Joint Commission IDs top-performing hospitals

Hospitals are doing more to adhere to evidence-based guidelines, report finds

Topics: Performance Improvement, Evidence-Based Practice, Methodologies

October 31, 2013

The Joint Commission on Wednesday recognized 1,099 U.S. hospitals as "Top Performers" for their adherence to evidence-based clinical processes.

The third-annual list—included in the organization's 2013 Improving America's Hospitals report—recognizes 77% more hospitals than last year's list, which named 620 hospitals as top performers.

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Overall, roughly 33% of the 3,300 Joint Commission-accredited hospitals that submitted quality data for 2012 were named to the list. Of the 2013 top performers, 424 have achieved the distinction for two consecutive years, and 182 have earned the title every year since the program launched in 2011.

Another 20% of Joint Commission-accredited hospitals were just one measure short of qualifying as a top performer.

How the Commission identifies 'top performers'

For its report, the Joint Commission assessed the performance of accredited hospitals on 47 accountability measures of evidence-based care processes.

"Top Performer" designations were then awarded based on the accountability measures for heart attack, heart failure, pneumonia, surgical care, children's asthma care, inpatient psychiatric services, venous thromboembolism (VTE) care, stroke care, and immunization. Hospitals were required to select and report on four measure sets in 2012.

To earn "Top Performer" status, a hospital must:

  • Meet or exceed  95% performance on a composite score for all reported accountability measures;
  • Meet or exceed 95% performance on each and every reported accountability measure where there are at least 30 denominator cases; and
  • Have at least one core measure set with a composite rate of at least 95% and where all applicable individual accountability measures have a performance rate of at least 95%.

Report: Hospital performance has improved 'significantly' over time

Overall, hospital performance on accountability measures has improved "significantly" over time, meaning "patients are getting better care thanks to the shared commitment by hospitals to using data and proven quality improvement methods to always do the right thing and improve safety and quality," the report stated.

In 2012, Joint Commission-accredited hospitals achieved nearly 98% composite performance on 18.3 million opportunities to perform care processes related to accountability measures, up from nearly 82% in 2002. Additionally, the report found that in 2012:

  • Heart attack care adhered to evidence-based guidelines in 98.8% of cases, up from 88.6% in 2002;
  • Pneumonia care adhered to evidence-based guidelines in 97.4% of cases, up from 72.4% in 2002; and
  • Surgical care adhered to evidence-based guidelines in 98.3% of cases, up from 82.1% in 2005.

Need for improvement

While the data show large gains in hospital quality performance, improvements can still be made, as indicated by significant variation in guideline adherence. Many facilities can improve on measures relating to providing care plans or discharge instructions, creating home management care plans for pediatric asthma patients, transmitting continuing care plans for psychiatric patients, and providing warfarin discharge instructions for VTE patients, the report notes.

The Joint Commission plans to increase the required number of selected core measure sets for which a hospital must submit data from four to six in the coming year. "By raising the bar, The Joint Commission is helping its accredited hospitals monitor and improve performance in more clinical conditions and patient populations," the report said (Joint Commission report, 10/29; Zhani, Joint Commission release, 10/30; Ryan, Wichita Eagle, 10/30; Merrill, St. Louis Post-Dispatch, 10/30; Robeznieks, Modern Healthcare, 10/30 [subscription required]).

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