Guide to Health Care Quality

by US Department of Health and Human Services

How to Know It When You See It

This guide is designed to help you get quality health care. Getting quality health care can help you stay healthy and recover faster when you become sick.

The tips presented here are provided to help you be active in making decisions about your health care. The goal is to make sure you receive the best possible care.

You Deserve Quality Health Care

Getting quality health care can help you stay healthy and recover faster when you become sick. However, we know that often people do not get high-quality care. A 2004 study of 12 large U.S. communities found that just over half (54.9 percent) of people were receiving the care they needed.

What exactly is health care quality? We know that quality means different things to different people. Some people think that getting quality health care means seeing the doctor right away, being treated courteously by the doctor's staff, or having the doctor spend a lot of time with them.

While these things are important to all of us, clinical quality of care is even more important. Think of it like this: getting quality health care is like taking your car to a mechanic. The people in the shop can be friendly and listen to your complaints, but the most important thing is whether they fix the problem with your car.

Health care providers, the government, and many other groups are working hard to improve health care quality. You also have a role to play to make sure you and your family members receive the best quality care possible.

Be Active: Take Charge of Your Health Care

The single, most important thing you can do to ensure you get highquality health care is to find and use health information and take an active role in making decisions about your care.

Here are some steps you can take to improve your care:

• Work together with your doctor and other members of the health care team to make decisions about your care.

• Be sure to ask questions.

• Ask your doctor what the scientific evidence has to say about your condition.

• Do your homework; go online or to the library to find out more information about your condition.

• Find and use quality information in making health care choices. Be sure the information comes from a reliable source.

Talking with Your Doctor

Here are some examples of questions to ask your doctor. It is not a complete list. You will probably have many other questions. You should keep asking questions until you understand what is wrong with you and what you need to do to get better.

Understand your diagnosis:

• What is wrong with me?
• What do I need to do to get better?
• Where can I get more information about my condition?

If you need a lab test, an x-ray, or another kind of test, ask your doctor:

• How will the test be done?
• How accurate will the results be?
• What are the benefits and risks of the test?
• When and how will I receive the results?
• What should I do if I don't receive the results?

If you receive a prescription for a new medicine:

• What is the name of the medicine?
• What is it supposed to do?
• When should I take the medicine, and how much should I take?
• Does the medicine have any side effects?

If you need surgery:

• What kind of operation do I need?
• Why do I need an operation?
• What are the benefits and risks of the operation?
• How long will it take to recover?
• What will happen if I don't have the operation?
• Are there any other treatments I could have instead of an operation?
• Where can I get a second opinion?

Understanding Health Care Quality

Research has shown that science-based measures can be used to assess quality for various conditions and for specific types of care. For example, quality health care is:

• Doing the right thing (getting the health care services you need).
• At the right time (when you need them).
• In the right way (using the appropriate test or procedure).
• To achieve the best possible results.

Providing quality health care also means striking the right balance of services by:

• Avoiding underuse (for example, not screening a person for high blood pressure).

• Avoiding overuse (for example, performing tests that a patient doesn't need).

• Eliminating misuse (for example, providing medications that may have dangerous interactions).

We would like to think that every doctor, nurse, pharmacist, hospital, and other provider gives high-quality care, but we know this is not always the case. Quality varies depending on where you live. Quality can vary from one State to another, and it can vary from one doctor's office across the street to another. Health care quality varies widely and for many reasons.

For example, timely receipt of clot-busting drugs can save lives for patients suffering heart attacks. The national standard for providing clot-busting drugs is within 30 minutes of a patient's arrival at the hospital. But we know that this varies widely across States, from a low of 20 minutes in one State to a high of 140 minutes in another.

Efforts to Improve Health Care Quality

Improving health care quality is a team effort, and it is ongoing on many levels. To succeed, every part of the health care system must become involved, including government and nongovernment organizations, doctors, nurses, pharmacists, hospitals, other providers, and you, the patient.

Sarah's Story Sarah can tell you a story about the importance of getting good quality health care. Last year, she decided to have elective surgery to repair a hernia. She visited the surgeon in his office before the operation and was very pleased with his bedside manner and friendly staff. Sarah put herself in the doctor's hands and didn't ask many questions. Although Sarah's operation went smoothly, she soon developed a high fever from an infection. The doctor said she would have to stay in the hospital a few extra days. That's when things began to go wrong. When she really needed them, the nurses were slow to respond to her calls, her doctor didn't always stop in to see her during his hospital rounds, and she sometimes didn't get her pain medicine on time. Fortunately, Sarah's infection finally cleared up, and she was sent home to recuperate from her surgery. Sarah is fine now, but this story could have had a very different ending. If you need surgery, be sure to ask your doctor about the risks and benefits of the operation.

One way to assess and track quality of care is by using measures that are based on the latest scientific evidence. A health care measure clearly defines which health care services should be provided to patients who have or are at risk for certain conditions. Measures also set standards for screening, immunizations, and other preventive care.

There are two types of measures: clinical measures and consumer ratings.

Because measures are intended to set general standards for a broad population, they may or may not apply to you. Always check with your doctor about your level of risk for a particular condition and which types of screening and tests you should have.

About the Author

The Department of Health & Human Services is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. The department includes more than 300 programs, covering a wide spectrum of activities.