The Joint Commission’s newly released annual report on hospital quality shows hospitals continue to perform well on quality accountability measures. The report noted that Joint Commission-accredited hospitals achieved 97.6 percent composite accountability measure performance.
Nearly 37 percent of the 3,300 Joint Commission hospitals were designated Top Performer on Key Quality Measures, an 11 percent increase from last year. In addition to the 1,224 hospitals receiving Top Performer designation, 718 hospitals missed achieving the designation by only a slight margin, according to the report.
Hospital performance was evaluated on 46 accountability measures. A statement released by The Joint Commission noted that the data demonstrate “the nationwide implementation of evidence-based quality improvement processes is working.”
But quality experts and consumer groups have expressed concern with the Top Performer designation. Their concerns center on using process rather than clinical outcome measures such as how many patients died or had to be readmitted to the hospital within 30 days of receiving care. (“Are Joint Commission ‘Top Performers’ enjoying grade inflation?” Modern Healthcare, November 14, 2014)
Lisa McGiffert of the Safe Patient Project said, “When we reward hospitals or give them accolades, it should be based on something a little more concrete.” It may be misleading to patients to focus on organizations that have proved they regularly follow standards of care or protocols, she added, even though processes are meaningful internally to hospitals as they track how efficiently they provide care.
Critics acknowledge that process measures are much easier to measure than outcomes, but tracking a hospital’s adherence to set standards really doesn’t have a lot to do with how patients turn out, and it’s not really a true measure of the quality of a hospital, noted the author of the Skeptical Scalpel blog.
This has been an ongoing complaint about The Joint Commission. Its CEO defended the report and the Top Performer designation by noting that the process measures were selected based on evidence that they drive better outcomes and have clear steps hospitals can follow to achieve them. (“Are Joint Commission ‘Top Performers’ enjoying grade inflation?” Modern Healthcare, November 14, 2014)
“I understand the argument consumer groups are making, and moving in the direction of more outcome measures is right,” said Dr. Robert Wachter, a leading quality and safety expert and associate chairman of the department of medicine at UCSF Medical Center in San Francisco. But until the science catches up with the demand, the right thing for the Joint Commission and others to do is use a thoughtful combination of hospital process, outcome and structural measures (such as having an electronic health record) to make assessments. (“Are Joint Commission ‘Top Performers’ enjoying grade inflation?” Modern Healthcare, November 14, 2014)
More about the report can be found here.
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