U.S. hospitals have significantly improved the care they provide for patients with myocardial infarction, heart failure, and pneumonia, according to a new report from the Joint Commission.
Hospitals accredited by the commission are adhering to quality measures for MI patients 96.7% of the time, up from 86.9% just 7 years earlier. The results are part of the Joint Commission's annual report on quality and safety, which was issued last month.
The report also highlights major improvements in heart failure and pneumonia. In 2008, hospitals provided evidence-based heart failure care 91.6% of the time, up from 59.7% in 2002. Evidence-based pneumonia care was provided 92.9% of the time in 2008, up from 72.3% in 2002. (See box.)
These national findings are based on aggregated data drawn from all Joint Commission–accredited hospitals between 2002 and 2008. Scores for care for heart failure, for example, are composite scores based on a set of specific quality measures in that area. There is no composite score for surgical care, which is measured according to several subcategories, including antibiotic use. Children's asthma care was surveyed for the first time in 2008, with both subcategories scoring over 99%.
The findings are cause for celebration, according to Jerod M. Loeb, Ph.D., executive vice president for quality measurement and research at the Joint Commission in Oakbrook Terrace, Ill. “This improvement translates into significant enhancements in terms of morbidity and mortality across the conditions that we're measuring,” he said in an interview.
In addition to improvements on several measure sets over time, the report also found that hospitals are getting more consistent. For 8 of the 28 measures that the Joint Commission tracked in 2008, hospitals had consistently high performance. Approximately 90% of hospitals scored 90% or more on those eight measures in 2008.
Dr. Loeb credited hospitalists as being one of the driving forces behind this success. Although there is no literature to back up the claim at this point, Dr. Loeb said he believes that in organizations with hospitalists, fewer things fall through the cracks and there is greater attention paid to standardization.
“I think the hospitalist community has been a strong proponent of these measures over the years and of the standardization upon which this measurement strategy is based,” he said.
But while the Joint Commission philosophy is that variation in care is detrimental, Dr. Loeb said the organization does not advocate “cookbook medicine.” In fact, the quality measures endorsed by the Joint Commission were constructed to allow for clinical judgment, he said. And organizations' scores are not negatively affected when they deliver care that is contrary to the measures but clinically appropriate for the individual patient, Dr. Loeb said.
Despite the successes documented in the report, hospitals are still struggling on a few measures. For example, in 2008, hospitals scored only 52.4% on providing fibrinolytic therapy to heart attack patients within 30 minutes of arrival. Similarly, in 2008, hospitals scored only 60.3% on providing antibiotics to ICU pneumonia patients within 24 hours of arrival. Both of the measures were first introduced in 2005.
There are many reasons why hospitals could be falling behind on those measures, Dr. Loeb said. In some cases it takes a few years for hospitals to make progress on a new measure. Joint Commission officials saw this with measures calling for clinicians to provide smoking cessation advice. In 2002, hospitals scored 37.2% on providing smoking cessation advice to pneumonia patients, but that number jumped to 96% in 2008.
“The learning curve in health care is lengthy,” Dr. Loeb said. “For those things that we've been measuring for a longer period of time, organizations are doing better.”
For measures related to antibiotic administration, the numbers have been slower to climb because of ongoing controversy about when antibiotics are appropriate, Dr. Loeb said.
Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2009 is available online at www.jointcommission.org
Elsevier Global Medical News