Click for more options

Improving Colorado Health Care & Health Insurance Quality

Improving Quality in Changing Times: Health Outcomes

Public opinion and research evidence support the perception that the quality of health care in the United States is sub-optimal. Efforts to improve quality can be directed at four levels, individually or in combination: the patient, the clinician, the practice or hospital microsystem, and the larger health care delivery macrosystem. Research at the Colorado Health Outcomes Program (COHO) of the University of Colorado Health Sciences Center (www.uchsc.edu/coho) is addressing quality at many of these levels.

Patients assert control over the quality of health care through their decisions to accept, modify, or ignore medical advice. COHO research emphasizes the role of information technology in helping patients make more informed decisions about their health. COHO investigators have shown that sharing medical records with heart failure patients increases self-efficacy and adherence, while direct email links with clinicians are used judiciously and improve satisfaction with communication. We are currently assessing a web-based patient portal to assist individuals with diabetes in setting their own goals for self-care.

Nationally, many efforts have been made to improve quality by changing the practice patterns of clinicians. Such interventions have been only modestly successful and are difficult to sustain, in large part because physicians are overwhelmed with myriad competing demands and expectations. For this reason, COHO research has not emphasized clinician interventions but has rather focused on interventions to improve microsystems of care. COHO is the data coordinating center for the National Surgical Quality Improvement program of the VA health care system and a comparable program in the private sector. Since this program began in 1994, surgical mortality has fallen by 45% and postoperative morbidity by 28% in the VA system. COHO has also conducted interventions at the practice level in both the public and private sectors to improve primary care and preventive service delivery.

Quality improvement at the macrosystem level involves policy efforts such as expanding health care coverage or using payment policies to improve care. COHO has evaluated one statewide effort to expand coverage for uninsured children in Colorado, the State Child Health Insurance Plan (SCHIP), and has found that accessibility, unmet needs for care, and patient ratings of overall quality improved after enrollment.

Such efforts to improve the quality of health care take place at the interface of biomedicine, public health, and health policy. The necessary tools encompass the sciences of individual behavior change, organizational change, epidemiology, economics, and informatics. COHO's multidisciplinary approach is designed to apply these tools systematically.

Coverage by Region:

Resources:

Articles:

Colorado Consumers Guide to Health Insurance:

Links: