Ordering Health Care Organizations in a Quality Report
In what order will different health plans or providers be presented in your report? Consider the following four options:
- Alphabetical Ordering.
- Rank Ordering by Performance.
- Ordering Within Cost Tiers.
- Providing Users with Ordering Options.
Alphabetical Ordering
Almost all early reports used alphabetical ordering of providers.
Advantages to Alphabetical Ordering
- It is easy for a user to find a particular provider they are looking for in the data.
- The order stays the same from one measure to the next.
- Providers generally view this as a “neutral” approach that they prefer.
Disadvantages to Alphabetical Ordering
- It is much harder for consumers to identify high and low performers quickly and accurately when alphabetical order is used than when rank ordering is used.[1]
Rank Ordering by Performance
Studies of reporting strategies point to clear advantages to rank ordering plans or providers by performance, from high to low.[1] This approach is considered highly “evaluable,” that is, easy for people to interpret.
Advantages to Rank Ordering
- Consumers are three to four times more likely to identify high and low performers accurately when this approach is used.
- Health care organizations are more likely to respond to the report with quality improvement efforts.
Disadvantages to Rank Ordering
- Health care organizations generally do not like this approach, since it makes it clear that some are nowhere near as good as others. Many prefer reports that are as neutral as possible, with as little interpretation as possible.
- The high performer is likely to be different for different measures, which may make it difficult for a user to find a particular provider they are looking for. However, this problem can be mitigated in Web-based reports; for example:
- The site could permit a user to look at all or a selected number of the measures available for a given entity or a small number of entities.
- The site could permit users to reorder the data as they choose.
Ordering Within Cost Tiers
Many sponsors want to incorporate cost or price as well as quality information into their reports. One effective approach is to provide information about quality within cost tiers.[2] For example, the sponsor can identify three cost tiers—high, medium and low—and within each tier, present quality ratings of plans or providers that fit into that cost tier.
Advantages to Ordering Within Cost Tiers
- This approach avoids a major problem with presenting cost information on its own: that consumers typically believe that high cost equals high quality. Presenting data in cost tiers can make it clear that it is possible to get high quality health care without choosing the most expensive plan or provider.
Disadvantages to Ordering Within Cost Tiers
- Some consumers may find it cognitively difficult to look at a combination of cost and quality information.
Providing Users With Ordering Options
One advantage of Web-based reports is that you can take advantage of interactive functions. One of these capabilities is letting individual users choose the way they want the data to be ordered in a display.
This tactic works best in tables, rather than graphs. If data are presented in columns, for example, the user can click on the column with the names of providers to order alphabetically by provider; if they choose to rank by performance, they can click on a column with quality data. In this format, you might have different columns of quality data and permit the consumer to click on each one to customize the report.
Advantages to Providing Ordering Options
- It gives readers options. Users can either use the “default” approach they see initially or choose their own way to display the data.
- More computer-savvy users will appreciate and perhaps even come to expect these options.
Disadvantages to Providing Ordering Options
- This strategy requires using the Web.
- In addition, it requires the resources to incorporate somewhat advanced functionalities into a report.
----------------
[1] Carman K. Improving quality information in a consumer-driven era: Showing differences is crucial to informed consumer choice. Presentation delivered at the 10th National CAHPS User Group Meeting, March 31, 2006. Pages 9–11. Available as PDF [670 KB].
Also see: McGee J. Best Practices for presenting Quality Data. Presentation delivered at the 11th National CAHPS User Group Meeting, CAHPS College, December 3, 2008. Slide 21. Available as PDF [440 KB].
[2] Hibbard JH, Sofaer S. Best Practices in Public Reporting: How to effectively present health care performance data to consumers. Agency for Healthcare Research & Quality: Rockville, MD; 2008.
