Core measures identified by Joint Commission
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is launching the ORYX performance assessment system to provide a continuous, data-driven accreditation process. Pharmacists can help their hospitals by anticipating the core measures to be used at those institutions, then becoming better acquainted with health outcomes measures used and the interpretation of the data.
Collection of core data will commence in hospitals and long-term care facilities as early as 2002. Be prepared to anticipate and capture data at your institution, based on the health care services your hospital provides. JCAHO expects that data will be collected monthly by health care organizations, then transmitted quarterly to JCAHO. However, what is sent to the Joint Commission will not be raw data as collected by the organization. Rather, the data will be in summary form, in a specified format. The Joint Commission says implementation of the ORYX performance assessment system will improve clinical outcomes for patients. By improving health outcomes, health care organizations should then be able to decrease their costs of providing care to patients.
JCAHO states that these measures:1
• have precisely defined specifications;
• can be uniformly embedded in multiple performance measurement systems;
• have standardized data collection protocols based on a uniform medical language so they can be implemented uniformly across accredited organizations;
• meet established evaluation criteria;
• can be implemented in stages within and across accreditation programs;
• permit comparisons of organizational performance over time;
• foster the use of national performance benchmarks.
ORYX integrates measurable outcomes and other performance measurement data into the accreditation system. The next phase in implementing the system is the identification of 25 core measures in five focus area as tools for the evaluation of hospital performance. Those core measures are:1
1. Acute myocardial infarction (AMI).
• the number of AMI patients with a history of smoking who are given smoking cessation advice or counseling during hospitalization;
• the number of AMI patients who are given aspirin within 24 hours of arrival or within 24 hours prior to arrival at the hospital;
• the timely reperfusion (opening blocked arteries) of eligible AMI patients; time from arrival to initiation of thrombolysis medication administration or primary percutaneous transluminal coronary angioplasty procedure;
• the number of AMI patients who are prescribed aspirin at discharge from the hospital;
• the number of AMI patients who receive ß-blocker medication within the first 24 hours of arrival to the hospital;
• the number of AMI patients with low left ventricular ejection fraction (index of how well the heart functions) who are prescribed an angiotensin converting enzyme inhibitor (ACEI) medication at discharge from the hospital;
• the number of AMI patients who are ideal candidates for ß-blocker medication who are given a prescription for ß-blocker at discharge;
• the number of patients with a primary diagnosis of AMI who die during hospitalization.
2. Heart failure (HF).
• the number of HF patients with atrial fibrillation who are given a prescription for oral anticoagulation therapy (warfarin) at discharge from the hospital;
• the number of HF patients who receive patient education (as documented on their written discharge instructions) regarding all of the following: all discharge medications, weight monitoring, diet, activity level, follow-up appointment, and what to do if symptoms worsen;
• the number of HF patients not admitted on ACEIs or angiotensin receptor blocking agents who have left ventricular ejection fraction (LVEF) evaluated before or during admission;
• the number of patients with low LVEF who are prescribed an ACEI medication at discharge;
• the number of HF patients with a history of smoking who are given smoking cessation advice or counseling during hospitalization.
3. Community-acquired pneumonia.
• the number of patients ages 65 or older who are screened for or given pneumococcal vaccination during hospitalization;
• the number of pneumonia patients with a history of smoking, who are given smoking cessation advice or counseling during hospitalization, or advice or counseling is given to pediatric caregiver about effects of secondhand smoke;
• the number of patients who receive oxygenation assessment (determine amount of oxygen in blood) within 24 hours of hospital arrival;
• of patients who had blood cultures collected, the number who had them drawn prior to the first dose of antibiotic administration in the hospital;
• the time in hours from initial presentation at hospital to first dose of antibiotics;
• the number of pneumonia patients not admitted to an intensive care unit for whom the antibiotic given is consistent with current consensus guidelines (e.g., the American Thoracic Society, Infectious Disease Society of America, and the Centers for Disease Control and Prevention);
• the number of pneumonia patients admitted to an intensive care unit for whom the antibiotic given is consistent with current consensus guidelines (e.g., the American Thoracic Society, Infectious Disease Society of America, and the Centers for Disease Control and Prevention).
4. Surgical procedures and complications.
• the number of patients undergoing selected surgical procedures who develop a surgical site infection within 30 days of the procedure;
• the timing of when patients were given prophylactic intravenous antibiotic administration for selected surgical procedures.
5. Pregnancy and related conditions.
• the number of patients who have had a cesarean who have a vaginal delivery;
• the number of patients who have vaginal deliveries with third- or fourth-degree laceration;
• the number of infants who die within 28 days of birth.