One in three hospitals eligible for The Joint Commission's 'top performer' status has provided an evidence-based care practice 95% of the time for patients with certain conditions.
Some 1,099 hospitals received accolades as "Top Performers" from The Joint Commission's annual quality report Wednesday. That was one third of the hospitals eligible for evaluation through their commission accreditation.
The distinction indicates that hospitals have achieved a 95% reliability performance score on key measures they choose to report.
In releasing this year's report, TJC President and CEO Mark Chassin, MD, said that 479 more hospitals reached this quality threshold than last year while another 20% missed the mark by just one measure.
"These results are more than numbers," Chassin said at a news briefing. "They mean better care for the millions of Americans who require surgery, or who are hospitalized with heart attack, heart failure, stroke, or pneumonia. They mean better care for children coping with asthma, better inpatient psychiatric treatment, increased rates of immunization, and better prevention of dangerous blood clots known as venous thromboembolism."
That means that these 1,099 hospitals provided an evidence-based care practice 95 out of 100 times they had the opportunity to do so for patients with the conditions Chassin listed.
Difficult Measures
He noted that hospitals appear to have the most difficulty getting to 95% reliability in these critical measures:
- Removing urinary catheters after surgery
- Appropriately administrating antibiotics to patients not in the ICU
- Giving beta-blockers to patients peri-operatively
- Giving an angiotensin-converting-enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) to heart failure patients at discharge
Other troublesome measures remain in surgical care, such as giving venous thromboembolism prevention medication and stopping antibiotics within 24 hours after the procedure.
For nearly all measures, however, the commission said fewer hospitals failed to meet the thresholds in 2012 than failed in 2011 or in 2010.
The nearly 50 measures by which hospitals can choose to be evaluated are process measures. These are not measures of hospital safety, such as assessed by the Leapfrog Group's twice-annual A to F report card.
And on that point, Chassin noted, "It is true that the 40 measures that go into the determination of the top performer distinction don't cover every condition treated in hospitals. But they do address many common conditions." And, he said, "taken all together, the data on these 40 measures represents 18.3 million opportunities [hospitals had] to provide the right test, drug, or treatment to the patient."
Academic Hospitals Included
One criticism of the measurement formula last year was that it appeared to exclude nearly all of the 124 academic medical centers or teaching hospitals, many of which often deal with tougher patient populations. This year, 24 teaching hospitals made the list, including three Johns Hopkins hospitals.
Peter Pronovost, MD, director of the new Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, and senior vice president for safety and quality, said that came with a lot of hard work and commitment from the highest levels of Johns Hopkins leadership.
"No Johns Hopkins Medicine hospital made this list in the past," Pronovost said during the news conference. But this year, for the first time, Johns Hopkins Hospital in Baltimore, Sibley Memorial in Washington, D.C. and All Children's Hospital, Inc. in St. Petersburg, FL —all Johns Hopkins hospitals—improved enough to make the grade.
Pronovost said few academic medical centers made the list "despite ranking high on other quality and reputation lists such as U.S. News & World Report's Best Hospitals." Pronovost attributed the academic hospitals' performance shortfalls to "higher patient acuity and volume, [and] more decentralized structures compared with community hospitals."
In December, 2011, however, Johns Hopkins president and trustees "committed to performing at least 96% on all core measures, one of the first quantitative goals we ever made."
Hospital teams made a checklist of why such projects fail, tackling them one-by-one so that performance on process measures for heart attack, heart failure, pneumonia and surgical care all exceed 95%.
For one of the measures, "We reduced the time between arrival and treatment of heart attack patients requiring immediate care from around 90 minutes, the national benchmark, to an average of 66 minutes," Pronovost said, which required collaboration between emergency responders, interventional cardiologists, nurses and support staff.
"Now, the hospital's heart attack team is often activated before the patient even reaches the emergency department," he said.
Room for Improvement
In a phone interview, Chassin explained why, even after many hospitals have been evaluated for longer than three years on these core measures, two-thirds still can't make the grade.
"It is extremely unusual for healthcare organizations, especially hospitals, to have any process that functions at 95%, and be able to maintain it even more remarkable.," Chassin said.
"You look through the literature and see, the median performance on hand hygiene in hospitals around the world is 40%. Communication in transitions and coordination fails 40, 50, 60% of the time. And there are lots and lots of processes that work way under the 90%–95% level."
Chassin said that while growing numbers of hospitals are reaching the thresholds set by The Joint Commission, things will get tougher next year.
That's because starting Jan. 1, 2014, TJC-accredited hospitals will have to submit not four, but a minimum of six measure sets for evaluation, including one with five measures of perinatal quality in that measure set.
"We will be requiring that all hospitals with more than 1,100 deliveries report those measures because they are so essential to the improvement of moms and babies," Chassin said.
See Also: Joint Commission 'Top Performers' List Adds 200 Hospitals