The Joint Commission has recognized 620 hospitals for leading the way nationally in using evidence-based care processes that are closely linked to positive patient outcomes.
The hospitals identified as attaining and sustaining excellence in accountability performance in 2011 represent approximately 18% of Joint Commission-accredited hospitals that report core measure performance data.
"Improving America’s Hospitals: The Joint Commission Annual Report on Quality and Safety 2012" summarizes the performance of more than 3,300 Joint Commission-accredited hospitals on 45 accountability measures of evidence-based care processes.
Although the data show impressive gains in hospital quality performance, according to the Commission, room for improvement exists. Some hospitals perform better than others in treating particular conditions.
The list of "Top Performers on Key Quality Measures" increased more than 50% to 620 hospitals from its debut last year, with 244 hospitals appearing on the list for the second consecutive year. The designation is based on performance related to accountability measures for myocardial infarction, heart failure, pneumonia, surgical care, children’s asthma care, inpatient psychiatric services, venous thromboembolism care and stroke care.
Each of the top performers achieved a performance of 95% or above on a single composite score that includes all accountability measures for which it reports data to The Joint Commission. In addition, each hospital met or exceeded 95% performance on all accountability measures for which it reports data to The Joint Commission, but excluding measures with fewer than 30 eligible cases or patients.
The composite includes all 2011 accountability measures except two inpatient services measures — hours of seclusion and hours of physical restraint, measures for which a lower score is preferred. For the first time, measures in the inpatient psychiatric services, VTE care and stroke care measure sets were included in the composite calculation. Including these newer measures resulted in a decrease from the 91.7% composite score reported last year.
"The Joint Commission began releasing this information as a way to shine a light on and encourage excellence on accountability measures," Mark R. Chassin, MD, FACP, MPP, MPH, president of The Joint Commission, said in a news release. "The significant increases in the number of hospitals achieving Top Performers status demonstrates that these organizations are intently focused on delivering high-quality care within their communities."
Data and criteria
All measures tracked over at least two years showed improvement from the year of inception to 2011:
• The myocardial infarction care result rose from 88.6% in 2002 to 98.5% in 2011, meaning hospitals provided an evidence-based MI treatment 985 times for every 1,000 opportunities to do so. This composite includes aspirin at arrival, aspirin at discharge, ACEI or ARB at discharge, beta-blocker at discharge, fibrinolytic therapy within 30 minutes, PCI therapy within 90 minutes and statin prescribed at discharge.
• The 2011 pneumonia care result rose to 96.2% from 72.4% in 2002. This composite includes pneumococcal vaccination, blood cultures in the ICU, blood cultures in the ED, antibiotics to ICU patients, antibiotics to non-ICU patients and influenza vaccination.
• The surgical care result rose to 97.6% in 2011 from 82.1% in 2005. This composite includes antibiotics within one hour before the first surgical cut, appropriate prophylactic antibiotics, stopping antibiotics within 24 hours, cardiac patients with 9 a.m. postoperative blood glucose, patients with appropriate hair removal, beta-blocker patients who received beta-blocker perioperatively, prescribing VTE medicine/treatment, receiving VTE medicine/treatment and urinary catheter removal.
• The 2011 children’s asthma care result was 94.7%, up from 79.8% in 2008. This composite includes relievers for inpatient asthma, systemic corticosteroids for inpatient asthma and home management plan of care.
• The 2011 inpatient psychiatric services result was 87.3%, up from 80.5% in 2009. The composite includes multiple antipsychotic medications, justification for multiple antipsychotic medications, continuing care plan created and continuing care plan transmitted.
• The 2011 VTE care result was 89.9%, up from 82.7% in 2010. This composite includes VTE medicine/treatment, VTE medicine/treatment in ICU, VTE patients with overlap therapy, VTE patients with UFH monitoring and VTE warfarin discharge instructions.
• The 2011 stroke care result was 94.9%, up from 92.7% in 2010. The composite includes VTE medicine/treatment, discharged on antithrombotic therapy, anticoagulation therapy for atrial fibrillation/flutter, thrombolytic therapy, antithrombotic therapy by end of hospital day two, discharge on statin medication, stroke education and assessment for rehabilitation.
In addition to the 620 hospitals achieving Top Performers status, another 583 hospitals (17% of hospitals reporting measures) fell slightly short by missing 95% performance on only one measure. To help these 583 hospitals potentially achieve Top Performers status next year, The Joint Commission encourages use of the Core Measure Solution Exchange, which allows healthcare professionals from accredited organizations to freely exchange quality improvement practices, as well as the Leading Practices Library and the Strategic Surveillance System (S3), which provides a series of risk assessments and comparative reports to assist in the development of improvement plans.
Although hospitals achieved 90% or better performance on most individual process of care measures, the report states that more improvement is needed. For example, only 60.2% of eligible MI patients received fibrinolytic therapy within 30 minutes of arrival at the hospital.
"The list of Top Performers on Key Quality Measures" and the measure set or sets for which the hospital was recognized are available at www.jointcommission.org/accreditation/top_performers.aspx. Additional quality, safety and patient satisfaction results for specific hospitals can be found at www.qualitycheck.org.
