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By Robert Lowes for Medscape
The pace of quality improvement for America’s hospitals may not be quite as rapid as it once was, but it’s still respectable, judging by the latest list of top performers compiled by the Joint Commission and released on November 13.
The number of top-performing hospitals increased from 1099 in 2013 to 1224 in 2014 for an 11% increase. That compares with far larger increases of 77% from 2012 to 2013, and 53% from 2011 to 2012. Only 406 hospitals ranked as top performers in 2011.
The honor reflects a hospital’s collective scores on measures of evidence-based care during the previous year. The Joint Commission used 46 measures to judge hospital performance in 2013. They fall into 10 core measure sets, or categories, each of which contains at least one measure:
- Heart attack
- Heart failure
- Perinatal care
- Surgical care
- Children’s asthma care
- Inpatient psychiatric services
- Venous thromboembolism care
- Stroke care
Three of the seven individual measures in the heart-attack set, for example, are fibrinolytic therapy within 30 minutes, aspirin at hospital arrival, and aspirin at discharge. There are eight measures for stroke care, including antithrombotic therapy by the end of the second day of hospitalization, and statin therapy upon discharge.
To earn top-performer status, a hospital must submit data in at least four of the 10 categories. In those selected categories, the hospital must score a cumulative 95% or above across all individual quality measures. For each reported individual measure where there were 30 denominator cases, the hospital needs to ace it at least 95% of the time.
Finally, the hospital must hit or exceed the 95% threshold for every individual measure within at least one core measure set. St. Francis Hospital in Litchfield, Illinois, for example, made the list by virtue of excelling in pneumonia care. In contrast, many hospitals were strong in five and six categories. Baptist Hospital of Miami (Florida) led the pack as the only facility earning accolades in seven.
Patient Hand-offs Need Work
The 1224 hospitals named as top performers by the Joint Commission represent 36.9% of the 3300-plus accredited hospitals that reported quality data for 2013 to the commission. The majority were general community hospitals, although the list included children’s, psychiatric, surgical, and cardiac specialty hospitals as well as large academic medical centers.