Mark Crane, September 15, 2011
Small and rural hospitals headed the list of top performing hospitals in using evidence-based processes closely linked to positive patient outcomes, according to the Joint Commission's annual report on quality and safety, Improving America's Hospitals.
The 405 hospitals identified as attaining excellence in accountability measure performance for 2010 represent approximately 14% of Joint Commission–accredited hospitals. The top performers were the most diligent in following best-practice protocols, such as giving aspirin to a person who is having a heart attack on arrival at the hospital, or the use of corticosteroids in children admitted with asthma, said the report, which was issued this week.
The nation's most highly regarded hospitals (the Mayo Clinic in Rochester, Minnesota; Johns Hopkins in Baltimore, Maryland; Massachusetts General Hospital in Boston; and the Cleveland Clinic in Ohio) were not included among the top performers. The list also did not include a single hospital in New York City or the most prominent facilities in Chicago and Houston.
Hospital performance nationwide continued to improve in using evidence-based treatments related to 22 accountability measures for heart attack, heart failure, pneumonia, surgical care, and children's asthma care.
In 2002, hospitals achieved 81.8% composite performance to perform care processes related to accountability measures. In 2010, hospitals achieved 96.6% composite performance, a 9-year improvement of almost 15 percentage points, the report found. More than 9 in 10 hospitals had scores of at least 90%, which is more than 4 times the figure of 9 years ago. The top performing hospitals all had scores of 95% or better.
"While the data across the annual report show impressive gains in hospital quality..., further improvements can still be made," Joint Commission President Mark R. Chassin, MD, MPH, said in a news release. "By following evidence-based care processes, hospitals can improve the quality of care they provide and meet national mandates regarding performance."
Hospitals had relatively low performance on providing fibrinolytic therapy within 30 minutes of arrival to patients having heart attacks (only 60.5% of hospitals achieved 90% compliance or better), and on providing antibiotics to immunocompetent intensive care unit patients with pneumonia (only 77.2% of hospitals achieved 90% compliance or better).
The list of top performers included a disproportionate share of small and rural hospitals, as well as 20 Veterans Affairs Medical Centers. "It is certainly true that larger hospitals, particularly if they are reporting on more measures than smaller hospitals, have a lot more work to do," Dr. Chassin told reporters during a conference call yesterday. "But on the other hand, they have more resources than small hospitals to do that. It may be a question of priority setting.
"I hope [the list] is both a wake-up call to the larger hospitals to put more resources into these types of programs, and a recognition that a small, rural hospital can do an excellent job," he said.
Starting in January, Joint Commission–accredited hospitals will be required to meet an 85% composite compliance target rate for performance on accountability measures. Some 121 hospitals would not pass that mark based on their 2010 scores.
"They know who they are," Dr. Chassin said. "We'll see if they have heeded the warning."