Consumers' guides that profile the quality of care of individual health care providers may be influential in shaping health care markets. We propose four simple questions that can be used to evaluate such guides: (a) Does the guide measure distinct and important domains of health care quality? (b) Are the individual measures of quality described simply and precisely? (c) Do the measures take into account relevant differences between patients? (d) Are the ratings of quality presentedfairly? Using these four questions, we examine the validity of one prominent guide that annually identifies America's best hospitals and present a set of recommendationsfor the design of future guides. Although the evaluation of health care quality is undoubtedly complex, the four questions that we pose provide a basisfordeveloping a more rational approach to informing the public about health care quality.
Get full access to this article
View all access options for this article.
References
1.
America's best hospitals: 1996 annual guide
. (1996, August 12). U.S. News and World Report, 65-87.
2.
Annual report of the California Hospital Outcomes Project: Vol. 1. Study overview and results summary. (1993a, December). Sacramento, CA: Office of Statewide Hospital Planning and Development.
3.
Annual report of the California Hospital Outcomes Project: Vol. 2. Technical appendix. (1993b, December). Sacramento, CA: Office of Statewide Hospital Planning and Development.
4.
Baker, D. W.
, Stevens, C. D., & Brook, R. H. (1991). Patients who leave a public hospital emergency department without being seen by a physician. Journal oftheAmerican MedicalAssociation, 266, 1085-1090.
5.
Bennett, C. L.
, Garfinkle, J. B., Greenfield, S., Draper, D., Rogers, W., Mathews, C., & Kanouse, D. E. (1989). The relation between hospital experience and in-hospital mortality for patients with AIDS-related PCP. Journal of the American Medical Association, 261, 2975-2979.
6.
Blumberg, M. S.
(1987). Comments on HCFA hospital death rate statistical outliers. Health Services Research, 21, 715-739.
7.
Brennan, T. A.
, Hebert, L. E., Laird, N. M., Lawthers, A., Thorpe, K. E., Leape, L. L., Localio, A. R., Lipsitz, S. R., Newhouse, J. P., & Weiler, P. C. (1991). Hospital characteristics associated with adverse events and substandard care. Journal of the American Medical Association, 265, 3265-3269.
8.
Brook, R. H.
(1994). Health care reform is on the way: Do we want to compete on quality?Annals of Internal Medicine, 120, 84-86.
9.
Chassin, M. R.
, Park, R. E., Lohr, K. N., Kessey, J., Brook, R. H. (1989). Differences among hospitals in Medicare patient mortality. Health Services Research, 24, 1-31.13.
10.
Cleary, P. D.
, Edgman-Levitan, S., Roberts, M., Moloney, T. W., McMullen, W., Walker, J. D., & Delbanco, T. L. (1991, Winter). Patients evaluate their hospital care: A national survey. Health Affairs, 254-267.
11.
Cleveland health quality choice: Summary report. (1995, May 24). Cleveland, OH: Quality Information Management Corporation.
12.
A consumer guide to coronary artery bypass graft surgery: Vol. 4: 1993 data. (1995). Harrisburg: Pennsylvania Health Care Containment Council.
13.
The cost/quality challenge. (1994). Boston: Massachusetts Healthcare Purchaser Group.
14.
Coronary artery bypass graft surgery: Vol. 4. Technical report, 1993. (1995). Harrisburg: Pennsylvania Health Care Containment Council.
15.
Donabedian, A.
(1980). Explorations in quality assessment and monitoring: Vol. 1. The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press.
16.
Green, J.
, Passman, L. J., & Wintfeld, N. (1991). Analyzing hospital mortality: The consequences of diversity in patient mix. Journal of the American Medical Association, 265, 1849-1853.
17.
Green, J.
, & Wintfeld, N. (1995). Report cards on cardiac surgeons: Assessing New York State's approach. New England Journal of Medicine, 332, 1229-1232.
18.
Green, J.
, Wintfeld, N., Sharkey, P., & Passman, L. J. (1990). The importance of severity of illness in assessing hospital mortality. Journal of the American Medical Association, 263, 241-246.
19.
Greenfield, S.
, Aronow, H. U., Elashoff, R. M., & Watanabe, D. (1988). Flaws in mortality data: The hazards of ignoring comorbid disease. Journal of the American Medical Association, 260, 2253-2255.
20.
Hannan, E. L.
, Kilburn, H., Racz, M., Shields, E., & Chassin, M. R. (1994). Improving outcomes of coronary artery bypass surgery in New York State. Journal of the American Medical Association, 271, 761-766.
21.
Hartz, A. J.
, Krakauer, H., Kuhn, E. M., Young, M., Jacobsen, S. J., Gay, G., Muenz, L., Katzoff, M., Bailey, R. C., & Rimm, A. A. (1989). Hospital characteristics and mortality rates. New England Journal of Medicine, 321, 1720-1725.
22.
