Report Shows Gains In Safety, Quality

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In some very critical areas, Joint Commission-accredited hospitals in America have steadily improved the quality of patient care over a six-year period, saving lives and improving the health of thousands of patients, according a Joint Commission report. Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2008, an analysis of National Patient Safety Goal compliance and hospital quality measures related to heart attacks, heart failure, pneumonia, or surgical conditions, provides scientific evidence of improved patient care.

There were some dramatic improvements over the six-year period of data collection, especially in providing smoking cessation advice. For example, hospitals provided this advice to 98.2 percent of heart attack patients in 2007 compared with 66.6 percent in 2002. Hospitals greatly improved their results from 2002 to 2007 in providing this advice to heart failure patients (from 42.2 percent in 2002 to 95.7 percent in 2007) and patients with pneumonia (from 37.2 percent to 93.7 percent). Other strong improvements included providing discharge instructions to heart failure patients (from 30.9 percent to 77.5 percent) and providing pneumococcal screening and vaccination to pneumonia patients (from 30.2 percent to 83.9 percent).

However, the report does show that, for the third consecutive year, not all hospitals deliver the same level of quality and that some hospitals perform better than others in treating particular conditions. For example, hospitals provided discharge instructions to heart failure patients on average 92.1 percent of the time in the highest performing state, but provided discharge instructions 56.5 percent of the time in the lowest performing state. The performance difference among states is greater than 10 percentage points on 12 of the 24 quality measures tracked by The Joint Commission in 2007. There are exceptions to this variability. For example, virtually all—99.1 percent to 100 percent—accredited hospitals in the United States report that they measure oxygen in the bloodstream of patients with pneumonia.

“Joint Commission-accredited hospitals deserve congratulations for making major improvements in the quality of care. On some of the measures reported here more than 90 percent of these hospitals perform at rates of 90 percent or more. However, there is more work to be done,” says Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission. “Improvement is a continuous process and in health care especially, it’s one where the target is constantly moving. The wide range of performance on some measures serves as a reminder that we must continue to work to improve patient care.”

The performance results released in the 2008 report reflect The Joint Commission’s tracking of hospital performance on 25 individual quality measures reflecting the best evidence-based treatments. There are eight measures of care relating to heart attack, four to heart failure, eight to pneumonia, and five to surgical care. Data from more than 3,000 hospitals show:

* The heart attack care result improved from 86.9 percent in 2002 and from 94.4 percent in 2006 to 96 percent in 2007. (A 96 percent score means that hospitals provided an evidence-based treatment 96 times for every 100 opportunities to do so.)

* The heart failure care result improved from 59.7 percent in 2002 and from 84.1 percent in 2006 to 88 percent in 2007.

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* The pneumonia care result improved from 72.3 percent in 2002 and from 87.3 percent in 2006 to 89 percent in 2007.

* On 11 of the 18 requirements of the 2007 National Patient Safety Goals, 90 percent or more of the 1,466 hospitals that received accreditation surveys during 2007 demonstrated compliance. National Patient Safety Goals provide strategies to prevent common health care errors such as medication mix-ups and surgery on the wrong body part.

Even with the improvements of the past six years, the report makes clear that more improvement is still needed. For example, treatments were still not being performed consistently in 2007 on some measures introduced in 2002:

* Discharge instructions for heart failure patients – only 27.5 percent of hospitals achieved 90 percent compliance

* Pneumococcal screening for pneumonia patients – only 38.6 percent of hospitals achieved 90 percent compliance

* ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin receptor blocker) prescribed at discharge for heart failure patients – only 57.7 percent of hospitals achieved 90 percent compliance

* ACE inhibitor or ARB prescribed at discharge for heart attack patients – only 68.8 percent of hospitals achieved 90 percent compliance

The Joint Commission issues this report as part of its ongoing efforts to emphasize the importance of accountability and continuous improvement for hospitals, and to empower consumers with information that will make them more active participants in their health care.

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