Judith H. Hibbard, Dr.P.H., has conducted some of the most important research on consumers' involvement in their health care. In particular, she has focused on how consumers, through their own actions, can obtain higher quality medical care. Two streams of research characterize her current work: 1) consumer use of comparative information to make informed choices; and 2) consumers and patients as "co-producers" of care.

Hibbard's first HCFO grant assessed how information can be presented to consumers so that it easier to understand and more likely to be used in their choices. The research team, which included cognitive science researcher Paul Slovic, used controlled laboratory studies to test different ways of presenting health care performance measures so that it was most likely to be understood and used. The findings showed that a particular presentation approach, called "evaluability" could make a dramatic difference in whether the information was actually weighted and used in choice. Using evaluability strategies in reporting means presenting the data in a way that a viewer can very easily and quickly see which are high- and which are low-performing options. So, for example, ordering by performance is an evaluability strategy.

Hibbard's current HCFO grant evaluates the impact on both consumers and hospitals of a hospital safety report produced by the Alliance in Madison, Wisconsin. The report was carefully designed, "evaluable," and publicly accessible. The early findings show that making performance information public increases hospital concern for their public image and motivates quality improvement activity among those hospitals that had poor scores on the public report. Hospitals that received a private confidential report on their own performance and had equally poor scores engaged in far fewer quality improvement activities. Hospitals with no performance report engaged in the least number of quality improvement activities (Hibbard, Stockard, Tusler, 2003).

These projects build on Hibbard's earlier work, which included evaluating consumers' use of physician fee information and, later, their use of quality information. From these studies, Hibbard concluded that cost information did not affect consumers' choices or utilization rates. In fact, she learned that consumers sometimes used a high price as a proxy for high quality. She also concluded that consumers were overwhelmed initially by the quality information available and were unsure of how to use it in making choices about their health care.

"My research has led me to believe that, to make good choices, consumers need both cost and quality information. For that quality information to be useful, it must be understandable, usable, and meaningful to consumers," Hibbard says.

In addition to her consumer-information research, Hibbard has been working to develop a measure of patient activation among people with chronic illness. Patient activation is defined as "having the knowledge, skill, confidence, and motivation to manage one's own health."

Hibbard says, "I believe that if patient involvement in care is important to good outcomes, then it is important to measure it and to be able to know how well we are doing in supporting the patient role."

A valid measure of involvement could be used to evaluate interventions that support patient engagement and, possibly, to evaluate the quality of care. As with other areas of quality, according to Hibbard, the first step on the road to improvement is measurement.

Selected Recent Publications

Hibbard, J.H. et al. "Does Making Hospital Performance Public Increase Quality Improvement Efforts?" Health Affairs, Vol. 22, No. 2, 2003, pp. 84-94.

Shaller, D. et al. "Consumers and Quality-Driven Health Care: A Call to Action," Health Affairs, Vol. 22, No. 2, 2003, pp. 95-101.

Hibbard, J.H. and E.M. Peters. "Supporting Informed Consumer Health Care Decisions: Data presentation approaches that facilitate the use of information in choice," Annual Review of Public Health, Vol. 24, 2003, pp. 413-433.

Hibbard, J.H. et al. Decision Making in Consumer-Directed Health Plans, AARP Public Policy Institute, June 2003.

Hibbard, J.H. et al. "Engaging Health Care Consumers to Improve the Quality of Care," Medical Care, Vol. 41, No. 1. (Supp I), 2003, pp. 61-70.

Leatherman,S. et al. "A Research Agenda to Advance Quality Measurement and Improvement," Medical Care, Vol. 41, No. 1. (Supp I), 2003, pp. 80-86.

Hibbard, J.H. et al. "Strategies for Reporting Health Plan Performance Information to Consumers: Evidence from Controlled Studies," Health Services Research, Vol. 37, No. 2, 2002, pp. 291-313.

Hibbard, J.H. et al. "The Impact of a CAHPS Report on Employee Knowledge, Beliefs, and Decisions," Medical Care Research and Review, Vol. 59, No. 1, March 2002, pp. 103-115.

Hibbard, J.H. "Strategically Using the Pathways through which Public Reports may Result in Improved Care," The International Journal for Quality in Health Care, Vol. 13, No. 5, 2001.

Hibbard, J.H. et al. Making Health Care Report Cards Easier to Use. The Joint Commission Journal on Quality Improvement, Vol. 27, No. 11, November, 2001, pp. 591-604.

Hibbard, J.H. et al. "Is the Informed-Choice Approach Appropriate for Medicare Beneficiaries?" Health Affairs,Vol. 20 No. 3, 2001, pp. 199-203.

Hibbard, J.H. et al. "The Impact of a Community-Wide Self-Care Information Project on Self-Care and Medical Care Utilization," Journal of Evaluations and Health Professions, Vol. 24, No. 4, 2001, pp. 404-423.