Explain Whether a High or Low Health Care Quality Score Is Better

Ideally, all the measures in a given report would be structured so that people were consistently looking for a high score or a low score as an indicator of good performance. Switching directions can be confusing and create a cognitive burden on users of the information.[1]

But sometimes it is not possible to avoid switching directions. For example, a report on medical groups may include measures one would want to be high, such as patient reports on physician-patient communication, as well as measures that should be low, such as the number of medication errors.

In that situation, you will need to include a statement at the top of a data presentation explicitly saying whether users should look for a high or low score. Don’t assume that it will be self-evident. If you are changing from basketball scores to golf scores midstream, people need help reorienting.

For example, a model report on the AHRQ Quality Indicators shows a bar graph about the death rate for brain surgery. Here’s the introduction to the bar graph:

EXAMPLE: Explain Whether Users Should Look for a High score or Low Score

Title: Model Report on AHRQ Quality Indicators
Sponsor: Agency for Healthcare Research
URL: http://www.qualityindicators.ahrq.gov/Downloads/Modules/QI_Reporting/Model_Report_Composite.pdf
Death rate for brain surgery
This graph shows you the percent of patients who died after brain surgery (called a craniotomy). This information is for patients admitted during [insert year].
When you are choosing a hospital, you should look for the hospital that has a lower number of deaths for this operation. A lower number is shown by a shorter bar on the graph below.

Source: Agency for Healthcare Research and Quality. Hospital Quality Model Report: Composites. 2009. Available at http://www.qualityindicators.ahrq.gov/Downloads/Modules/QI_Reporting/Model_Report_Composite.pdf.

[1] Peters EM, Dieckmann N, Dixon A, Hibbard JH, Mertz CK. Less is More in Presenting Quality Information to Consumers. Medical Care Research and Review 2007. 64(2):169-190.

Also in "Describing Measures in User-Friendly Ways"

Page last reviewed March 2016
Page originally created February 2015
Internet Citation: Explain Whether a High or Low Health Care Quality Score Is Better. Content last reviewed March 2016. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/talkingquality/translate/labels/explain-score.html
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