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Consumers can get better comparisons of hospitals and other health facilities on the Web through JCAHO program
On June 15, the Joint Commission on Accreditation of Healthcare Organizations introduced its revamped Quality Check database as the latest Web resource for consumers wishing to know who does what best in health care.
QualityCheck.org allows the user to compare directly nearly 16,000 JCAHO-accredited healthcare organizations. Improved features include searching for hospitals within specified distances from any zip code and comparing up to six accredited organizations at once. Hospital comparisons show accreditation decision and effective dates, including requirements for improvement where applicable; compliance with National Patient Safety Goals; performance on National Quality Improvement Goals; and any special quality awards.
Initially, the quality report includes four conditions with multiple measures in eachheart attack, heart failure, pneumonia, and pregnancy and related conditions. Next to be posted will be surgical infection prevention measures, and in development are intensive care unit measures, pediatric asthma, pain management, and deep vein thrombosis.
In the launch news teleconference, JCAHO president Dennis O'Leary noted that organizations had been able to view their own reports for about six weeks and had returned "remarkably little negative input."
Hospital pharmacists that Drug Topics spoke with were generally in favor of the initiative, but they did offer caveats. Mary Inguanti, R.Ph., director of pharmacy, Saint Francis Hospital and Medical Center, Hartford, Conn., "completely supports the areas they're measuring and the whole spirit of it." However, she expressed disappointment that the data are for 2003. "They just unveiled the 2005 safety goals, so this is very dynamic, and hospital operations are moving toward meeting or exceeding them. Old news does a disservice to the program."
Quality Check will display an organization's National Patient Safety Goal performance from the year of its last survey. "Accredited organizations are surveyed a minimum of once every three years, and the Joint Commission usually renders a decision within four months of a survey," said JCAHO spokesman Mark Forstneger. Results will be updated quarterly, with the oldest quarter rolled off as data for a new quarter are added and the results recalculated. The first update will be in the fall of 2004.
Linda McCoy, Pharm.D., pharmacy manager - QI/Risk/Special Projects, Good Samaritan Regional Medical Center, Phoenix, questioned how much the consumer is going to understand about the information posted. "People working in health care are probably going to find the information more beneficial."
One change has been a move from numerical scores to a system of more user-friendly checks, pluses, and minuses, although Historical Performance Reports will continue to be available with numerical scoring.
The Joint Commission hopes organizations will explore the reason for minuses, make changes, and demonstrate improvements over time. Ertel said it will likely not affect her pharmacy directly. "But the hospital has looked at it to see where we are."
Because her hospital always looks at scores to see where it can make improvements, McCoy doesn't see this initiative as any different from what's already in place. "The Joint Commission standards are always out there pushing us to do better and to excel, so I'm not sure this is going to add anything else to that."
Inguanti said it is already affecting her pharmacy and organization. "We have a very collaborative practice here with medical staff and patient care services in the pharmacy, and this is a very important project for us. But I'm disappointed at the old data out there. We have huge initiatives for all the core measures we're participating in. We have work groups. We have action plans. We have implemented changes we're tracking. We have medical records abstracters. Some of these numbers [on the Web]they're so antiquated, so not where we are."
O'Leary noted that data collecting for such initiatives is very expensive and labor-intensive. "There are probably finite limitations in an organization's ability to collect data. Absent electronic records, our measurement capabilities are severely constrained."
McCoy sees that as a huge consideration. "Are we taking people away from other activities that would promote a safer environment in order to audit and collect data?" She noted that, given the shortage of R.Ph.s and nurses, the new standards and some of the expectations would demand additional resources. "When we all get electronic medical records and other technology advancements, then everybody's going to be looking at the same page."
Dana Cassell. JCAHO Web tool offers clues to best in health care.
Aug. 23, 2004;148:HSE9.