Hospital Quality Improvement

The Joint Commission which accredits hospitals and other facilities has issued a report on the state of quality in America’s hospitals.  (JC Report) The report covers information submitted by 3000 hospitals on 31 measures of care, including care for heart attacks, heart failure, pneumonia, surgical care and asthma in children.  On twelve quality measures which have been examined over a longer period of time, performance improvement ranged from about 5% to over 55%.

The quality metrics basically focus on evidence-based treatment being provided to patients, for example, giving advice on not smoking to heart attack patients or stopping antibiotics within 24 hours for those persons having surgery.  Ninety percent of hospitals scored 90% or better on eight of the 28 measures tracked during 2008.  Performance was not as good on some of the newer metrics.  Overall, the report appears to indicate that focusing providers’ attention on specific items that are believed to improve care and outcomes can achieve results.

Some caveats should be considered, however, including the fact that the data are self-reported.  With measures and measuring programs of this type too, the improvement may result from better reporting of what was already being done.  Some studies have suggested that these kinds of quality of care improvement measures don’t necessarily seem to result in actual better health outcomes or lower costs.  Finally, while most of these measures are ones that probably should be applied to all patients, there is a danger that population-based metrics will lead providers to ignore differences in individual patients which may make the particular care item inappropriate for them.