Joint Commission Reports More Gains on Quality Measures

U.S. hospitals have improved the care they provide for patients with myocardial infarction, heart failure, and pneumonia, according to a report issued last month by the Joint Commission.

Hospitals accredited by the commission are adhering to quality measures for MI patients 97% of the time, up from 87% just 7 years earlier. The results are part of the Joint Commission's annual report on quality and safety, which also reported that in 2008, hospitals provided evidence-based heart failure care 92% of the time (up from 60% in 2002), and evidence-based pneumonia care 93% of the time in 2008 (up from 72% in 2002). (See box.)

Composite scores were calculated using data drawn from all Joint Commission–accredited hospitals between 2002 and 2008. Children's asthma care was surveyed for the first time in 2008, with two subcategories both scoring over 99%.

“This improvement translates into significant enhancements in terms of morbidity and mortality across the conditions that we're measuring,” Jerod M. Loeb, Ph.D., executive vice president for quality measurement and research at the commission, said in an interview. For 8 of the 28 measures tracked in 2008, hospitals had consistently high performance, with about 90% of hospitals scoring 90% or more.

Dr. Loeb described hospitalists as one of the driving forces behind this success. Although there is no literature yet to back up the claim, he said he believes that in organizations with hospitalists, fewer things fall through the cracks and more attention is paid to standardization.

Dr. Loeb said the Joint Commission does not advocate “cookbook medicine.” The quality measures endorsed by the commission allow for clinical judgment, and scores do not decline when organizations deliver care that is contrary to the measures but clinically appropriate for individual patients, he said.

Despite the successes documented in the report, hospitals are still struggling on a few measures. For example, hospitals in 2008 scored only 52% on providing fibrinolytic therapy to heart attack patients within 30 minutes of arrival. Also, hospitals in 2008 scored only 60% on providing antibiotics to ICU pneumonia patients within 24 hours of arrival. Both measures were introduced in 2005.

In some cases it takes a few years for hospitals to make progress on a new measure. Joint Commission officials saw this with measures calling for clinicians to provide smoking cessation advice. In 2002, hospitals scored 37.2% on providing smoking cessation advice to pneumonia patients, but that number jumped to 96% in 2008.

“The learning curve in health care is lengthy,” Dr. Loeb said. “For those things that we've been measuring for a longer period of time, organizations are doing better.”

For measures related to antibiotic administration, the numbers have been slower to climb because of ongoing controversy about when antibiotics are appropriate, he added.

“Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2009” is available online at www.jointcommission.org

Source ELSEVIER GLOBAL MEDICAL NEWS