Quality Check measures added by Joint Commission

As of January 2010, The Joint Commission has incorporated into its Quality Check web site (www.qualitycheck.org/consumer/searchQCR.aspx) the Centers for Medicare & Medicaid Services' (CMS') 30-day readmission rates for heart attack, heart failure, and pneumonia Medicare patients.

Quality Check displays data on National Quality Improvement Goals for hospitals on selected performance measures in six treatment areas: children's asthma care, heart attack, heart failure, pneumonia, pregnancy, surgical care, and pregnancy. The ED's performance in all of these areas becomes part of the hospital's data submission to Quality Check. That information then can be accessed by consumers as part of their search for hospital care.

Bruce S. Auerbach, MD, FACEP, vice president and chief, emergency and ambulatory services at Sturdy Memorial Hospital in Attleboro, MA, says, "Once a person has been admitted to the hospital, the ED really has no further involvement in what goes on while in they're in the hospital or upon discharge." However, he notes, "Some EDs have instituted programs that process or provide more care in the ED or through which patients are overseen in adjacent areas — like observation or clinical decision units — as a means to manage those individuals they think they can take care of within a 24-hour-period and not admit them." These patients, he continues, will be discharged from the ED or the other units, in which case the ED staff that oversee that unit will provide discharge instructions, he says.

In addition, he notes, some institutions will put case managers in the ED. "Because they have so much to do with discharge planning, they will use them in the ED even for patients who are being admitted since they can start work early on discharge planning so that when they're discharged there are no obstacles in the way of going home," Auerbach explains.

Margaret VanAmringe, vice president of public policy and government relations in the Washington, DC, office of The Joint Commission, says that in addition to accreditation status and performance data, the Quality Check site also indicates "merit badges" for organizations that meet certain criteria for recognition, such as the Malcolm Baldrige National Quality Award. That annual award recognizes U.S. organizations in the health care, business, education, and nonprofit sectors for performance excellence.

Why were these particular measures added? "We're trying to follow what is going on at the Hospital Compare web site [www.hospitalcompare.hhs.gov] so that people who got to ours do not have to go to another site just to get a couple of measures that are part our core measures set," VanAmringe explains. "We really had to be careful about these three because they are only for Medicare patients, while all the others are for all adult patients." That presents the need to identify for consumers that the cohort is narrower, and that by and large it only represents the elderly, she says.

The need to show "good" numbers in these areas has taken on increased importance with the emphasis placed by national organizations on limiting preventable readmissions. The need for positive numbers might increase soon, warns VanAmringe. "Everybody right now, from a public policy and quality and safety standpoint, is looking at preventable readmissions, and if Congress passes a health care reform bill and it has a penalty for high readmission rates, then it becomes a monetary incentive as a quality and safety issue," she notes.