Performance reports on quality - prototypes, problems, and prospects

Article Abstract:

The development of standardized reports on health care quality requires governmental and private support as well as cooperation between companies. Such reports, known as report cards, include different information, such as service accessibility, patient satisfaction, mortality rates, and immunization rates. Some standardized reports are widely used by health plans. The problems with such reports include their expense, inability to incorporate risk, and incompleteness. National health care reform, if it had passed, would have led to further development of standard reports. However, competition between providers will encourage the development of report cards and government will probably continue to support such development. Report cards will be helpful even if they only distinguish between poor and excellent providers. Report cards should be based on scientific evidence that demonstrates effectiveness and they must include evaluations of risk. Report cards need not be the same in all regions and the indicators should change as the field of medicine changes.

Column, Managed care plans (Medical care)

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Does increased access to primary care reduce hospital readmissions?

Article Abstract:

Intensive primary care management of people with chronic diseases may not reduce their rates of hospitalization. Researchers allocated 1,396 veterans to receive either standard care or intensive intervention by a primary care physician and nurse after discharge from nine Veterans Affairs Medical Centers. All of the patients had been hospitalized for diabetes, congestive heart failure or chronic obstructive lung disease. People with these diseases commonly have frequent hospital admissions. Compliance with intensive intervention ranged from 83% to 93% depending on the site. During the six-month study, patients receiving intensive intervention made more visits to general medicine clinics and fewer visits to specialty clinics than those in the control group. However, more patients in the intensive intervention group were readmitted to the hospital and were readmitted sooner than those in the control group. They also had more readmissions than those in the control group. But they were more satisfied with their care than the patients in the control group.

Care and treatment, Hospitals, Veterans, Hospital admission and discharge

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Assessment of quality-of-life outcomes

Article Abstract:

Careful measurement and analysis of quality-of-life outcomes may inform health workers and policymakers about costs and benefits of treatments that cannot solely be determined using objective measures of health. Quality of life is not normally considered to be directly measurable, but may be indirectly determined by asking questions, each of which is an item that can be combined to yield an overall quality-of-life score. The difficulties of working with subjective measures of health may be managed by ensuring the accuracy and sensitivity of measurements. This may be seen in the coverage of all relevant symptoms in a questionnaire, or the ability of a measure to detect changes that would be expected to result from certain objective, clinical changes. Interpretation may be aided by asking disease-specific questions and calibrating responses against familiar quality-of-life changes such as a change in sleeping habits or a death in the family.

Usage, Measurement, Quality of life, Health status indicators

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