Top performers named in JC report

Data point to what makes a good hospital great

They come from 45 states, represent 14% of Joint Commission-accredited hospitals, and are the first class of hospitals to be recognized as top performers in the commission's annual report. Their stellar showing was based on performance related to 22 accountability measures in areas such as heart attack, heart failure, surgical care, and children's asthma care.

The data were drawn from more than 3,000 facilities, 405 of which achieved aggregate scores on all the measures of 95 or better, and of 95 or better on individual scores where there were at least 30 cases to count.

In other findings, the report noted progress in using evidence-based treatments, with nearly 97% performance ratings in composite scores. For heart attack care, there was an 11.5 point increase to 98.4% in the last 9 years, and for pneumonia, hospitals met goals 95.2% of the time, up from 72.3% in 2002. Surgical care results improved to 96.4%, up 14.3 percentage points since 2005, and the 2010 children's asthma care result reached 92.3%, up 12.5 points since 2008.

The total number of hospitals that achieved composite accountability measures greater than 90% has dramatically increased since 2002; it now stands at 91.7%, a more than 71-point increase.

Not all of the report was good: Hospitals need to do better providing fibrinolytic therapy within 30 minutes of arrival to heart attack patients, as only 60.5% of hospitals achieved 90% compliance or better. And just 77.2% of hospitals reached 90% compliance in providing antibiotics to pneumonia patients in the intensive care unit.

Joint Commission statistician Stephen Schmaltz, MPH, PhD, says that The Joint Commission decided to use those 22 accountability measures in determining the top-performing hospitals, but the set isn't stagnant. Indeed, they have already determined that there will be some additional measures added to the next annual report — a measure set for stroke and for VTE. Accountability measures meet four criteria: It is based on strong research; it captures whether evidence-based care has been delivered; it addresses a process proximate to the outcome; and it has minimal or no unintended adverse outcomes.

Schmaltz says that some measures that are important — like counseling for smoking — don't meet all the criteria and thus aren't used in the top performing hospital evaluations.

Since public reporting started in 2004, Schmaltz says hospitals have improved year on year, and he doesn't think that is going to stop now. "I think there will be even more top performers next year from hospitals that were close this year and want to prove something."

While there is a lot of attention being paid right now to the top performing hospitals, Schmaltz says they also look at those hospitals that are not doing well to see if there are common issues. So far, they know that they tend to be smaller, are more likely to be rural, and probably have issues with resources. The Joint Commission will continue to study them, he adds, looking for why some hospitals don't do well or don't improve over time.

Doing well starts to take on new import in January, he says: Hospitals that don't reach the 85% threshold will have to produce an improvement plan on how they will go forward. In the interim, he suggests that those who want to improve take a look at the JC website's solutions center for ideas on how to improve.

The complete report is available online at http://www.jointcommission.org/assets/1/6/TJC_Annual_Report_2011_9_13_11_.pdf.

For more information on this story, contact Stephen Schmaltz, MPH, Ph.D., Statistician, Joint Commission, Oak Brook Terrace, IL. Email: sschmaltz@jointcommission.org.