Hospital Quality Performance (Continued)
National Performance Performance Improvement Rates
Heart Attack, Heart Failure and Pneumonia Care
Key to abbreviations: ACEI: Angiotensin converting enzyme inhibitor, ARB: angiotensin receptor blocker, LVF: Left ventricular function. See Glossary for definitions.
Hospitals Improved Performance on Composite Measures of Quality
Hospitals also improved on “composite” measures showing how consistently they provided “evidence-based” care. Composite measures combine the results of all individual measures on a similar medical condition into a single percentage rating calculated by adding or “rolling up” the number of times recommended care was provided to patients and dividing this sum by the total number of opportunities to provide this care. From 2002 to 2006, all three composite measures of quality improved: 86.9 percent to 94.4 percent for heart attack care, 59.7 percent to 84.1 percent for heart failure care, and 72.3 percent to 87.3 percent for pneumonia care.
Performance Improvement On Composite Measures, 2002-2006
Performance Summary, Composite, And Individual Measures
Each set’s results are ranked by 2002-2006 improvement. 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.
Much Room For Improvement Remains
The Joint Commission also tracks the percentage of hospitals achieving the annual targeted performance of 90 percent
or more compliance on a measure. This performance result is different than the previously described individual and
composite measures, which show the percentage of time an evidence-based treatment is given when it is recommended.
90 percent of American hospitals achieved 90 percent compliance on only four of 22 measures tracked during 2006. The percentage of hospitals with performance over 90 percent 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 pneumonia patients, 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 to 0.7 percent.
While most of the performances 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:
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Discharge instructions for heart failure patients – 17.7 percent not being performed consistently
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Pneumococcal screening for pneumonia patients – 22.7 percent not being performed consistently
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ACE inhibitor prescribed at discharge for heart failure patients – 36.1 percent not being performed consistently
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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, National Patient Safety Goals, and coalitions with other organizations also interested in furthering patient safety (see the section on “The Joint Commission’s Commitment to Safety” for more information).
There was improvement from 2005 to 2006 -- more hospitals provided certain treatments more than 90 percent of the time. The greatest improvement from 2005 to 2006 was in providing smoking cessation advice for heart failure patients, with 26.3 percent more hospitals providing this treatment 90 percent of the time. Smoking cessation advice was provided 90 percent of the time to pneumonia patients by an increase of 25.8 percent hospitals over 2005, and antibiotics were provided to non-ICU (intensive care unit) pneumonia patients by an increase of 24.6 percent hospitals over 2005. Performance improvement on the other 17 measures ranged from 0.5 percent to 18.6 percent.
Key to abbreviations: ACE: angiotensin converting enzyme; ARB: angiotensin receptor blocker; PCI: percutaneous coronary interventions. See Glossary for definitions.
Significant Differences Exist In The Performance Of Hospitals By State
The performance of hospitals in different states, for example, on the measure of providing discharge instructions to heart failure patients ranged from a high of 91 percent in the highest-performing state to a low of 49.4 percent in the lowest-performing state. On specific measures of surgical care, state variability is as high as 80 percent. From 2005 to 2006, state high performance and low performance improved on all measures of heart attack, heart failure and pneumonia care except for one: providing smoking cessation advice to heart failure patients, where low performance dropped from 76.5 percent in 2005 to 74.4 percent in 2006.
The following table compares the low and high ranges of state performance to national averages. More illustrations of hospital performance by state can be found in the Quality Performance Detail section of this report.
State Performance Variability Compared To Natinal Averages
Each individual measure within set is ranked according to state performance variability, which shows the difference between the highest-performing and lowest-performing states.
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