A Wider Lens, a Clearer Picture

Imagine you or a loved one is sick. Your doctor shares some treatment options — all of which are costly or come with significant risks. Do you make a decision based on only one expert's advice? Or seek out more information on your own?

Getting a second opinion or doing your own research can feel burdensome, but it’s worth the effort when the stakes are high. At the Foundation, we practice diligence to ensure that we are effective stewards of the generous resources we manage. Every year, we award tens of millions of dollars in grants to organizations working to end domestic violence and improve systems of care for California’s most vulnerable. Given these million dollar stakes, we are committed to learning and assessing the impact of our grantmaking so that when we do make funding decisions, we know they’re the right ones.

To help us do this, we’ve selected organization-wide performance measures, and dedicated staff time and resources to examining data, documenting past successes, and identifying opportunities to disseminate what we’ve learned. We have also sought “second opinions” to monitor the validity of our measures. For example, one of our organizational goals is to improve patient engagement in the healthcare safety net. To track our progress on this goal, we monitor data from the California Health Interview Survey (CHIS) run by UCLA. We use the survey to proxy patient engagement ratings on things like responsiveness, care coordination, and communication with providers. These are the three measures we chose to track:

• Responsiveness: Patients receive timely responses to their medical questions from their provider’s office.
• Care Coordination: There is someone at the doctor’s office who helps coordinate care with the patients’ other providers or services.
• Communication: The provider listens carefully to the patient.

Below are the CHIS 2013 findings:

While we value this trustworthy source of information, we also recognize that a single source data will never tell us the whole story. So, I decided to look for a second opinion!

And I didn’t have to look far. Patient engagement is a longstanding priority in our work, and we’ve funded several surveys, conducted by Langer Research Associates, in order to gain a clearer picture of the healthcare needs and preferences of low-income Californians. A new report featuring 2014 data was just released this February. Although the CHIS and Langer data are by no means apples to apples, the comparison gave me a better sense of what other experts in the field are seeing — how do the findings reinforce one another and where do they diverge?

I began by identifying questions in the Langer survey covering similar content to those asked in CHIS:

• Responsiveness: Patients’ ability to get an appointment as soon as they want one.
• Care Coordination: Use of a health navigator or care team.
• Communication: How well the provider communicates and explains things to patients in a way they can understand.

Our own survey shows the following 2014 outcomes related to patient experience:

What I found most interesting about this comparison is that although the absolute values of the ratings are largely different, the disparity in patient satisfaction among low-income Californians relative to the general population is directionally consistent: Low-income Californians deem their providers to be less responsive to their needs and to be less effective communicators. Both sources clearly show us that we can do more to level the playing field.

They also tell us that we must continue to ensure that our grantmaking is strategically directed at projects and approaches that will bridge the divides made evident in this research. As we track and measure our ongoing work, I look forward to seeing and learning even more — about year over year trends, other demographic breakdowns, etc.

I know that not all of us gravitate toward numbers, but through testimony or interviews, observation, or just mapping-out our logic for a colleague, there are many ways we can test our assumptions and inform our decisions, both in our personal lives and in the workplace.

¹ CHIS 2013-2014 Adult Questionnaire, January 2015. See questions J79, J80, J112, and J113 for precise question language and denominator information. http://healthpolicy.ucla.edu/chis/design/Documents/chis2013adultquestionnaire.pdf

² Langer Research Associates, February 2014. See Appendix D, questions 10a, 11b, 14,15, and 20a for question wording and denominator information. http://www.blueshieldcafoundation.org/publications/delivering-promiseadvances-and-opportunities-health-care