Of Joint Commission-accredited hospitals reporting accountability measure data for 2012, 33% have been designated Top Performer hospitals for using evidence-based care processes that are delivered in the right way and at the right time, according to Improving Americas Hospitals: The Joint Commissions Annual Report on Quality and Safety 2013.
The 1,099 Top Performer on Key Quality Measures hospitals named in the report represent a 77% increase in Top Performer organizations from 2012.
The Top Performer designation is based on performance related to accountability measures for myocardial infarction, heart failure, pneumonia, surgical care, childrens asthma care, inpatient psychiatric services, venous thromboembolism care, stroke care and immunization.
All measures tracked over at least two years showed improvement from the year of inception to 2012.
The 2012 myocardial infarction care result is 98.8%, up from 88.6% in 2002. A 98.8% score means hospitals provided an evidence-based MI treatment 988 times for every 1,000 opportunities to do so. This composite includes aspirin at arrival, aspirin at discharge, ACEI or ARB at discharge, beta-blocker at discharge, fibrinolytic therapy within 30 minutes, PCI therapy within 90 minutes and statin prescribed at discharge.
The 2012 pneumonia care result is 97.4%, up from 72.4% in 2002. This composite includes blood cultures in the ICU, blood cultures in the ED and antibiotics to non-ICU patients.
The 2012 surgical care result is 98.3%, up from 82.1% in 2005. This composite includes antibiotics within one hour before the first surgical cut, appropriate prophylactic antibiotics, stopping antibiotics within 24 hours, beta-blocker patients who received beta-blocker perioperatively, cardiac patients with controlled postoperative blood glucose, patients with appropriate hair removal, prescribing VTE medicine/treatment, receiving VTE medicine/treatment and urinary catheter removed.
The 2012 childrens asthma care result is 95.5%, up from 79.8% in 2008. This composite includes relievers for inpatient asthma, systemic corticosteroids for inpatient asthma and home management plan of care.
The 2012 inpatient psychiatric services result is 89.7%, up from 80.5% in 2009. The composite includes continuing care plan created and continuing care plan transmitted.
The 2012 VTE care result is 91%, up from 82.7% in 2010. This composite includes VTE medicine/treatment, VTE medicine/treatment in ICU, VTE patients with overlap therapy, VTE patients with UFH monitoring and VTE warfarin discharge instructions.
The 2012 stroke care result is 96.2%, up from 92.7% in 2010. The composite includes anticoagulation therapy for atrial fibrillation/flutter, antithrombotic therapy by end of hospital day two, assessment for rehabilitation, discharge on antithrombotic therapy, discharge on statin medication, stroke education, thrombolytic therapy and VTE medicine/treatment.
The 2012 immunization result is 88.6%. This is the first year this measure set has been reported. The composite includes influenza vaccination and pneumococcal vaccination.
Room for improvement
Although hospitals achieved 95% or better performance on most individual measures, more progress is needed, according to a Joint Commission news release. For example, hospitals can improve their performance on these measures relating to providing care plans or discharge instructions: creating home management care plans for child asthma patients (86.7% performance), transmitting continuing care plans for psychiatric patients (86.1%) and providing warfarin discharge instructions for VTE patients (82.2%). Some hospitals also perform better than others in treating particular conditions.
To further improve performance, the required number of selected core measure sets for which a hospital must submit data to The Joint Commission will increase from four to six, effective Jan. 1. By raising the bar, according to the news release, The Joint Commission is helping its accredited hospitals monitor and improve performance in more clinical conditions and patient populations.