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Quality Of Care: Balance Of Knowledge, Communication

BOSTON — We’re hearing from a lot of different groups lately about what’s wrong with health care and how to fix it. But what do patients think? To find out, we asked Massachusetts residents who said they had a serious illness, medical condition, injury or disability requiring a lot of medical care, or spent at least one night in the hospital within the last year.

Our poll, Sick in Massachusetts, finds that 48 percent of those who responded said they are “very satisfied” with the quality of their health care.

Dr. Tara Lagu, researcher at Baystate Medical Center in Springfield and assistant professor at Tufts Medical School, joined Morning Edition Tuesday to talk about the how to measure the quality of health care — regardless of how it is paid for.

Tara Lagu: One of the ways quality has been measured, at least at the level of physicians and practices, is that we measure what doctors are doing. Are they meeting all the check boxes? And I think that we as physicians really are going to have to start to have a cultural shift as we realize that quality is about getting the boxes checked, but it’s also about connecting with the patient, communicating with the patient. And so, it’s not that surprising to me that you could identify a “high quality doctor” and then get there and find that they spend the entire visit staring at the computer typing furiously trying to make sure they get everything done in the ten minutes.

Deborah Becker: So what do you recommend that patients do in terms of trying to find this information about quality? And what are we doing to try to make sure that that information is as comprehensive as possible and does include this patient experience that you’re referring to when doctors are rated?

So in Massachusetts, we’re very lucky in that we have a regional, nonprofit collaboration between hospitals, physicians and insurers that presents both these checked boxes. Do doctors measure all the right things and give all the right drugs? We present those data on the Massachusetts Health Quality Partner website, but MHQP also presents data about patient experience.

One of the things that is done in the United Kingdom is that patients are actually able to go on to some of these websites and both write about their experience and read about the experience that other patients have had. And similar to a review of a hotel or a restaurant, you can actually read the reviews and say, ‘OK, is this a person that shares my values?’ And if they are, then if they like this doctor, it might be a doctor that I would choose.

If there are a bunch of online reviews of a doctor, I’m obviously going to trust my neighbor over that. I’d look for word of mouth and I presume a lot of other patients probably do the same thing. Where should they look for information about a doctor and what do you find to be most useful?

Word of mouth can still be one of best ways to find a doctor. If you really want to go with a scientific sample that gets the most patients and really you can be very sure of the results and you don’t have this issue of who’s writing in and who are these people. I think a patient experience survey in what’s presented on the MHQP website can be extremely useful. But if you’re somebody who has special needs or unique needs or really wants something very specific, something like online reviews can be helpful as well.

I think it’s tough when you’ve got the whole art, science question in medicine and rating quality when it seems to be a mixture of both, really.

And I think, overtime, websites will emerge actually that will be more like dating websites than anything else, where you type in your specific needs and at the end of the day you get out a match or a few matches that might be right for you. There will be a time when you can say, ‘OK, I need this insurance and this doctor and this kind of communication style,’ and you type that in and the website gives you the answer that you want. It’s not here yet, but I don’t think it’s too far away.

The Blue Cross Blue Shield of Massachusetts Foundation, the Harvard School of Public Health (HSPH) and WBUR worked in partnership to produce Sick in Massachusetts. The Foundation commissioned and funded the HSPH poll. An independent research firm, SSRS, conducted the telephone interviews and provided WBUR with the names of poll participants. WBUR met with the partners to review the poll questions and analyze the results. WBUR shared story scripts with Robert Blendon at HSPH for fact checking purposes. WBUR, using internal editing procedures, decided how to frame and expand on issues raised by the results.

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