Those figures indicate that recommended, evidence-based treatments are not being given to patients in a consistent manner, and patients deserve 100% consistency to improve their outcomes, said Rachel Yaron, vice president of quality and safety at 86-bed St. Clares Hospital, Weston, Wis. But those figures also offer incentives to boost hospitals closer to their goals. When I read that, my initial reaction was Oh, dear; and I think that was (the commissions) intention, Yaron said. Hospitals need to see the numbers in absolute terms so they can jump-start efforts to increase quality, she said.
The report includes the status of the commissions National Patient Safety Goals, a series of measures that highlight specific practices in areas of care for greater improvement. Compliance with the goalsin 2006, it was 16 requirements in seven goalsis mandatory for accreditation.
Under those national goals, critical test results and values are not reaching caregivers in a timely fashion 27% of the time. Medical reconciliation continues to be a problem, with hospitals not developing a process for obtaining and documenting a patients current medications 34% of the time.
While compliance might not be perfect, hospitals are still complying at rates of 80% or more, which is still pretty good, said Nancy Foster, vice president for quality and patient-safety policy at the American Hospital Association.
The good news is that hospitals continue to improve in individual measures; the next step to creating consistent, highly reliable care will be to focus on identifying underlying strategies and creating systems of care, she said. Were really at the beginning of the curve of that science.
Overall, compliance in the four areas of care reported on has increased at hospitals. From 2002 to 2006, heart attack care has improved 7.4%, while heart failure care saw the most dramatic improvement over the same four years, with an increase of 24%. Pneumonia care increased 15% since 2002.
Performance generally was lower for measures introduced in 2005 compared with ones introduced in 2002, which shows that, What gets measured gets done, said commission President Dennis OLeary, who is retiring at year-end.
But what providers and consumers must keep in mind is that standards and measures themselves are evolving as organizations continue to finesse evidence-based practices and to determine what practices should be measured, said Karen Linscott, acting chief executive officer of Leapfrog Group, a safety advocacy organization. Adopted measures have to be meaningful for the healthcare industry, she said.
The Joint Commission results align with similar findings by the National Committee for Quality Assurance, which in September reported tremendous strides in cardiac care. In 1996, 62% of heart attack patients received a beta-blocker drug to minimize risk for a second attack; by 2006, 98% of patients were given the drug, and that performance has been consistent over time, the NCQA reported.