Executive Summary

Improving America´s Hospitals: The Joint Commission´s Annual Report on Quality and Safety 2007 presents how America´s accredited hospitals performed against quality performance measures and safety goals during 2006 and in previous years.

KEY FINDINGS

1. Accredited U.S. hospitals continue to show measurable improvements in health care quality and patient safety.
2. Requiring hospitals to follow a standard process for continual quality measurement, reporting and improvement has contributed significantly to this improvement.
3. Much room for improvement remains.
4. Significant variability exists in the performance of hospitals by state, as well as between the highest- and lowest-performing hospitals.
5. The Joint Commission continues to make performance measurement and reporting requirements more comprehensive and increasingly relevant toward improving accountability and health outcomes.

1. Accredited U.S. hospitals continue to show measurable improvement in quality and safety.
   The quality of care provided for heart attack, heart failure, pneumonia and surgical care patients continues to improve, according to 2006 performance data provided by hospitals accredited by The Joint Commission. Hospitals also achieved 90 percent or higher compliance on most of the 2006 Joint Commission National Patient Safety Goal (NPSG) requirements.
   
   
   • The Joint Commission measures quality improvement by tracking hospital performance in providing common treatments shown by scientific evidence to lead to the best outcomes for patients. The data demonstrate that patients are more consistently receiving these “evidence-based” treatments. Quality performance results consistently improved from year to year, with few exceptions, on 13 individual measures of performance quality analyzed from 2002 through 2006 and on six measures examined from 2005 through 2006. More than 3,000 hospitals contributed data. Six of the 13 measures analyzed from 2002-2006 apply to heart attack care, four to heart failure care and three to pneumonia care. Of the six new measures tracked during 2005-2006, one relates to heart attack care, three to pneumonia care and two to surgical care. For more on hospital quality performance, go to the Quality and Safety Key Performance Results section.
     
     
   • Each year, hospitals must meet the requirements of the Joint Commission´s National Patient Safety Goals (NPSGs) as part of the accreditation process. In 2006, seven goals and 16 requirements were applicable to hospitals. On 10 of the requirements, 90 percent or more of the 1,429 hospitals demonstrated compliance. This report also shows 2003-2006 NPSG compliance data. Data regarding compliance with NPSGs should be interpreted with caution; compliance often requires significant behavioral and/or systemic change, and lower rates can relate to a variety of factors. For more on NPSG compliance, go to the Quality and Safety Key Performance Results section.
     
     
   • Even small percentage improvements in performance are statistically significant. Many of the smaller percentage improvements occurred within large patient populations, meaning that significantly more patients received the benefits of an evidence-based treatment or safety precaution. Also, in some cases, performance was already quite high and there was little room for improvement.
     
     
   • Quality and safety improvement in hospitals contributes to saved lives and better health and quality of life for many patients, as well as to lower health care costs. On the other hand, when hospitals do not consistently provide standard evidence-based treatments, the risk of adverse outcomes for patients increased. This enhanced risk may result in new or prolonged illnesses, unnecessary hospitalization, increased costs, increased time away from work, reduced life quality, or even death.
     
     
2. Requiring hospitals to follow a standard process for continual quality measurement, reporting and improvement has contributed significantly to this improvement. Implemented several years ago, this process requires hospitals to report quality-related performance. In turn, performance results are publicly reported through this report, the Quality Check website (www.qualitycheck.org) and other means.
   
   
   • The results show that the process had a positive impact on specific aspects of health care quality and support the continued use of performance measurement as a means for encouraging improvement in hospitals. For more on the value of performance measurement and on how quality measures are determined, go to the Background Information section.
     
     
3. Much room for improvement remains. While the data presented in this report show good progress, they also demonstrate that much room for improvement on most measures remains.
   
   
   • 90 percent of American hospitals achieved 90 percent compliance on only four of 22 quality-related measures tracked during 2006. The percentage of hospitals with favorable performance ranges from 99.6 percent to 0.7 percent on 22 measures of heart attack, heart failure, pneumonia care and surgical care. The best performance was in providing an oxygenation assessment for patients with pneumonia, with 99.6 percentage of hospitals achieving annual overall performance over 90 percent. The other three measures that showed achievement by hospitals of more than 90 percent related to heart attack care. Performance on the other 18 measures ranged from 88.7 percent down to 0.7 percent.
     
