Hospital Quality Performance

Joint Commission-accredited hospitals have significantly improved the quality of care over a six-year period, saving lives and improving the health of thousands of patients. The Joint Commission has contributed significantly to this quality improvement by requiring hospitals to report quality performance.

Despite the quality gains made over the past several years, improvement on most quality measures is still needed. In addition, not all hospitals deliver the same level of quality; some hospitals perform better than others in treating particular conditions. The quality performance of hospitals varies from state to state, as well.

Key Findings

1. Joint Commission-accredited hospitals have significantly improved the quality of care provided to heart attack, heart failure, pneumonia and surgical patients. This improvement has saved lives and improved the health of thousands of 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 improvement, with progress on the three measures ranging from 3.6 to 12.1 percentage points.

For more performance results, go to the Performance Detail section.

The performance results reflect The Joint Commission’s tracking of 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 patients. More than 3,000 hospitals contributed data. To learn more, go to the Understanding the Quality of Care Measures section.

In 2007, results improved on all 25 quality performance measures of heart attack, heart failure, pneumonia and surgical care. Of the 25, 13 were analyzed from 2002 through 2007, seven from 2005 through 2007, and two from 2006 to 2007. In addition, 2007 data on three new measures are included in this report. These results provide an increasingly in-depth picture of hospital quality improvement.

The magnitude of national improvement on individual evidence-based measures tracked from 2002-2007 ranged from 4.4 percent to 56.5 percent, and improvement has increased steadily since 2002. The performance of hospitals improved the fastest on measures where performance was lower at the beginning of the tracking period. On measures tracked for the first time in 2005 or 2006, performance is generally lower and there is more variability than on the performance measures tracked since 2002, showing a correlation between performance measurement and quality.

There were some dramatic improvements over the six-year period of data collection, especially in providing smoking cessation advice. For example, hospitals provided this advice to 98.2 percent of heart attack patients in 2007 compared with 66.6 percent in 2002. Hospitals greatly improved in their results from 2002 to 2007 in providing this advice to heart failure patients (to 95.7 percent from 42.2 percent) and pneumonia patients (to 93.7 percent from 37.2 percent). Other strong improvements included providing discharge instructions to heart failure patients (to 77.5 percent from 30.9 percent) and providing pneumococcal screening and vaccination to pneumonia patients (to 83.9 percent from 30.2 percent).

National Performance Improvement
By Individual Measures

These graphics portray the results for 20 measures tracked at least two years.

Key to abbreviations: ACEI: Angiotensin converting enzyme inhibitor, ARB: angiotensin receptor blocker, LVS: Left ventricular systolic. See Glossary for definitions.

See Glossary for definitions.

National Performance Summary, 2002-2007

All improvements in performance are statistically significant. Many of the smaller percentage improvements occurred within large patient populations, meaning that significantly more patients received a treatment. In some cases, performance was already quite high and there was less room for improvement. Note: The last column is reported as percentage points. This is the difference on a percentage scale between two rates, in this case 2002 performance versus 2007 performance.

2. By requiring hospitals to report 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. An industry leader in performance measurement, The Joint Commission supervises a network of 51 measurement systems that is the source of all quality-related data on The Joint Commission’s Quality Check Web site (www.qualitycheck.org) and provides 93 percent of the data displayed on the Centers for Medicare and Medicaid Services’ (CMS) Hospital Compare Web site.

For more on the value of performance measurement, go to the Joint Commission Accreditation: How Performance Measurement Supports Quality Improvement and Patient Safety section.

3. 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. 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.

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 25 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.

State Performance Variability Compared To National Averages

The following table compares the low and high ranges of state performance to national averages. Each individual measure within each set shows the difference between the highest-performing and lowest-performing states. More illustrations of hospital performance by state can be found in the Performance Detail section. Note: The last column is reported as percentage points. This is the difference on a percentage scale between two rates, in this case 2002 performance versus 2007 performance.

4. Improvement on most quality and safety measures is still needed.

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

• 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

90 percent of American hospitals achieved 90 percent compliance on only five of 24 measures tracked during 2007. The percentage of hospitals performing over 90 percent ranges from 99.8 percent to 7.2 percent on 23 measures of heart attack, heart failure, pneumonia and surgical care. The best performance was in providing an oxygenation assessment for patients with pneumonia, with 99.8 percentage of hospitals achieving annual overall performance over 90 percent. The other four measures that showed achievement by hospitals of more than 90 percent related to heart attack care. Performance on the other 19 measures ranged from 89.7 percent to 7.2 percent. Most of the performance levels on the lower end of the scale involved measures first reported in 2005, 2006 or 2007.

The Joint Commission is working to address these and other issues in a number of ways, including through standards, National Patient Safety Goals, and coalitions with other organizations also interested in furthering patient safety.

Percentage of Hospitals Achieving Annual Compliance of 90 Percent

The following table shows percentage of hospitals achieving the annual targeted performance of 90 percent or more compliance on a measure. Note: The last column is reported as percentage points. This is the difference on a percentage scale between two rates, in this case 2002 performance versus 2007 performance.

For more on where improvement is still needed, go to Performance Detail section.