3 Key “Do’s” of Public Reporting R. Adams Dudley, MD, MBA Professor of Medicine and Health Policy Support: Agency for Healthcare Research and Quality, Robert Wood Johnson Foundation, California Health Care Foundation, California Hospital Assessment and Reporting Taskforce Disclosures: None

“If you only do 3 things, please be sure to…” 1.Know your customer: survey users and analyze click patterns! 2.Choose measures that matter to those customers: even if you have to develop them yourself! 3.Make sure they get the message: present the data so people can understand!

Tip #1: Know your customer: survey users and analyze click patterns!

A Burning Question for Public Reporting Collaboratives: How Can Our Reporting Activities Be Sustainable? To answer this, you need to know: –if your target users are coming to your site, –what information they use (among what is there) and –what information they seek but do not find

How might public reporting improve performance? Inducing providers to improve (target user = providers) OR Changing where patients go –Change consumers’ choices by education, engagement (target user = consumers) –By network or benefits design (target user = employers, labor unions, or health plans)

AHRQ Is Creating Tools To Help Know Your Users Team at University of California, San Francisco and University of Oregon –Creating survey tool –Writing software to analyze click patterns

Approach Multi-website survey of users Multi-website analysis of click pattern data Work with as many sites as volunteer

What can we learn from surveys? Some examples: Who are you? (e.g., age, education, patient/friend of patient vs. provider) Why are you here? (e.g., select doctor) Did you find the information you wanted? Did it affect your behavior? (e.g. your choice of doctor) What would have improved your experience?

What can we learn from click patterns? FOR EXAMPLE: Which diseases get the most clicks? What search key words do they use? How long do people spend on the Web site? Where do people leave the site most commonly?

Comparing Sites Do the answers to surveys/click analyses depend on how you set up your site? –We should be able to help participants increase traffic, impact, sustainability

Interested? For website survey/click analysis participation, contact: –Naomi Bardach and Adams Dudley at UCSF and

Tip #2: Choose measures that matter to your customers, even if you have to develop them yourself!

The Existence of NQF Has Not Eliminated Controversy about What to Measure E.g., in pediatrics, there are so few measures that CHIPRA now requires AHRQ to find or build new pediatrics measures –If pediatrics measures are important to your group’s sustainability, what can you do?

Readmissions: An Example Health plans partially fund the California Hospital Assessment and Reporting Taskforce. They were concerned about preventable readmissions –No measures available that tell hospitals how readmissions might be prevented.

2 Questions Added to CAHPS Hosp Survey

Value of Added Discharge Preparation Questions Answers to discharge preparation questions are associated with readmission—Hospitals that do worse have higher risk-adjusted readmission rates The questions also suggest what hospitals could do to improve (inform about meds, warning signs) Low cost to implement, important to customers

Tip #3: Make sure they get the message: present the data so people can understand!

Using a Framework to Communicate about Health Care Quality SOURCE: Judith Hibbard University of Oregon

Why a Framework? Consumers do not understand quality in the way it is measured and reported Providing a conceptual framework will help (just don’t call it that!)

What are the Criteria for a Quality Framework? Must communicate what quality of care is Must be no more than 3-4 categories Must be consistent with how the health care industry conceptualizes quality

The best quality medical care is when the doctor does things that are: EFFECTIVE = proven to work. SAFE = protects from medical errors. PATIENT FOCUSED = responsive to patients’ needs and preferences.

Un-translated and No Framework

Translated in Plain Language and No Framework

Framework and Translated into Plain Language

Comprehension of Hospital Quality Concepts Index Statistically significant at p<.05 when comparing all three versions from each other

Conclusions For any organization, sustainability depends on: –Knowing your customers/users –Providing services that matter to them –Making sure they receive and understand the service AHRQ is providing tools that will help you understand how to accomplish these 3 things in public reporting

Conclusions For website survey/click analysis participation, contact: –Naomi Bardach and Adams Dudley at UCSF and To learn more about frameworks see Model Public Report Elements: A Sampler: –