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Show Report Cards: A Consumer-Driven Reality by Sara V. Sinclair, R.N., CNHA, FACHCA Introduction Although report cards are new on the health care scene, performance measurement and accountability are becoming requirements in our changing health care system. Both are sought by today's more knowledgeable consumers of health care, which include not only the patient, but employers, payers, health plans, and insurers. The employers, payers, health plans, and insurers are the most experienced in these areas of inquiry, but the number of patients who inquire is growing. Report cards seek to evaluate the performance and accountability of providers using the following general dimensions: access afforded, appropriateness of care delivered, the provider's capability (training, experience), cost, outcomes of the care delivered, and the satisfaction level of the patient. There has been a perception by many that purchasers of health care are only interested in controlling costs. In reality, purchasers want to buy value, which means not only controlled costs, but quality and access as well. Report cards are seen as one way to measure the value of services delivered. There is also a growing realization that quality health care is not automatically more expensive, but that cost-effectiveness is part of the definition of quality. Health care providers and professionals are not only expected to focus on the clinical outcomes of their care delivery efforts, but also on the degree to which care and its outcomes match consumers' expectations, as well as on the quality and cost of the customer service involved. The consumer of health care, as defined above, is more and more in the driver's seat in this day and age, and report cards are part of that phenomenon. They are perceived by many to have the power to point out weaknesses in the quality and appropriateness of care delivered, promote quality improvement, and positively affect costs. The state of Utah is focusing on the implementation of Healthprint, the incremental health reform plan developed through the efforts of Governor Michael O. Leavitt, the legislature, and the Health Policy Options Commission (the forerunner of the Health Policy Commission) with input from all types of stakeholders, public and private. Healthprint places emphasis on consumer responsibility and choice, and supports a competitive health care market place. Since report cards are in their infancy, many questions remain to be answered, and the report cards which do exist have room for improvement. The purpose of this article is to give an overview of Utah's report card activity while covering some of the general information surrounding report card development. Performance Measures: Challenge to Identify and Apply Performance of providers and health care systems can be evaluated by looking at a number of dimensions. However, the following seem to be among the most measurable and meaningful features to the broadest audience (USQA Quality Monitor, 1994), as noted above: •ACCESS-degree to which people have the ability to get wellness and illness care; •APPROPRIATENESS-degree to which the approach to care is consistent with current scientific evidence; •CAPABILITY-degree to which training and experience support the provision of care; •COST-effectiveness of direct and indirect costs of providing the health care services received; •OUTCOME-degree to which health and well-being are achieved; •SATISFACTION-degree to which care and its outcomes compare to the patients' needs and expectations. Performance measurement is not easy. There is a general concern that quality of care is difficult to define. Thus, it is challenging to reach a consensus on how to measure performance accurately, fairly, and consistently. The performance measures used tend to vary from one report to another, and not all report cards measure the same things. As the practice of developing report cards matures and improves, enhanced consistency of performance measures is expected to occur. It is important that these measures be valid in order to have meaning and value. Evaluative studies to determine the validity of report cards are just beginning to take place, but are essential to establish their value. In September of 1994, the United States General Accounting Office (GAO) submitted a report to the Chairman of the Committee on Labor and Human Resources, U.S. Senate, entitled, "Health Care Reform, 'Report Cards' are Useful but Significant Issues Need to be 12 Report Cards |