Engaging consumers in questions about health care quality, efficiency, and value through hospital compare: Formative research findings from consumer focus groups

Research Objective: Medicare's Compare consumer websites are increasingly used as vehicles for publicly reporting complex performance information for federal quality and value-based reform initiatives. Yet prior research, focused on presenting comparative performance measures to inform consumer choice, suggests that consumers lack a frame of reference for understanding technical information on quality and value. Organizing and presenting this information for lay audiences has therefore proved challenging. Using consumers' subjective perceptions to frame discussions of healthcare quality and value, this qualitative research explored the face validity of the Institute of Medicine's (IOM) aims for improvement and the National Quality Strategy's (NQS) quality domains as conceptual and organizational frameworks for engaging consumers and publicly reporting on Hospital Compare. Study Design: Inductive analysis of facilitated focus group discussions. Population Studied: Adult health care consumers (n=31) living in the Atlanta, GA metro area, mixed by race, gender, education, and prior hospital experience. Principal Findings: Consumers' subjective perceptions of quality, based on concrete phenomena they observe first-hand, identify factors associated with quality as defined by the IOM/NQS domains. Consumers understand measures reported on Hospital Compare as aggregate indicators of hospital quality when the information is presented in this context. Implications for Policy, Delivery, or Practice: Framing discourse around questions about health care quality and value, rather than consumer choice, creates the opportunity to develop a common language to engage consumers, using the IOM or NQS domains as a framework. The specificity of quality measures reported on Hospital Compare can enhance understanding of these quality domains.