TJC Announces 11% Increase in Top Performers

The Joint Commission has added 125 hospitals to its ranks of Top Performers—hospitals that demonstrate high rates of evidence-based care practices. There is at least one top performer in every state and significant improvement among academic hospitals.

Some 1,224 hospitals have earned the distinction of Top Performer on Key Quality Measures in The Joint Commission's annual report, which was released Thursday. This number represents almost 37% of TJC- accredited hospitals, an 11% increase over last year's numbers.

"The release of this report provides the opportunity to gauge progress in healthcare quality improvement, which we've been tracking over the past 12 years of this program," said Mark Chassin, MD, president and CEO of The Joint Commission. "The collective performance of these accredited hospitals on individual accountability measures continues to steadily improve, as it has from the beginning of the program."

There is at least one top performer in every state.

Hospitals that earned the distinction of Top Performer demonstrated an evidence-based care practice at least 95% of time that they had the opportunity to do so.

The data in the report shows overall improvement in the treatment of pneumonia, children's asthma, surgical care, heart failure, and other common conditions. Perinatal care was listed as a quality of care measure for the first time this year, with 180 hospitals voluntarily submitting that benchmark. In future years, hospitals that deliver 1,100 babies yearly will be required to report perinatal quality.

Quality markers that hospitals are still struggling with include antibiotic selection for ICU patients, urinary catheter removal, the pneumonia measures set, and PCI within 90 minutes in heart attack patients.

Academics Catching Up
One perennial criticism of The Joint Commission's annual quality report has been the near complete absence of academic or teaching hospitals from the Top Performer list. While the number is still comparatively low, 35 academic hospitals made it to the list this year—up from 24 last year. More than a quarter (29%) of TJC- accredited teaching hospitals made the list—a number which is growing closer to the overall number of 37%.

"I have to say, I always knew they could do it," said Chassin.

Public hospitals are still underrepresented among the list with only 11% of Top Performers specifying government ownership. "I think it has been difficult for some hospitals, particularly those that may be feeling under-resourced, to devote attention to this quality improvement effort than others… It is a challenge for some hospitals to find the resources to do it, but they should be focusing on this and prioritizing it highly, in my opinion," he said.

Some critics of the annual report have claimed that a scoring bias that favors smaller and more rural hospitals. Chassin acknowledges that larger hospitals have more patients to keep track of, but notes that smaller hospitals also have fewer resources. "It's a question of priority setting," he says. "We want to see more resources being devoted to quality and quality improvement, and this recognition program was designed to encourage that kind of priority-setting."

Special Recognition
While The Joint Commission only requires hospitals to submit four measure sets of quality of care data of 95% or above to be named a Top Performer, 44 hospitals submitted data for five or more sets of measures, and achieved Top Performer recognition on that expanded set of measures.  

A page at the end of the report was dedicated to recognizing these 44 organizations that went beyond the call of duty. "Achieving these criteria is not easy," said Chassin. "For most hospitals, it took many years of hard work."

Of the hospitals that were not named top performers, 718 missed the distinction by only one quality measure and are "on track to receive Top Performer recognition," he said. "Well over half of Joint Commission-accredited hospitals—fully 58%—are top performers this year, or are on track to become one soon."