Press; 1999. Available at http://books.nap.edu/openbook.php?record_id=9728.

Also in "Explain and Motivate"

Page last reviewed November 2018
Page originally created February 2015
Internet Citation: Why Aren't Numbers and Graphs Sufficient for a Quality Report?. Content last reviewed November 2018. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/talkingquality/explain/numbers.html
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