Joint Commission Annual Report Shows Gains in Patient-Care Quality

Accredited hospitals in America have steadily improved the quality of patient care over a seven-year period, saving lives and improving the health of thousands of patients, according to the Joint Commission’s latest annual report.

The report, “Improving America’s Hospitals: The Joint Commission’s Report on Quality and Safety 2009,” provides scientific evidence of improvements in the care of patients with heart attacks, heart failure, pneumonia and surgical conditions. Since their inception as core measures in 2002, pneumococcal vaccination and smoking cessation advice measures have demonstrated the greatest rates of improvement. Children’s asthma care also was measured and included in the report for the first time.

“In addition to saving lives and improving health, improved quality reduces health care costs by eliminating preventable complications,” says Mark R. Chassin, MD, MPP, MPH, president of the Joint Commission. “Quality improvement is an important aspect of the ongoing reform effort to make healthcare accessible to more Americans and ‘bend the curve’ on increasing costs. By eliminating the preventable complications that today drive up the cost of care, we would easily save the many billions of dollars lawmakers are struggling so hard to locate.”

The fourth annual report shows continual improvement between 2002 and 2008 on 12 quality measures reflecting the best evidence-based treatments for heart attack, heart failure and pneumonia – practices demonstrated by scientific evidence to lead to the best outcomes. The magnitude of national improvement on these measures ranged from 4.9 percent to 58.8 percent. Hospital performance also improved on 13 other measures.

The report presents scientific evidence of improvement and how it relates to common medical conditions and procedures. Five new measures were introduced in 2008, bringing the total number of Joint Commission measures covered in this report to 31. There are eight measures of care relating to heart attack, four to heart failure, nine to pneumonia, eight to surgical care, and two to children’s asthma care. More than 3,000 Joint Commission-accredited hospitals contributed data.

The data show:

• Hospital performance on two individual measures of quality relating to inpatient care for childhood asthma is excellent after only one year of measurement. Specifically, there was 99.8 percent performance on providing “relievers” to childhood asthma inpatients and 99.1 percent performance on providing systematic corticosteroids to childhood asthma inpatients.

• The overall heart attack care result improved to 96.7 percent in 2008 from 86.9 percent in 2002. (A 96.7 percent score means that hospitals provided an evidence-based treatment 967 times for every 1,000 opportunities to do so.)

• The overall heart failure care result improved to 91.6 percent, up from 59.7 percent in 2002, an improvement of 31.9 percentage points.

• The overall 2008 pneumonia care result is 92.9 percent, up from 72.3 percent in 2002 – an improvement of 20.6 percentage points.

 Even with the improvements of the past seven years, the report makes clear that more improvement is still needed. For example, hospitals finished 2008 with relatively low performance on the following two measures introduced in 2005:

• Only 52.4 percent of hospitals provided fibrinolytic therapy within 30 minutes of arrival to heart attack patients.

• Only 60.3 percent of hospitals provided antibiotics to intensive care unit pneumonia patients within 24 hours of arrival.

 The report also shows that variability is still present in the level of quality of patient care delivered.

“The data in this report show steady improvement over time on vitally important measures of quality. Furthermore,” adds Chassin, ”with more than 95 percent of hospitals now exceeding 90 percent performance on some measures, we are beginning to see the kind of consistent excellence to which we aspire for all of healthcare.”