     
   • While most of the performance levels on the lower end of the scale involved measures first reported in 2005 or 2006, treatments are still not being performed consistently for some measures introduced in 2002. For example:
     
     
     • Discharge instructions for heart failure patients – 17.7 percent not being performed consistently
     • Pneumococcal screening for pneumonia patients – 22.7 percent not being performed consistently
     • ACE inhibitor prescribed at discharge for heart failure patients – 36.1 percent not being performed consistently
     • ACE inhibitor prescribed at discharge for heart attack patients – 43.6 percent not being performed consistently
     
     The Joint Commission is working to address these and other issues in a number of ways, including standards development, promulgation of National Patient Safety Goals, and collaborative efforts with other organizations interested in furthering health care quality and patient safety improvement. For more data showing room for improvement, go to the Quality and Safety Key Performance Results section.
     
     
4. Significant variability exists in the performance of hospitals by state, as well as between the highest- and lowest-performing hospitals. This variability has been known within the hospital industry for a long time.
   
   
   • Statewide performance of hospitals, for example, on the measure of providing discharge instructions to patients with heart failure ranges from 49.4 percent to 91 percent. On the measure of providing pneumococcal screening and vaccination, performance ranges from 55.5 percent to 91 percent. State variability is as high as 80 percent on specific measures of surgical care. There are exceptions to this variability; state performance ranges from 98.9 percent to 100 percent on measuring oxygen in the bloodstream of patients with pneumonia. For more statewide results, go to the Quality and Safety Key Performance Results section.
     
     
   • There are significant differences between the highest- and lowest-performing hospitals. The data show that some hospitals perform better than others in treating particular conditions. Detailed results for specific hospitals can be found at www.qualitycheck.org. Health care consumers can assure the best care for themselves and their families by comparing hospital quality and safety, asking their doctors questions, considering options, and making informed decisions. For more on how to evaluate local hospital performance, go to the Quality and Safety Key Performance Results section.
     
     
5. The Joint Commission continues to make performance measurement and reporting requirements more comprehensive and increasingly relevant to improve accountability and health outcomes. In 2008, The Joint Commission plans to add measures to the pneumonia and surgical care measure sets. It is anticipated that new measure sets respecting hospital outpatient care and hospital-based inpatient psychiatric care will also be added. In addition, The Joint Commission will begin to report information on the CAHPS Hospital Survey, also known as Hospital CAHPS or H-CAHPS, which stands for Consumer Assessment of Healthcare Providers and Systems. H-CAHPS is a standardized survey instrument and data collection methodology for measuring adult patient perspectives of hospital care and services. Hospitals across the country use this survey and voluntarily report data to the Centers for Medicare & Medicaid Services.
   
   Over the next few years, the Joint Commission plans to continue its collaborative efforts with the Centers for Medicare and Medicaid Services (CMS), the National Quality Forum (NQF), the Hospital Quality Alliance (HQA) and other organizations to assure efficiency, consistency and scientific credibility in data collection. In turn, the public reporting of increasingly robust data will become even more relevant to quality improvement, benchmarking, accountability, decision-making, accreditation and research. Collaboration should lead to industry-wide agreement on priorities and on new and improved methods for optimizing health care quality and patient safety.

OTHER METHODS OF MEASURING QUALITY AND SAFETY
In addition to the evidence-based quality measures and the National Patient Safety Goals described earlier in this summary, The Joint Commission tracks quality and safety improvement by other methods, as well. Each year, for example, through its accreditation program, The Joint Commission identifies top standards compliance issues – quality standards that were the most difficult for hospitals to meet. The Joint Commission also monitors the number and root causes of sentinel events. For more on top compliance issues and sentinel events, go to the Quality and Safety Key Performance Results section.

FOR MORE DETAILED INFORMATION
This report features detailed information on all performance results, as well as additional background on how the performance measures were determined. To find specific information, please refer to the Table of Contents.