Joint Commission Report Shows Improvement In Healthcare Quality In Hospitals

Main Category: Public Health
Article Date: 23 Nov 2007 - 14:00 PDT

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American hospitals are making measurable strides in the quality of care provided for patients with heart attacks, heart failure, pneumonia and surgical conditions, according to The Joint Commission's second annual report on healthcare quality and patient safety in the nation's hospitals. The report portrays the aggregate performance of accredited hospitals against The Joint Commission's standardized national performance measures and its National Patient Safety Goals.

The report also shows, however, that whether patients receive proven treatments for these common reasons for hospitalization often depends on where they live. For example, statewide performance of hospitals on the measure of providing discharge instructions to patients with heart failure ranges from 49% to 91%.

The Joint Commission issues this annual report as part of its ongoing efforts to emphasize the health importance of accountability and continuous improvement for hospitals, and to empower consumers with information that will make them more active participants in their healthcare. The report examines how America's accredited hospitals performed against quality-related performance measures and safety goals during 2006 and in previous years.

"The improvements achieved have saved lives and resulted in better quality of life for thousands of patients," says Dennis S. O'Leary, MD, president, The Joint Commission. "Our experience continues to underscore the importance of investing in performance measurement and pursuing the improvement opportunities that these efforts identify."

Among the specific findings in the 2007 report:

Accredited hospitals continue to show measurable improvements in performance. The magnitude of improvement from 2002-2006 ranges from 3.6% to 52.2%. Some improvements over the five-year period of data collection-such as in providing smoking cessation advice-have been dramatic. Hospitals provided this advice to 89.4% of patients admitted with pneumonia in 2006 compared with only 37.2% of such patients in 2002. Hospitals also demonstrated 90% or higher compliance with 10 of 16 National Patient Safety Goal requirements that address issues such as medication safety, caregiver communication and preventing patient falls.

Requiring hospitals to follow standardized processes for quality measurement, reporting and improvement has contributed significantly to the positive results. For measures tracked for the first time in 2005, performance was generally lower and more variable than for measures tracked since 2002. This demonstrates a clear correlation between performance measurement and quality improvement. Much of the improvement reflected in this report can be attributed to the consistent application of focused, evidence-based measures which are the foundation of The Joint Commission's performance measurement endeavors.

Room for improvement exists for most of the quality measures. A 90% compliance level was achieved for only four of 22 quality-related measures tracked during 2006. In addition, certain treatments are not being performed consistently for some measures in place since 2002. For example, two measures introduced in 2002 that relate to prescribing of ACE inhibitors at discharge for patients with heart failure or with heart attack show the most room for improvement, with hospitals offering these treatments only 64 and 56% of the time, respectively.

Hospitals continue to be challenged in meeting certain patient safety requirements. Non-compliance rates for six of the 16 National Patient Safety Goal requirements range between 16 and 37%. While some of this performance can be explained by more searching during on-site evaluations by Joint Commission survey teams, a number of hospitals appear to be struggling with the re-design of patient care processes- such as the reconciliation of medication lists when patients move from one care site to another- that the goal requirements are seeking.

Significant variability exists in the performance of hospitals by state, as well as between the highest- and lowest-performing hospitals. For example, on the measure of providing pneumococcal vaccination, performance ranged from 55.5% to 91%. On specific measures of surgical care, the difference between the highest state rate and the lowest state rate ranged as high as 80%.

Joint Commission data also show that some hospitals perform better than others in treating particular conditions. To view hospital-specific performance on specific measures, go to Quality Check® at http://www.qualitycheck.org/.

In 2008, The Joint Commission plans to add measures to the pneumonia and surgical care measure sets, and to introduce new measure sets for hospital outpatient care and hospital-based inpatient psychiatric care. In addition, The Joint Commission will begin to publicly report hospital performance data that are gathered by the Centers for Medicare and Medicaid Services, such as the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) results. The Joint Commission offers a comprehensive guide to hospital performance measurement at the Quality Check website.

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