Critics say list is skewed of hospitals named top performers on key quality measures

The big boys aren’t necessarily thrilled about the Joint Commission’s first-ever list of top performing hospitals on key quality measures.

Because few major healthcare systems, academic centers or prestigious hospitals such as Johns Hopkins, Mayo, New York-Presbyterian and Duke made the list, some critics have said the list skews small and rural hospitals in the September-released report based on 2010 information: “Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2011.”

“In using process measures, there are no adjustments for risk or acuity,” said a spokesperson for a notable Florida hospital omitted from the list. “Hospitals with a higher case mix caring for sicker patients have complicating co-morbidity factors to consider, such as more medications and conditions to manage. That, combined with a greater number of physicians and staff treating patients in larger healthcare systems, and significantly higher volumes, achieving 95 percent consistency in processes of care presents a much greater challenge.”

It’s also important, critics point out, to note how the link between “processes of care” and “outcomes” is controversial. Some researchers have shown the measures the Joint Commission identifies as best practices don’t correlate to results. For instance, in an Archives of Surgery study released last October, measured deaths and complications in high-risk surgeries at 2,000 hospitals found no relationship between best-practice performances and whether patients felt better. According to published reports, nearly a dozen other studies in medical journals since 2006 also have cast doubt on a connection between various performance measures and how likely patients are to survive their stay in the hospital, with researchers emphasizing that better quality measures are rates of deaths, readmissions, complications and infections.
The Joint Commission, the leading accreditor of healthcare organizations in the United States, acknowledged that it might be more difficult for larger hospital systems, with bigger staffs, busier emergency departments and more complicated patients, to ensure the commission-recommended best practices are met with every patient.

The results were based on data reported about evidence-based clinical processes shown to improve care for certain conditions. Only 405 hospitals, or 14 percent of the nation’s accredited hospitals, 142 in states with Medical News markets earned the distinction of top performer on key quality measures for attaining and sustaining excellence in accountability measures performance.

“We expect the percentage of hospitals and critical access hospitals achieving these thresholds to increase as we report on the Top Performers on Key Quality Measure Program in the fall of each successive year,” said Joint Commission president Mark Chassin, MD. “This program is designed to be an incentive for better performance on accountability measures and to support organizations in their quest to do better.”

The list differs from the many other hospital rating reports because it relies on 22 processes of care rather than outcomes that the Joint Commission has determined should be standard practices for patients in five categories–heart attack, heart failure, pneumonia, surgical care, and children’s asthma. Examples include giving a person who is suffering a heart attack aspirin upon arrival at the hospital or using corticosteroids in children admitted with asthma. To be recognized as a top performer on key quality measures, an organization must meet 95 percent or more on performance thresholds on accountability measure data.

Leaders at Joint Commission-recognized hospitals were thrilled to add it to their list of achievements. Kathy Mitchell, chief nursing officer at Doctors Hospital of Sarasota in Florida, which was named a top performer on key quality measures for four areas—heart attack, heart failure, pneumonia and surgical care—said the recognition shows the success of the administration and staff supporting the process of best-practice interventions from the time the patient arrives to the time of discharge.

“A devoted team meets daily to review all of our admissions with respect to their individual diagnosis and the highest standards of care,” she said. “I’m proud that our bedside caregivers understand that these measures are in the best interest of the patient and ensure that our practice does not deviate from the highest level of quality for our community.”

On Jan. 1, 2012, the Joint Commission will take another important step when it integrates performance expectations on accountability measures into accreditation standards. Joint Commission-accredited hospitals will be required to meet a new performance improvement requirement that establishes an 85 percent composite compliance target rate for performance on ORYX® accountability measures. The new requirement, which will not apply to the critical access hospital program, is intended to help improve performance on selected ORYX core measures of patient care.

“Better performance will help hospitals meet the pay-for-performance requirements of federal and state governments and private payers,” said Chassin. “By following evidence-based care processes, hospitals will continue to improve the quality of the care they provide.”

Key Findings

• The percentage of hospitals achieving composite accountability measures greater than 90 percent has dramatically improved, from 20.4 percent in 2002 to 91.7 percent in 2010.

• Heart attack care result is 98.4 percent, up from 86.9 percent in 2002, signaling an improvement via measures such as aspirin upon arrival and discharge; ACEI or ARB and beta-blocker at discharge; fibrinolytic therapy within 30 minutes and PCI therapy within 90 minutes.

• Pneumonia care result is 95.2 percent, up from 72.3 percent in 2002. Factors contributing to the uptick: pneumococcal vaccination, blood culture in the Emergency Department, antibiotics to immunocompetent patients and influenza vaccination.

• Surgical care result is 96.4 percent, up from 82.1 percent in 2005, with a lengthy composite list that includes antibiotics within one hour of the first surgical cut.

• Children’s asthma care result is 92.3 percent, up from 79.8 percent in 2008.

SOURCE: Joint Commission.

Top Performers

Joint Commission Report in Manatee/Sarasota

Sarasota Memorial Hospital, a dominant player in the Manatee-Sarasota area, is notably absent from the Joint Commission’s list of the area’s top performing hospitals on key quality measures.

Instead, the Joint Commission recognized smaller, more rural hospitals: HCA’s

Doctors Hospital of Sarasota and Fawcett Memorial Hospital, and HMA’s Venice Regional Medical Center in Port Charlotte.

Doctors Hospital and Fawcett Memorial were named top performers on key quality measures for four areas: heart attack, heart failure, pneumonia and surgical care. Venice Regional was recognized as a top performer on key quality measures in three areas—heart attack, heart failure and pneumonia.

Only one hospital in Florida achieved recognition in all five quality measures including the elusive children’s asthma category: Lawnwood Regional Medical Center & Heart Institute in Fort Pierce, located roughly 150 miles west from Sarasota.

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