For the first time since their controversial debut seven years ago, publicly available summaries of hospital accreditation survey results are targeted for an overhaul to reflect changing times and stiffer expectations.
The Joint Commission on Accreditation of Healthcare Organizations announced in the June edition of its Perspectives publication that it would reorganize and streamline the performance reports it publishes on hospitals and other types of healthcare businesses to make them more representative of quality and safety issues addressed in its standards.
"The current reports no longer reflect information that is meaningful to the field or the public," said Charles Mowll, JCAHO vice president of business development, government and external relations.
The JCAHO came to that conclusion after conducting consumer research in 2000 and 2001 and also seeking comment from its public advisory group about the usefulness of the reports.
The Web-accessible summaries, which give hospitals an overall score on a 100-point scale, also include scores in 45 performance areas.
To consumers who expect a page or two of data, the volume of evaluated material plus another eight to 10 pages of explanation about standards and context "is not their idea of usable information," Mowll said. Under the current format, the reports are "difficult to read, difficult to understand-they're probably information overload," he said.
The first attempt to meet consumer preferences for simplicity in 1994 resulted in a short but tempestuous burst of opposition from hospital executives and state hospital association officials to a proposed disclosure format that converted the scores in each performance area to a rating of one to five stars.
Critics said the system oversimplified complex accreditation data to the point of being useless-and it trivialized quality data by using a rating system often applied to restaurants and movies. The proposal was scrapped in favor of the numerical system and supporting data used to this day.
Public disclosure at that time was itself a controversial move, coming at a time when consumer demand for healthcare performance data was building. The effort to convert accreditation results to summary reports followed a May 1993 decision by the JCAHO board to begin releasing hospital-specific accreditation data to the public for the first time.
Among hospital executives, "the comfort level settled in" once the reports became routine, said Richard Wade, spokesman for the American Hospital Association. And routine access to hospital reports has become popular despite the knocks against them.
From May 2001 to April 2002, a performance-data section of the JCAHO's Web site called Quality Checks was accessed 495,000 times, and 117,500 requests were made for a particular performance report.
The planned overhaul reintroduces the balancing act between accredited customers of the JCAHO and the customers of the hospitals who want usable information. "Hospitals want a fair representation of their performance, and they have told us the information has to be more meaningful and more representative of our current standards," Mowll said.
The JCAHO came to the AHA about a year ago with ideas for revisions, which Wade said were in the general direction the hospital industry wanted to move: patient safety and quality reporting. The current reports, by contrast, "were trying to cull a lot of data that was hard for the public to get a hold of," he said.
For example, people looking over the current reports would be hard-pressed to glean much insight into patient-safety issues, even though about 50% of JCAHO hospital standards relate in some way to those issues, Mowll said.
Commission executives envision a new format for performance reports centered on patient safety and quality, with six to eight performance areas under each of those two categories.
Once the overhaul of the hospital accreditation manual is completed early next year, a new performance-report format will be drafted for hospitals and consumers to review. Wade predicted "some tussles" over the final product but in an atmosphere of good faith.
Implementation of the revised hospital-specific reports is scheduled for mid-2004, with other accreditation programs such as home care and long-term care to follow.