Joint Commission Names Top Performing U.S. Hospitals

“Improving America’s Hospitals: The Joint Commission Annual Report on Quality and Safety 2012,” includes 620 hospitals that are leading the way nationally in using evidence-based care processes closely linked to positive patient outcomes. The hospitals identified as attaining and sustaining excellence in accountability performance in 2011 represent approximately 18 percent of Joint Commission-accredited hospitals reporting core measure performance data.

The annual report also summarizes the performance of more than 3,300 Joint Commission accredited hospitals on 45 accountability measures of evidence-based care processes closely linked to positive patient outcomes. While the data show impressive gains in hospital quality performance, improvements can still be made. Some hospitals perform better than others in treating particular conditions.

The list of Top Performers on Key Quality Measures™ increased more than 50 percent to 620 hospitals from its debut last year, and 244 of the hospitals named in the new report are appearing on the list for the second year in a row. The designation is based on performance related to accountability measures for heart attack, heart failure, pneumonia, surgical care, children’s asthma care, inpatient psychiatric services, venous thromboembolism (VTE) care, and stroke care. Each of the Top Performers met two 95 percent (95/95) performance thresholds on 2011 accountability measure data. First, each hospital achieved performance of 95 percent or above on a single, composite score that includes all the accountability measures for which it reports data to The Joint Commission, including measures that had fewer than 30 eligible cases or patients. Second, each hospital met or exceeded 95 percent performance on every accountability measure for which it reports data to The Joint Commission, excluding any measures with fewer than 30 eligible cases or patients. The list of Top Performers on Key Quality Measures and the measure set or sets for which the hospital was recognized are available online at http://www.jointcommission.org/accreditation/top_performers.aspx.

Additional quality, safety and patient satisfaction results for specific hospitals can be found at www.qualitycheck.org.

“The Joint Commission began releasing this information as a way to shine a light on and encourage excellence on accountability measures. The significant increase in the number of hospitals achieving Top Performers status demonstrates that these organizations are intently focused on delivering high quality care within their communities,” says Mark R. Chassin, M.D., FACP, M.P.P., M.P.H., president, The Joint Commission. “Making the Top Performers list is no easy feat. I salute these organizations for their hard work in attaining excellence. By consistently using evidence-based treatments, their patients are getting better hospital care.”

Overall, The Joint Commission annual report shows 88.8 percent of hospitals achieved a composite accountability measure performance of 90 percent in 2011, compared to 20.4 percent of hospitals in 2002. For the first time, measures in the inpatient psychiatric services, VTE care and stroke care measure sets were included in this calculation. Including these newer measures resulted in a decrease from the 91.7 percent composite score reported last year. This composite includes all 2011 accountability measures except for two inpatient services measures – hours of seclusion and hours of physical restraint. On these measures, a lower score is preferred.

The newest data show:

• In addition to the 620 hospitals achieving Top Performers status, another 583 hospitals (17 percent of hospitals reporting measures) fell slightly short by missing 95 percent performance on only one measure. To help these 583 hospitals potentially achieve Top Performers status next year, The Joint Commission is encouraging use of the Core Measure Solution Exchange that allows health care professionals from accredited organizations to freely exchange quality improvement practices, as well as the Leading Practices Library and the Strategic Surveillance System (S3)™, a tool that provides a series of risk assessments and comparative reports to assist in the development of improvement plans.
• All measures tracked over at least two years showed improvement from the year of inception to 2011.
• The heart attack care result is up 9.9 percentage points, from 88.6 percent in 2002 to 98.5 percent in 2011. A 98.5 percent score means that hospitals provided an evidence-based heart attack treatment 985 times for every 1,000 opportunities to do so. This composite includes aspirin at arrival, aspirin at discharge, ACEI or ARB at discharge, beta-blocker at discharge, fibrinolytic therapy within 30 minutes, PCI therapy within 90 minutes, and statin prescribed at discharge.
• The 2011 pneumonia care result is 96.2 percent, up from 72.4 percent in 2002 – an improvement of 23.8 percentage points. This composite includes pneumococcal vaccination, blood cultures in the intensive care unit (ICU), blood cultures in emergency department, antibiotics to ICU patients, antibiotics to non-ICU patients and influenza vaccination.
• The surgical care result has improved to 97.6 percent in 2011 from 82.1 percent in 2005 an improvement of 15.5 percentage points. This composite includes antibiotics within one hour before the first surgical cut, appropriate prophylactic antibiotics, stopping antibiotics within 24 hours, cardiac patients with 9 a.m. postoperative blood glucose, patients with appropriate hair removal, beta-blocker patients who received beta-blocker perioperatively, prescribing VTE medicine/treatment, receiving VTE medicine/treatment, and urinary catheter removed.
• The 2011 children’s asthma care result is 94.7 percent, up from 79.8 in 2008 – an improvement of 14.9 percentage points. This composite includes relievers for inpatient asthma, systemic corticosteroids for inpatient asthma, and home management plan of care.
• The 2011 inpatient psychiatric services result is 87.3 percent, up from 80.5 percent in 2009 – an improvement of 6.8 percentage points. The composite includes multiple antipsychotic medications, justification for multiple antipsychotic medications, continuing care plan created, and continuing care plan transmitted.
• The 2011 venous thromboembolism (VTE) care result is 89.9 percent, up from 82.7 in 2010 – an improvement of 7.2 percentage points. This composite includes VTE medicine/treatment, VTE medicine/treatment in ICU, VTE patients with overlap therapy, VTE patients with UFH monitoring, and VTE warfarin discharge instructions.
• The 2011 stroke care result is 94.9 percent, up from 92.7 percent in 2010 – an improvement of 2.2 percentage points. The composite includes VTE medicine/treatment, discharged on antithrombotic therapy, anticoagulation therapy for atrial fibrillation/flutter, thrombolytic therapy, antithrombotic therapy by end of hospital day two, discharged on statin medication, stroke education and assessed for rehabilitation.

Although hospitals achieved 90 percent or better performance on most individual process of care measures, the report contends that more improvement is needed. For example, only 60.2 percent of eligible heart attack patients receiving fibrinolytic therapy within 30 minutes of arrival at the hospital.