Thirty-three percent of Joint Commission-accredited hospitals reporting accountability measure data for 2012 are Top Performer hospitals, using evidence-based care processes that are delivered in the right way and at the right time, according to Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2013.
The 1,099 “Top Performer on Key Quality Measures®” hospitals named in the new report represent a 77 percent increase in Top Performer organizations from last year. Of the 1,099 Top Performer hospitals, 424 achieved the distinction for two years in a row and 182 have earned the recognition every year since the program’s inception in 2011. Another 20 percent of Joint Commission-accredited hospitals reporting accountability measure performance data for 2012 were only one measure short of the Top Performer goal.
The Top Performer designation is based on performance related to accountability measures for heart attack, heart failure, pneumonia, surgical care, children’s asthma care, inpatient psychiatric services, venous thromboembolism (VTE) care, stroke care, and immunization. Hospitals are required to select and report on four measure sets, and each of the recognized hospitals had to achieve cumulative performance of 95 percent or above for all reported accountability measures. They also had to achieve performance of 95 percent or above on each and every reported accountability measure where there were at least 30 denominator cases. In addition, at least one core measure set had a composite rate of 95 percent or above, and within that measure set all applicable individual accountability measures had a performance rate of 95 percent or above. The list of Top Performer hospitals and the measure sets for which the hospital was recognized is available online at: www.jointcommission.org/topperformer/
The annual report also summarizes the performance of more than 3,300 Joint Commission-accredited hospitals on 47 accountability measures of evidence-based care processes closely linked to positive patient outcomes.
“By tracking the data found in each year’s edition of this report, you can see how results considered outstanding several years ago are now achieved by almost every Joint Commission-accredited hospital in America today. More than half of Joint Commission-accredited hospitals have reached or have nearly reached Top Performer distinction, showing that we are approaching a time in which consistent excellence in hospital performance on these important quality measures is the new normal,” says Mark R. Chassin, MD, FACP, MPP, MPH, president and CEO of the Joint Commission. “This means patients are getting better care thanks to the shared commitment by hospitals to using data and proven quality improvement methods to always do the right thing and improve quality and safety.”
Hospital performance on accountability measures has improved significantly over time, greatly enhancing the quality of care provided in Joint Commission-accredited hospitals. The Joint Commission illustrates improvement with a “composite” result, which sums up the results of all individual accountability measures into a single summary score. In 2012, Joint Commission-accredited hospitals achieved 97.6 percent composite accountability measure performance on 18.3 million opportunities to perform care processes closely linked to positive patient outcomes – an improvement of 15.8 percentage points since 2002, when hospitals achieved 81.8 percent composite performance on 957,000 opportunities.
• All measures tracked over at least two years showed improvement from the year of inception to 2012.
• The 2012 heart attack care result is 98.8 percent, up from 88.6 percent in 2002 – an improvement of 10.2 percentage points. A 98.8 percent score means that hospitals provided an evidence-based heart attack treatment 988 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 2012 pneumonia care result is 97.4 percent, up from 72.4 percent in 2002 – an improvement of 25.0 percentage points. This composite includes blood cultures in the intensive care unit (ICU), blood cultures in the emergency department (ED) and antibiotics to non-ICU patients.
• The 2012 surgical care result is 98.3 percent, up from 82.1 percent in 2005 – an improvement of 16.2 percentage points. This composite includes antibiotics within one hour before the first surgical cut, appropriate prophylactic antibiotics, stopping antibiotics within 24 hours, beta-blocker patients who received beta-blocker perioperatively, cardiac patients with controlled postoperative blood glucose, patients with appropriate hair removal, prescribing VTE medicine/treatment, receiving VTE medicine/treatment and urinary catheter removed.
• The 2012 children’s asthma care result is 95.5 percent, up from 79.8 percent in 2008 – an improvement of 15.7 percentage points. This composite includes relievers for inpatient asthma, systemic corticosteroids for inpatient asthma and home management plan of care.
• The 2012 inpatient psychiatric services result is 89.7 percent, up from 80.5 percent in 2009 – an improvement of 9.2 percentage points. The composite includes continuing care plan created and continuing care plan transmitted.
• The 2012 venous thromboembolism (VTE) care result is 91.0 percent, up from 82.7 in 2010 – an improvement of 8.3 percentage points. 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 2012 stroke care result is 96.2 percent, up from 92.7 percent in 2010 – an improvement of 3.5 percentage points. The composite includes anticoagulation therapy for atrial fibrillation/flutter, antithrombotic therapy by end of hospital day two, assessed for rehabilitation, discharged on antithrombotic therapy, discharged on statin medication, stroke education, thrombolytic therapy and VTE medicine/treatment.
• The 2012 immunization result is 88.6 percent. This is the first year this measure set has been reported. The composite includes influenza vaccination and pneumococcal vaccination.
• The percentage of Joint Commission-accredited hospitals achieving composite accountability measure performance greater than 95 percent* in 2012 is 83.0 percent, up from 74.6 percent in 2011 – an improvement of 8.4 percentage points. (*This threshold was 90 percent in previous annual reports, but was increased to 95 percent to better reflect the overall higher performance of the majority of Joint Commission-accredited hospitals).This composite includes all 2012 accountability measures except for one pneumonia care measure (antibiotics to ICU patients), the perinatal care measure set (includes elective delivery, antenatal steroids and exclusive breast milk feeding), and four inpatient psychiatric services measures. On two of the inpatient psychiatric services measures – hours of seclusion and hours of physical restraint – a lower score is preferred. The measures for multiple antipsychotic medications and justification for multiple antipsychotic medications were not included for 2012 only, since they were also not included in the calculations for the Top Performer on Key Quality Measures® program for 2013. In 2008, only 33.8 percent of Joint Commission-accredited hospitals achieved 95 percent performance on measures in four sets – heart attack care, pneumonia care, surgical care and children’s asthma care.
Although hospitals achieved 95 percent or better performance on most individual measures, more improvement is needed. For example, hospitals can improve their performance on these measures relating to providing care plans or discharge instructions: creating home management care plans for child asthma patients (86.7 percent performance), transmitting continuing care plans for psychiatric patients (86.1 percent performance) and providing warfarin discharge instructions for VTE patients (82.2 percent performance). Some hospitals also perform better than others in treating particular conditions.
In order to further improve performance, the required number of selected core measure sets for which a hospital must submit data to The Joint Commission will increase from four to six, effective January 1, 2014. By raising the bar, The Joint Commission is helping its accredited hospitals monitor and improve performance in more clinical conditions and patient populations. For quality, safety and patient satisfaction results for specific hospitals, visit: www.qualitycheck.org
Source: Joint Commission