The hospitals identified as attaining and sustaining excellence in accountability performance in 2011 represent approximately 18% of Joint Commission-accredited hospitals that report core measure performance data.
"Improving America’s Hospitals: The Joint Commission Annual Report on Quality and Safety 2012" summarizes the performance of more than 3,300 Joint Commission-accredited hospitals on 45 accountability measures of evidence-based care processes.
Although the data show impressive gains in hospital quality performance, according to the Commission, room for improvement exists. Some hospitals perform better than others in treating particular conditions.
The list of "Top Performers on Key Quality Measures" increased more than 50% to 620 hospitals from its debut last year, with 244 hospitals appearing on the list for the second consecutive year. The designation is based on performance related to accountability measures for myocardial infarction, heart failure, pneumonia, surgical care, children’s asthma care, inpatient psychiatric services, venous thromboembolism care and stroke care.
Each of the top performers achieved a performance of 95% or above on a single composite score that includes all accountability measures for which it reports data to The Joint Commission. In addition, each hospital met or exceeded 95% performance on all accountability measures for which it reports data to The Joint Commission, but excluding measures with fewer than 30 eligible cases or patients.
The composite includes all 2011 accountability measures except two inpatient services measures — hours of seclusion and hours of physical restraint, measures for which a lower score is preferred. For the first time, measures in the inpatient psychiatric services, VTE care and stroke care measure sets were included in the composite calculation. Including these newer measures resulted in a decrease from the 91.7% composite score reported last year.
"The Joint Commission began releasing this information as a way to shine a light on and encourage excellence on accountability measures," Mark R. Chassin, MD, FACP, MPP, MPH, president of The Joint Commission, said in a news release. "The significant increases in the number of hospitals achieving Top Performers status demonstrates that these organizations are intently focused on delivering high-quality care within their communities."
Data and criteria
All measures tracked over at least two years showed improvement from the year of inception to 2011:
• The myocardial infarction care result rose from 88.6% in 2002 to 98.5% in 2011, meaning hospitals provided an evidence-based MI treatment 985 times for every 1,000 opportunities to do so. This composite includes aspirin at arrival, aspirin at discharge, ACEI or ARB at discharge, beta-blocker at discharge, fibrinolytic therapy within 30 minutes, PCI therapy within 90 minutes and statin prescribed at discharge.
• The 2011 pneumonia care result rose to 96.2% from 72.4% in 2002. This composite includes pneumococcal vaccination, blood cultures in the ICU, blood cultures in the ED, antibiotics to ICU patients, antibiotics to non-ICU patients and influenza vaccination.
• The surgical care result rose to 97.6% in 2011 from 82.1% in 2005. This composite includes antibiotics within one hour before the first surgical cut, appropriate prophylactic antibiotics, stopping antibiotics within 24 hours, cardiac patients with 9 a.m. postoperative blood glucose, patients with appropriate hair removal, beta-blocker patients who received beta-blocker perioperatively, prescribing VTE medicine/treatment, receiving VTE medicine/treatment and urinary catheter removal.
• The 2011 children’s asthma care result was 94.7%, up from 79.8% in 2008. This composite includes relievers for inpatient asthma, systemic corticosteroids for inpatient asthma and home management plan of care.
• The 2011 inpatient psychiatric services result was 87.3%, up from 80.5% in 2009. The composite includes multiple antipsychotic medications, justification for multiple antipsychotic medications, continuing care plan created and continuing care plan transmitted.
• The 2011 VTE care result was 89.9%, up from 82.7% in 2010. This composite includes VTE medicine/treatment, VTE medicine/treatment in ICU, VTE patients with overlap therapy, VTE patients with UFH monitoring and VTE warfarin discharge instructions.
• The 2011 stroke care result was 94.9%, up from 92.7% in 2010. The composite includes VTE medicine/treatment, discharged on antithrombotic therapy, anticoagulation therapy for atrial fibrillation/flutter, thrombolytic therapy, antithrombotic therapy by end of hospital day two, discharge on statin medication, stroke education and assessment for rehabilitation.
In addition to the 620 hospitals achieving Top Performers status, another 583 hospitals (17% of hospitals reporting measures) fell slightly short by missing 95% performance on only one measure. To help these 583 hospitals potentially achieve Top Performers status next year, The Joint Commission encourages use of the Core Measure Solution Exchange, which allows healthcare professionals from accredited organizations to freely exchange quality improvement practices, as well as the Leading Practices Library and the Strategic Surveillance System (S3), which provides a series of risk assessments and comparative reports to assist in the development of improvement plans.
Although hospitals achieved 90% or better performance on most individual process of care measures, the report states that more improvement is needed. For example, only 60.2% of eligible MI patients received fibrinolytic therapy within 30 minutes of arrival at the hospital.
"The list of Top Performers on Key Quality Measures" and the measure set or sets for which the hospital was recognized are available at www.jointcommission.org/accreditation/top_performers.aspx. Additional quality, safety and patient satisfaction results for specific hospitals can be found at www.qualitycheck.org.
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