Global ratings on quality of care of limited value

The patient perspective on quality of care is often summarized in a global rating. However, whether a global rating is an appropriate summary measure remains questionable. Research by the NIVEL and the Centre for Consumer Experience in Health Care shows that several quality aspects are not reflected by a global rating. The study is now published by the journal Health Expectations.
 

Patients suffering from breast cancer prioritize fast access to care and diagnostics, probably because breast cancer is a life threatening disease that elicits a sense of urgency. Patients suffering from diabetes are primarily concerned with disease management, which requires support and information for self management and frequent testing to monitor the disease. Patients that undergo a hip- or knee surgery prioritize information on the risks of surgery as well as how to avoid complications following surgery. 

Global ratings and patient priorities
Patients global ratings do not always reflect their experiences regarding priorities. This is particularly pronounced for patients with breast cancer. NIVEL-researcher Dolf de Boer says: “Breast cancer patients prioritize fast access to care and diagnostics. Nevertheless, they may still provide a high global rating, even if care or diagnostics were not provided particularly fast. As such, patients that choose a hospital should look beyond the global rating of care.” According to de Boer, this has also implications for health care providers: “Hospitals that receive high global ratings from their patients may still need to improve some aspects of care that are not represented by these ratings.”

Method
The paper reports data from five disease-specific surveys (Consumer Quality Index surveys): the CQI Mammacare, the CQI Hip or knee surgery, the CQI Diabetes, the CQI Rheumatoid Arthritis and the CQI Cataract surgery. These surveys measure both patient experiences and patient priorities. CQI surveys are being developed for a large number of diseases and care processes as a comprehensive assessment of quality of care should include the patient perspective. The CQI method has been developed by the NIVEL and the department of Social Medicine from the Amsterdam Medical Centre. Funding was provided both by health insurance companies (Agis and Miletus) and governmental bodies (ZonMw).