Executive Summary

Joint Commission-accredited hospitals have steadily improved quality over a six-year period, saving lives and improving the health of thousands of patients. Improving America´s Hospitals: The Joint Commission´s Annual Report on Quality and Safety 2008 provides scientific evidence of this improvement and also reviews hospital performance regarding National Patient Safety Goals (NPSGs).

Key Findings

Joint Commission-accredited hospitals have significantly improved the quality of care provided to heart attack, heart failure, pneumonia and surgical patients.

Hospitals are more consistently providing evidence-based treatments – treatments shown by scientific evidence to lead to the best outcomes for patients, according to performance measurement results compiled over the past six years:

• The heart attack care result improved to 96 percent in 2007 from 86.9 percent in 2002 and from 94.4 percent in 2006. A 96 percent score means that hospitals provided an evidence-based treatment 96 times for every 100 opportunities to do so.
• The heart failure care result improved to 88 percent in 2007 from 59.7 percent in 2002 and from 84.1 percent in 2006.
• The pneumonia care result improved to 89 percent in 2007 from 72.3 percent in 2002 and from 87.3 percent in 2006.

On three evidence-based measures of surgical care quality measured from 2005 to 2007, Joint Commission-accredited hospitals also showed continual progress, with improvement on the three measures ranging from 3.6 to 12.1 percentage points.

For more performance results, go to the Key Performance Results and Performance Detail sections.

The performance results reflect The Joint Commission’s tracking of hospital performance on 25 individual quality measures reflecting the best “evidence-based” treatments. There are eight measures of care relating to heart attack, four to heart failure, eight to pneumonia, and five to surgical care. More than 3,000 hospitals contributed data. To learn more, go to Understanding the Quality of Care Measures.

By requiring hospitals to report and improve quality performance, The Joint Commission has contributed significantly to quality improvement.

Quality improvements have corresponded to performance reporting requirements, supporting the continued use of performance measurement to encourage improvement in hospitals. For more on the value of performance measurement, go to the Joint Commission Accreditation: How Performance Measurement Supports Quality Improvement and Patient Safety section.

Where a patient receives care makes a difference.

Not all hospitals deliver the same level of quality; some hospitals perform better than others in treating particular conditions. This variability has been known within the hospital industry for a long time. Results for specific hospitals can be found at www.qualitycheck.org.

The quality performance of hospitals varies from state to state, as well. For example, the performance of hospitals on the quality measure of providing discharge instructions to heart failure patients ranged from a high of 92.1 percent in the highest-performing state to a low of 56.5 percent in the lowest-performing state. The performance difference among states is greater than 10 percentage points on 12 of the 24 quality measures tracked in 2007.

There are exceptions to this variability. For example, state performance ranges from 99.1 percent to 100 percent on measuring oxygen in the bloodstream of patients with pneumonia.

For more statewide quality results, go to the Key Performance Results and Performance Detail sections.

Improvement on most quality measures is still needed.

Even with the improvements of the past six years, more improvement is still needed. For example, treatments were still not being performed consistently in 2007 on some measures introduced in 2002:

• Discharge instructions for heart failure patients – only 27.5 percent of hospitals achieved 90 percent compliance
• Pneumococcal screening for pneumonia patients – only 38.6 percent of hospitals achieved 90 percent compliance
• ACE inhibitor or ARB (angiotensin receptor blocker) prescribed at discharge for heart failure patients – only
  57.7 percent of hospitals achieved 90 percent compliance
• ACE inhibitor or ARB prescribed at discharge for heart attack patients – only 68.8 percent of hospitals achieved 90 percent compliance

For more on where improvement is still needed, go to the Key Performance Results section.

Joint Commission-accredited hospitals are making excellent strides on National Patient Safety Goal compliance.

As part of The Joint Commission’s accreditation process, most hospitals achieved compliance with the 18 requirements of the nine 2007 National Patient Safety Goals (NPSGs), 100 percent compliance was achieved on one of the requirements and 99 percent on three others. On 11 of the requirements, 90 percent or more of the 1,466 hospitals surveyed demonstrated compliance.

"Compliance" means consistent performance of the requirement. When an organization is found to be "non-compliant," it does not mean that the organization is failing to do what is required; it means that the organization is not doing it consistently.

For more on NPSG compliance and 2003-2007 compliance trends, go to the Key Performance Results and Performance Detail sections.