USA - New Joint Commission report portrays patient safety and health care quality performance of nation's hospitals

Citation

(2007), "USA - New Joint Commission report portrays patient safety and health care quality performance of nation's hospitals", International Journal of Health Care Quality Assurance, Vol. 20 No. 7. https://doi.org/10.1108/ijhcqa.2007.06220gab.008

USA - New Joint Commission report portrays patient safety and health care quality performance of nation's hospitals

Keywords: Healthcare quality, Patient safety, Patient information

Hospitals across the USA have significantly improved the quality of care provided for patients suffering from heart attacks, heart failure, or pneumonia over the past four years, according to a new report from The Joint Commission. The report details the performance of accredited hospitals against standardized national performance measures and the Joint Commission’s National Patient Safety Goals.

“Improving America’s hospitals: a report on quality and safety” also shows, however, that the effectiveness with which hospitals carry out safe practices and provide patients proven treatments for common clinical conditions varies by state. These variations spotlight clear opportunities for hospitals to strengthen their efforts in delivering safe, effective care. For example, the Joint Commission report found that almost all heart attack patients are receiving the life-saving benefits of aspirin when they arrive at the hospital, yet many heart failure patients do not receive specific discharge instructions about their condition and necessary follow-up care when they leave the hospital. Hospital performance in complying with National Patient Safety Goal requirements has also been variable. Most hospitals do well in using objective methods to identify patients before undertaking treatments, but many are finding it challenging to put processes in place to avoid medication mix-ups.

The Joint Commission is issuing this detailed report as part of its ongoing efforts to stimulate continuous quality and safety improvement and to empower consumers with information that will make them more active participants in their health care. This report, which is the first of what is to become an annual report, covers the time period from 2002 through 2005.

“The real and potential improvements in patient safety and health care quality identified in this report underscore the value of ongoing measurement of hospital performance against standards and performance measures,” says Dennis S. O’Leary, MD, president, The Joint Commission. “This is the kind of information that will truly create informed consumers who can ask good questions about their care and even become involved in hospital performance improvement processes.”

Among the specific findings in the report are:

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  The magnitude of improvement in the safety and quality of care provided ranged from 1.1 to 42.8 percent over the four-year period between 2002 and 2005, with performance improving the fastest on measures where the initial performance level was lowest. For example, the greatest improvement occurred in providing smoking cessation advice to patients admitted to the hospital with pneumonia. The national rate for telling these patients about the benefits of quitting smoking shot up from 37 percent in 2002 to 80 percent by 2005. The overall use of specific care interventions for patients admitted with heart attacks, as well as the actual in-patient mortality rates, also improved. These specific care interventions have clearly been shown to reduce the risk of future heart attacks and lower mortality.

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  Room for improvement exists for most of the quality measures. For example, hospitals are currently achieving 90 percent performance or higher for about half of the measures tracked since 2002. Hospitals are performing at less than 65 percent for two of these measures – providing pneumococcol vaccination to patients admitted with pneumonia, and providing discharge instructions to patients admitted with heart failure.

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  Considerable variability exists in the performance of hospitals by state on most measures. For example, the statewide averages for providing discharge instructions to patients admitted with heart failure range from 33.5 percent to 89 percent. On the measure of providing pneumococcol vaccination to patients admitted with pneumonia, performance ranges from 48 to 84 percent across the states.

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  There are significant differences in performance between the highest- and lowest-performing hospitals. Joint Commission data show that some hospitals perform better than others in treating particular conditions, and that more than 90 percent of the nation’s hospitals are achieving 90 percent performance on only one measure. To view hospital-specific performance on the measures, go to the individual hospital’s quality report on quality check at www.qualitycheck.org

Hospital compliance is lowest for National Patient Safety Goal requirements that a “time out” be taken by the surgical team before surgery to confirm patient identity and correct procedure, and that certain potentially confusing abbreviations not be used in ordering medications. Although National Patient Safety Goal compliance is trended over time for the various requirements, the report urges caution in interpreting these trends because Joint Commission surveyors have become increasingly sophisticated in assessing compliance with some of the requirements.

The Joint Commission requires accredited hospitals to collect and report data on three of five performance measure sets that apply to common clinical conditions. These measures may not apply to specialty hospitals such as pediatric hospitals. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) have worked together to align the measures that both use. These standardized common measures, called “Hospital Quality Measures,” are integral to improving the quality of care provided to hospitalized patients and bringing value to stakeholders by focusing on the actual care processes and results. Measure alignment benefits hospitals by making it easier and less costly to collect and report data because the same data set can be used to satisfy both CMS and Joint Commission requirements.

All of the Hospital Quality Measures used by The Joint Commission and CMS are endorsed by the National Quality Forum (NQF). These measures are also utilized for the “Hospital Quality Alliance: Improving Care through Information” initiative, a voluntary public reporting initiative led by the American Hospital Association, the Federation of American Hospitals, and the Association of American Medical Colleges. This initiative is supported by The Joint Commission, CMS, NQF, the Agency for Healthcare Research and Quality, American Federation of Labor and Congress of Industrial Organizations, and AARP (formerly American Association of Retired Persons).