UNDERSTANDING THE QUALITY OF CARE MEASURES
Why they were created, what they report and why the results are important
Improving America’s Hospitals: The Joint Commission's Annual Report on Quality and Safety presents the overall performance of America’s accredited hospitals on quality of care measures relating to the care provided to heart attack, heart failure, pneumonia and surgery patients. All of the measures described in this report were chosen because they provide concrete data about the best kinds of treatments or practices for common conditions for which Americans enter the hospital and seek care. Hospitals that performed well are those that consistently provide “evidence-based” treatments – practices demonstrated by scientific evidence to lead to the best outcomes.
The results are important because they show that hospitals have improved. The results identify opportunities for further improvement, and support continual measurement and reporting. Quality improvement in hospitals contributes to saved lives, better health and quality of life for many patients, as well as to lower health care costs.
WHY THESE MEASURES?
The Joint Commission worked closely with clinicians, health care providers, hospital associations, performance measurement experts, and health care consumers across the nation to identify the quality measures. This collaborative process identified measures that reflect the best “evidence-based” treatments for heart attack, heart failure, pneumonia, and surgical care patients. These measures are the product of The Joint Commission’s Hospital Core Measure Initiative that sought to create a set of standard national measures that would permit comparisons across organizations. Subsequently, The Joint Commission collaborated with other organizations, including the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum (NQF), to align these measures with other measurement efforts to ease data collection efforts by hospitals and to ensure that the measure data were gathered and calculated in a consistent way in all organizations. These measures also are used for the “Hospital Quality Alliance (HQA): Improving Care through Information” initiative, a voluntary public reporting initiative led by the American Hospital Association, the Federation of American Hospitals and the Association of American Medical Colleges.
Data Collection Methods. The Joint Commission requires most hospitals to select three measure sets. Hospitals choose sets best reflecting their patient population and report on all the applicable measures in each of the sets they choose. Hospitals submit monthly data on all measures of performance within specific sets they choose to third-party vendors, which compile and provide data to The Joint Commission each quarter. Hospitals can obtain feedback reports through The Joint Commission’s extranet.
Note on Calculations and Methodology. For each of the three measure sets tracked continuously from 2002 to 2006 (heart attack care, heart failure care, and pneumonia care), a composite measure was created. A composite measure is calculated by adding or “rolling up” the number of times recommended care was provided over all the process measures in the given measure set and dividing this sum by the total number of opportunities for providing this recommended care, determined by summing up all of the process measure populations for this same set of measures. The composite measure shows the percentage of the time that recommended care was provided.
For example, if a heart attack patient receives each treatment included in the heart attack measure set, that’s a total of seven treatments in seven opportunities. If 60 patients receive all seven treatments, that’s 420 treatments in 420 opportunities – 100 percent composite performance. However, if some of the 60 patients don’t receive all seven treatments, and the treatments given to the 60 patients add to a total of 378, the composite score is 90 percent.
Composite performance measures are useful in integrating performance measure information in an easily understood format that gives a summary assessment of performance for a given area of care in a single rate. The three composite measures in this report are based on combining all of the process rate-based measures in the measure set. For a performance measure, each patient identified as falling in the measure population can be considered an opportunity to provide recommended care.
Inclusions and Exclusions. This report only includes data about patients considered “eligible” for one of the evidence-based treatments or measures. “What one should know about the data” information is included in the Performance Detail section of this report for each measure. This information describes the kinds of patients whose results are excluded from this report’s data. It’s important to understand that not every patient gets – or should get – a treatment. Often, patients have health care conditions or factors that influence the effectiveness of treatments, or whether or not a provider orders a particular treatment. Also, a patient may choose to refuse treatment or not follow the instructions of his or her care plan.
Related Quality Reporting Efforts of Other Organizations. The CMS Hospital Compare website (www.hospitalcompare.hhs.gov) reports quality information from U.S. hospitals on treatments for heart attack, heart failure, pneumonia and surgical care. Hospitals agree to submit this quality information for Hospital Compare to make public. Hospitals voluntarily submit these data from their medical records about the treatments their adult patients receive for these conditions, including patients with Medicare and those who do not have Medicare. Consumers can use Hospital Compare to compare care of local hospitals to state and national averages. The Hospital compare website was created through the efforts of CMS and the Hospital Quality Alliance (HQA), a public-private collaboration established to promote reporting on hospital quality of care.
Ninety-two percent of the data on Hospital Compare is common to The Joint Commission’s Quality Check website, coming from performance measurement vendors contracted by The Joint Commission. Unlike Quality Check, Hospital Compare includes data from some unaccredited organizations but does not include Veterans Administration and Department of Defense hospitals.