Health Plan Employer Data and Information Set and User's Manual (HEDIS) (Version 2.0) [Computer software]. (1993). Washington, DC: The National Committee for Quality Assurance.
23.
Hibbard, J. H.
, & Jewett, J. J. (1997). Will quality report cards help consumers?Health Affairs, 16, 218-228.
24.
Hosenpud, J. D.
, Breen, T. J., Edwards, E. B., Daily, O. P., & Hunsicker, L. G. (1994). The effect of transplant center volume on cardiac transplant outcome: A report of the United Network for Organ Sharing Scientific Registry. Journal of the American Medical Association, 271, 1844-1849.
25.
Iglehart, J. K.
(1988). Competition and the pursuit of quality: A conversation with Walter McClure. Health Affairs, 7, 79-90.
26.
Jensen, J.
(1992). Consumers see mortality data as a useful tool. Modern Healthcare, 22, 82-82.
27.
Jollis, J. G.
, Petersen, E. D., DeLong, E. R., Mark, D. B., Collins, S. R., Muhlbaier, L. H., & Pryor, D. B. (1994). The relation between the volume of coronary angioplasty procedures at hospitals treating Medicare beneficiaries and short-term mortality. New England Journal of Medicine, 331, 1625-1629.
28.
Kahn, K. L.
, Rogers, W. H., Rubenstein, L. V., Sherwood, M. J., Reinisch, E. J., Keeler, E. B., Draper, D., Kosecoff, J., & Brook, R. H. (1990). Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. Journal of the American Medical Association, 264, 1969-1973.
29.
Kassirer, J. P.
(1993). The quality of care and the quality of measuring it. New England Journal of Medicine, 329, 1263-1265.
30.
Linn, M. W.
, Linn, B. S., & Stein, S. R. (1982). Satisfaction with ambulatory care and compliance in older patients. Medical Care, 20, 606-614.
31.
Localio, A. R.
, Hamory, B. H., Sharp, T. J., Weaver, S. L., TenHave, T. R., & Landis, J. R. (1995). Comparing mortality in adult patients with pneumonia: A case study of statistical methods in a managed care program. Annals of Internal Medicine, 122, 125-132.
32.
McNeil, B. J.
, Pedersen, S. H., & Gatsonis, C. (1992). Current issues in profiling quality of care. Inquiry, 29, 298-307.
33.
1993 baseline performance profile. (1994). Boston: New England HEDIS Coalition.
34.
1995 best hospitals: The hospital rankings. (1995, July 24). U.S. News and World Report, 61-79.
35.
Phelps, C. E.
(1993). The methodologic foundations of studies of the appropriateness of medical care. New England Journal of Medicine, 329, 1241-1245.
36.
Podolsky, D.
, & Beddingfied, K. T. (1993, July 12). America's best hospitals. U.S. News and World Report, 66-74.
37.
Relman, A. S.
(1988). Assessment and accountability: The third revolution in health care. New England Journal of Medicine, 319, 1220-1222.
38.
Rosenthal, G. E.
, Chren, M. M., Lasek, R. L., & Landefeld, C. S. (1996). The "Annual Guide" to "America's Best Hospitals:" Evidence of influence among health care leaders. Journal of General Internal Medicine, 11, 366-369.
39.
Rosenthal, G. E.
, & Harper, D. L. (1994). Cleveland health quality choice: A model for community-based outcomes assessment. Joint Commission Journal on Quality Improvement, 20, 425-443.
40.
Rubenstein, L. V.
, Kahn, K. L., Reinisch, E. J., Sherwood, M. J., Rogers, W. H., Kamberg, C., Draper, D., & Brook, R. H. (1990). Changes in quality of care for five diseases measured by implicit review: 1981 to 1986. Journal of the American Medical Association, 264, 1974-1979.
41.
Rubin, R.
(1994, July 18). America's best hospitals. U.S. News and World Report, 54-65.
42.
Schneider, E. C.
, & Epstein, A. M. (1996). Influence of cardiac-surgery performance reports on referral practices and access to care: A survey of cardiovascular specialists. New England Journal of Medicine, 335, 251-256.
43.
Showstack, J. A.
, Rosenfeld, K. E., Garnick, D. W., Luft, H. S., Schaffarzick, R. W., & Fowles, J. (1987). Association of volume with outcome of coronary artery bypass graft surgery: Scheduled vs. nonscheduled operations. Journal of the American Medical Association, 257, 785-789.
44.
Sullivan, L. W.
, & Toby, W. (1992). Medicare hospital information report 1988, 1989, 1990 (Vols. 1-55). Washington, DC: Health Care Financing Administration, U.S. Department of Health and Human Services.
45.
Wilson, P.
, & McNamara, J. R. (1982). How perceptions of a simulated physician-patient interaction influence intended satisfaction and compliance. Social Science and Medicine, 16, 1699-1704.
46.
Winslow, R.
(1995, July 18). What actually makes a hospital the "best"?The Wall Street Journal, p. B1-B1.
