Choosing Quality Health Care - A Guide -Karen Karle- USF Social Worker
This guide was developed by the Agency for Healthcare Research and Quality (AHRQ), in
cooperation with other agencies of the U.S. Department of Health and Human Services, and
other public- and private-sector health organizations. AHRQ was formerly the Agency for
Health Care Policy and Research (AHCPR)
AHRQ is the lead Federal Agency charged with sponsoring and conducting research on the
quality and outcomes of health care services, as well as the cost, use, and access to
those services. For more information on AHRQ-sponsored research and products, call
1-800-358-9295, or visit AHRQ's site on the World Wide Web.
For reliable consumer health and human services information and resources, visit the
healthfinder® gateway Web site, developed by the U.S. Department of Health and Human
A Quick Look At Quality
Quality health care means doing the right thing, at the right time, in
the right way, for the right personand having the best possible results. Although we
would like to think that every health plan, doctor, hospital, and other provider gives
high-quality care, this is not always so. Quality varies, for many reasons. Fortunately,
there are scientific ways to measure health care quality. These tools, called measures,
have mostly been used by health professionals. They use measures to check up on and
improve the quality of care they provide.
But there is some quality information you can use right now to help you
compare your health care choices. And more and more is becoming available all the time.
Many public and private groups are working to improve and expand health care quality
measures. The goal is to make these measures more reliable, uniform, and helpful to
consumers in making health care choices.
Choosing Quality Health Care - A Guide
Before You Begin
care is something we all want. But research shows that many people do not have the
information they need to make informed health care choices. The first step is to
understand what quality means and how it is measured. To find out, read A Quick Look at
This guide can help you find and use information about quality that is
based on research. You can use this information as you make five important health care
Choosing a Health Plan
Today there are more health plans to choose from than
ever before. Not everyone has a choice. But if you do, this section can help you choose
the plan that offers the best quality for you and your family.
The quality of health plans varies widely. In 1997, a study published by the National
Committee for Quality Assurance (NCQA) showed differences in the ways managed care
organizations provide access to care, keep people healthy, treat illness, deliver
high-quality service, and satisfy patients. For example, studies show that treating heart
attack patients with beta blocker drugs saves lives. The NCQA found that in some health
plans, most heart attack patients got beta blockers. In other health plans, only one in
Research shows that Americans say that quality is the most important thing they think
about when choosing a health plan. But research also shows that few people understand
their options well enough to make an informed choice.
Choosing a Doctor
It is important to choose your
doctor with care, because quality varies. For example, the Pacific Business Group on
Health asked patients of California doctors' groups how they rated their care. The
results? More than 80 percent of the patients said they were satisfied with their care.
But fewer than two-thirds were happy with the ease of getting that care.
This chapter can help you choose a primary care doctor who will meet
your needs and give you quality care. The information also may be useful in choosing any
specialists you might need.
Primary care doctors are specially trained to serve as your main doctor
over the long term. They provide your medical and health care, help you stay healthy, and
help to manage your care. Your primary care doctor can refer you to specialists (doctors
who treat only certain parts of the body, conditions, or age groups) if you need them
Research shows that millions of Americans receive treatments that are unnecessary,
costly, and even harmful to their health. On the other hand, millions of Americans do not
get the treatments they need.
Study after study has found that the use of certain treatments varies
widelyfrom region to region, State to State, and city to city. But there are even
large differences in the use of treatments within a single health plan or hospital, or by
a single doctor.
That is why it is very important to work closely with your doctor when
treatment decisions need to be made. Make sure your doctor knows your questions, concerns,
and preferences. Ask your doctor if the treatments he or she recommends are based on the
latest scientific evidence.
Choosing a Hospital
How can you choose the best quality hospital for the care you need? It is important to
consider quality, because research shows that some hospitals simply do a better job than
others. For example, we know that hospitals that do a greater number of the same surgeries
have better outcomes for their patients.
Choosing Long-Term Care
"Long-term care" means helping people of any
age with their medical needs or daily activities over a long period of time. Long-term
care can be provided at home, in the community, or in various types of facilities. This
section deals mainly with older people who need long-term care. However, the information
also may be useful for younger people with disabilities or illnesses that require
When you look for long-term care, it is important to remember that quality varies from
one place or caregiver to another.
It is also important to think about long-term care before a crisis occurs. Making
long-term care decisions can be hard even when planned well in advance.