A Medical Device Daily Staff Report

U.S. hospitals have significantly improved the quality of care provided for patients suffering from heart attacks, heart failure, or pneumonia over the past four years, according to a report just issued by The Joint Commission (Oakbrook Terrance, Illinois).

The report details the performance of accredited hospitals against standardized national performance measures and the Joint Commission's National Patient Safety Goals.

"Improving America's Hospitals: A Report on Quality and Safety" also shows that the effectiveness with which hospitals carry out safe practices and provide patients proven treatments for common clinical conditions varies by state.

These variations spotlight opportunities for hospitals to strengthen their efforts in delivering safe, effective care.

For example, the Joint Commission report found that almost all heart attack patients are receiving aspirin when they arrive at the hospital, yet many heart failure patients do not receive specific discharge instructions about their condition and necessary follow-up care when they leave the hospital.

Hospital performance in complying with National Patient Safety Goal requirements has also been variable, the commission said. "Most hospitals do well in using objective methods to identify patients before undertaking treatments, but many are finding it challenging to put processes in place to avoid medication mix-ups."

The commission said it is issuing this report as part of its efforts "to stimulate continuous quality and safety improvement and to empower consumers with information that will make them more active participants in their healthcare."

The report — promised as the first in a series of annual reports — covers the period from 2002 through 2005.

"The real and potential improvements in patient safety and healthcare quality identified in this report underscore the value of ongoing measurement of hospital performance against standards and performance measures," said Dennis O'Leary, MD, president of the commission.

Among the specific findings:

• The magnitude of improvement in the safety and quality of care provided ranged from 1.1% to 42.8% over the four-year period between 2002 and 2005, with performance improving the fastest on measures where the initial performance level was lowest. The greatest improvement occurred in providing smoking cessation advice to patients admitted to the hospital with pneumonia. The national rate for telling these patients about the benefits of quitting smoking shot up from 37% in 2002 to 80% by 2005.

• Improvement is needed for most of the quality measures, the report said. "For example, hospitals are currently achieving 90% performance or higher for about half of the measures tracked since 2002. Hospitals are performing at less than 65% for two of these measures — providing pneumococcol vaccination to patients admitted with pneumonia, and providing discharge instructions to patients admitted with heart failure."

• It noted large variability among hospitals, state to state, for most measures. The statewide averages for providing discharge instructions to patients admitted with heart failure range from 33.5% to 89%. On the measure of providing pneumococcol vaccination to patients admitted with pneumonia, performance ranges from 48%-84% across the states.

• Commission data show some hospitals performing better than others in treating particular conditions, and that more than 90% of the nation's hospitals are achieving 90% performance on only one measure.

• Hospital compliance is lowest for National Patient Safety Goal requirements that a "time out" be taken by the surgical team before surgery to confirm patient identity and correct procedure and that certain potentially confusing abbreviations not be used in ordering medications.

Although National Patient Safety Goal compliance is trended over time for the various requirements, the report urges caution in interpreting these trends. Commission surveyors, it said, "have become increasingly sophisticated in assessing compliance with some of the requirements."

The commission requires accredited hospitals to collect and report data on three of five performance measure sets that apply to common clinical conditions. These measures may not apply to specialty hospitals such as pediatric hospitals. The commission and the Centers for Medicare and Medicaid Services have worked together to align the measures that both use. These standardized common measures, called "Hospital Quality Measures," are integral to improving the quality of care provided to hospitalized patients and bringing value to stakeholders by focusing on the actual care processes and results.

Women's health at FDA to get full funding

The Washington Post recently reported that the FDA will fully fund the Office of Women's Health during FY07.

The paper quoted an unnamed, high-level FDA official, who said that FDA had intended to withhold $1.2 million of the $4 million Congress allocated to the women's health office for FY07, and the remaining $2.8 million already has been allocated or spent.

The official said the decision meant the women's health office effectively would have had to stop future projects this year.

The Bush administration for several years has requested and Congress has allocated $4 million annually for the office, which was created in 1994.

FDA's 2007 operating plan provides $4 million for the women's health office, according to the Post.

"It is disappointing that on the important issue of women's health, FDA had to be persuaded to simply maintain the funding level that was requested by the [Bush] administration and provided by Congress," Rep. Rosa DeLauro (D-Connecticutt), chair of the House appropriations committee that funds FDA, said.