Involving Consumers in Quality of Care Assessment

Prologue: The voices of medical care consumers, never a major influence on providers, are beginning to enter the debate with increasing frequency. Despite our society's general acceptance of a market-driven economy, however, the question remains whether health care consumer data are a valid measurement of technical quality. Does the consumer have the knowledge base to make such a judgment? Opponents of consumers' ratings and data feel they reflect more about the interpersonal aspects of care and may be influenced by such factors as the quantity of services rather than technical quality. Here, Allyson Ross Davies and John Ware examine the assumption that consumers can provide valid information about the quality of medical care, specifically identifying those quality assessment and assurance activities that can rely on consumer data. After reviewing the research, the authors conclude that consumers can provide a valid assessment of quality and that bias from personal characteristics is not strong enough to invalidate consumers' ratings. Moreover, they find that “whatever quality means to the consumer, their perceptions of quality affect the choice among health care alternatives.” Davies, who holds a doctorate in health services research from the University of California at Los Angeles, is a health policy analyst for The RAND Corporation. Ware, who holds a doctorate in educational measurement and statistics from Southern Illinois University, is a senior research psychologist for RAND. Other researchers in the quality arena have praised the work of Davies and Ware as having “raised the art of surveying patients to a level not before attained, permitting health care providers to learn with precision … what their patients want and whether those desires are being met.”