Help People Use Health Care Quality Information To Make Decisions

Some members of your audience will have a good idea of how to go about using quality information to make a decision about a health provider or plan, but others will not. You can help the latter group:

• Clarify to what extent they have a choice and what their options are.
• Identify the factors they need to consider in making a choice.
• Identify preferences and the need for trade-offs.
• Reduce the burden of decisionmaking.

Clarify the Extent and Nature of Choices

Some people truly are limited in their choice of health plans. Many are also limited in their choice of hospitals, physicians, and other providers by their health plan’s network.

However, many others perceive that they have no choice even though they do, or they don’t think they are capable of making a choice. For instance, they may believe that their insurance plan covers a much more limited set of providers than it in fact does. Or they may believe that their doctor is supposed to select the hospital to which they will be admitted or the specialist they should see, and that they have little or no say in the matter.

To avoid seeming out of touch with consumers, your report should acknowledge that some people have limited choices. You can then explain how to use the information in the report for purposes other than choice. At the same time, you can do some “myth-busting” to ensure that people who have real choices are aware of them—for example, by explaining that people can ask their doctors about other hospitals they might prefer.

Identify Factors To Consider

Quality

Because many report users will not have a clear and comprehensive definition of health care quality, you can help them recognize the value of the information in the report by defining quality and providing a clear, understandable framework for understanding different aspects of quality. (Learn how you can Provide a Framework for Understanding Quality.)

This framework is also critical to helping people make a decision, so look for ways to reiterate the framework in the section of your report devoted to supporting consumers in using the information. For example, you might briefly recapitulate the key concepts in the framework and use them to organize this part of the discussion.

Other Factors

Even though a wide range of quality measures is available today, it is important to acknowledge that consumers’ decisions about health plans and providers need to take factors beyond quality into consideration as well. If you do not do this, your audience may think you are out of touch with their reality. This is one reason to offer information on other factors, such as location, hours, languages spoken, and cost.

• If you include this kind of information in your report, let readers know where to find it. If the information is on your Web site, include a link to it.
• If you do not include this information, let readers know where and how they can find it elsewhere.

Provider Characteristics

While it may not be feasible for you to collect and report information on all provider characteristics that may be relevant to patients, you can provide a checklist that patients can use to gather information themselves from prospective physicians or other individual providers. These checklists typically suggest questions that people can ask, or specific things they should be looking for when they visit the provider.

For example, the Agency for Healthcare Research and Quality has developed a resource for consumers called Your Guide to Choosing Quality Health Care. This guide includes checklists for consumers who need to make different kinds of health care choices. It is available at: http://archive.ahrq.gov/consumer/qnt/.

Identify Preferences and the Need for Trade-offs

Report sponsors need to emphasize that the “right choice” depends on the values, preferences, and perceived needs of each individual or family. One simple way to do this is to provide examples of the different values and preferences that different people bring to typical choices.

You can address this point in a discussion of factors to consider. For example, you can point out that:

• For some people, whether a provider speaks their primary language is extremely critical, while for others it is not that important.
• For working people, whether a provider has office hours outside of typical working hours and days may be very important, since they may not be able to leave work except in a dire emergency. For retired people, on the other hand, a midday visit may be feasible and even preferable.
• For some people, avoiding surgical complications such as infections may be extremely critical, whereas for others, having providers who communicate clearly and respectfully is the highest priority.

Everyone wants everything they want—but that doesn’t mean it is easy or even possible to get it all. Emphasize to your users that, when making decisions, they will have to identify not just all the factors important to them, but the factors that are most important—what one might call the “deal breakers.” Help them understand that, since they probably cannot get everything they want, they should make sure they get whatever is most important to them.

Reduce the Burden of Decisionmaking

Too much information can be a burden. Cognitive science tells us that people can keep only seven (plus or minus two) thoughts in their short-term memory at once.^[1] It is even more difficult to bring together a number of factors, and decide how much weight each should get, in order to arrive at a choice.

Faced with more options or measures than they can handle, people will often narrow their choices on their own. But they will not necessarily do this in a way that focuses their attention on the most important measures or the most promising options. To keep things simple, they may ignore some attributes or aspects of care that really do matter to them.

Strategies for Reducing the Decisionmaking Burden

One important way to maximize use of quality data is to help people reduce this cognitive burden. This may involve helping people narrow their choices by:

• Reducing the number of plans or providers they compare.
• Reducing the number of measures on which they compare them.

Another way to help people make better decisions is to help them to integrate information about more aspects of care than they can easily think about on their own. Summary scores and visual displays that help people see the “big picture” across many measures can be helpful in this regard.

• Learn about using summary scores in Combining Measures Into Composites or Summary Scores.
• Learn about using word icon charts that help people get the big picture quickly in Providing Self-Explanatory Symbols.

Encouraging people to think about possible trade-offs between conflicting attributes can also be helpful.

Both strategies—helping people narrow their choices and helping them integrate complex information about multiple aspects of care—are facilitated by the functionality of the Web, but are considerably trickier in print reports.

If you do not take advantage of any of these data display options, you have all the more responsibility for providing report users with other ways to make decision making easier for individuals.

^[1] Miller GA. The magical number seven, plus or minus two: some limits on our capacity for processing information. Psychol Rev 1956 Mar;63(2):81-97. Available at: http://www.musanim.com/miller1956/.