Do 'consumers' trust health care providers?
Hoosiers are about to tell the powers that be
Indiana's health care leaders are launching a statewide initiative to make sure their state's 5 million citizens are full partners in decisions affecting their care. The project, dubbed "Indiana's Eye on Patients," is designed to identify what specific health information consumers believe is most useful, to improve consumers' access to information, and to improve the care process in general through better communication. The project begins with research and then applies it, says Bob Morr, vice president of the Indiana Hospital and Health Association (IHHA) in Indianapolis.
"Everyone is a potential patient, and one of the most important things we've been hearing from residents in this state is their distrust of a system that they had trusted for years," says Morr. "They've been expressing frustration about the role the insurer or the health plan now plays in decision-making."
Morr says Hoosiers feel they are losing personal power in the health care transaction. "When asked in focus groups, 'Who do you think has the most effect over health care decisions for you: the health plan, the doctor, the hospital, the insurance company, or yourself,' [Indiana residents] say they want to see themselves put first in that order. Last would be an outside third-party payer." They also have concerns over what they perceive as a decline in quality of health care.
The Indiana State Medical Association and the Indiana University School of Medicine are co-sponsoring the initiative with the IHHA. They will lead a consortium that will publicly disseminate the data at a symposium in September.
"Many Hoosiers tell us they feel powerless when it comes to health care. They believe insurance plans, doctors, or hospitals control their medical destinies. They want to be in charge," says Roger J. Allman, president of King's Daughters' Hospital in Madison, IN. Once the launchers of the initiative learn precisely what consumers want, Allman says, they will work to provide it.
Eye on Patients includes five projects, each of which is designed to gather information that will help patients determine what care is right for them:
• Examining causes of variation.
Consumers had been asking why practice patterns vary not only across the country, but even within Indiana. Wide geographic variation in use rates, surgical procedures, and Medicare dollars spent is documented in the Dartmouth Atlas of Health Care. In addition, the IHHA databases show differences in admission and procedure rates among counties.
For example, a group of cardiologists, employers, and hospital leaders from Muncie identified other sites demographically similar to their area, such as South Bend, that had much lower angioplasty rates. According to the Atlas database, Muncie performed 8.1 angioplasties per 1,000 Medicare enrollees in 1995 — 26% higher than the national average (six procedures per 1,000 patients) and 43% higher than the rate in South Bend. The Muncie group has had great success in getting across-the-board support. "Changing behavior of physicians and health care leaders is one of the biggest hurdles to improving health care," stated John E. Wennberg, MD, principal investigator of the Atlas at Dartmouth (NJ) Medical School.
$150,000 has been committed to conduct a variation analysis at the School of Medicine.
• Researching public opinion.
About 20 focus groups will explore how hospitals and physicians can improve care and restore confidence in the system. Consumers will be asked to identify specific problems they have encountered and to discuss types of information they need to manage their own and their families' care. The results gathered will be widely circulated among hospitals and doctors and used as a framework for quality improvement projects within their organizations.
• Sharing decision-making.
Research has shown that the more information a patient has access to, the better his or her treatment choice, care, and outcome will be. Inappropriate utilization has been shown to decline when patients have more information, and cost savings are demonstrable. A task force will examine current products available for consumer education, including videotapes, Internet services, and manuals, to see which are most useful, most clinically sound, and most cost-effective. The group will discuss ways to encourage physician advocacy of sharing decision-making with consumers.
• Expanding patient perception databases.
Two years ago, a Patient Perception Profile initiative collaborated with the Picker Institute, a Boston-based firm specializing in patient survey research, to provide 36 hospitals and medical staffs with a database on patient feedback. The resulting comparative database now will be enhanced and expanded to include more hospitals, to increase the sample size, and to incorporate additional questions on how well the patient functions after discharge.
• Learning "what is right."
While Eye on Patients is a collective undertaking, the group understands that much can be learned from the individual efforts of providers, researchers, and others working to improve patient care. A special committee will issue a call for studies and will look at case studies on existing Indiana projects aimed at improving quality of care or patient-provider relations in such areas as end-of-life care, patient-focused billing, and shared decision-making protocols.
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