Groups push for transparency in Joint Commission’s hospital accreditation surveys
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Public records, Studies
The Lexington Herald-Leader’s Jim Warren reports that about 50 advocacy groups, including the Consumers Union and Mothers against Medical Error, have joined forces to ask Congress to make the survey data behind hospital accreditation freely available to the public.
Their main target is The Joint Commission, a non-profit group that sets performance standards and is hired by hospitals and other health-care organizations to measure whether they meet those standards. In many states, Joint Commission accreditation is the basis for hospital licensure. It conducts extensive surveys every three years or so, and funds its efforts by charging hospitals upward of $45,000 for the privilege of being evaluated.
The Joint Commission’s disclosure practices last made headlines in January when, in response to pressure from AHCJ’s Right to Know Committee, it made accreditation information more readily available online.
For help finding and understanding Joint Commission reports and similar sources, AHCJ members can check out board president Charles Ornstein’s latest guide to Deciphering Hospital Quality Data, in which he addresses the strengths and weaknesses of myriad data sources and provides pointers on how to access and utilize them.
Series reveals gaps in communication of hospital inspection results
Filed under: Government, Hospitals, Hot Health Headline
Jodie Jackson Jr. of the Columbia (Mo.) Daily Tribune took an in-depth look at patient safety at University Hospital, part of the University of Missouri Health Care system.
Jackson found that inspections, by CMS and the FDA, have repeatedly turned up systemic practices that compromised patient safety. At the same time, the Joint Commission awarded the hospital a full accreditation, raising questions about why the agencies don’t share information.
In a blog post, Jackson, a Midwest Health Journalism Program Fellow, says he has “examined some 700 pages of documents and have had national infection control leaders examine the reports that formed the basis for the series.”
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Joint Commission makes more accreditation details available on website
Filed under: Health data, Health journalism, Hospitals
Angie C. Marek, a member of AHCJ’s Right to Know Committee, contributed this update.
The Joint Commission, the largest nonprofit organization to accredit hospitals in the United States, has improved the quality of information available to consumers and journalists on its website. 
In response to a request by AHCJ’s Right to Know Committee, the agency has made it easy to tell whether a facility has recently lost accreditation or is in danger of losing it.
In the site’s Quality Check section, the search page now has a filter allowing viewers to select “Type of accreditation.” (The filter only appears in areas where there are hospitals that are not fully accredited.) Previously, to find hospitals with less-than-full accreditation, users had to examine each hospital’s record individually. Now the few that have not met standards can be quickly located.
“We’re pleased that the Joint Commission responded to our suggestion to make its website more useful,” said Charles Ornstein, president of AHCJ’s board of directors. “Reporters and consumers will now find it somewhat easier to learn about the institutions to which they entrust their health.”
Doctors certified to use strokebuster don’t
The Milwaukee Journal Sentinel’s John Fauber used data from the Joint Commission to discover that a clot-busting drug that could help patients mid-stroke is not being used in between 30 percent and 60 percent of the situations in which it should be effective. It’s a meaty story package, rich in background and context. As always, Fauber did his homework.
The clot-dissolving agent, known as tissue plasminogen activator, or t-PA, is the only approved drug for treating a stroke by stopping it and significantly reducing the risk of disability.
Yet the number of patients who get t-PA has remained dismally low, about 5% of all stroke patients, ever since the drug was approved 14 years ago. Much of that is because patients fail to recognize their symptoms and get to the hospital within the 4 ½ -hour window during which the drug can be administered.
Fauber writes that part of physicians’ reluctance to deploy t-PA can be attributed to built-in financial disincentives. In a small number of cases it can cause bleeding that might attract malpractice lawsuits, and it’s reimbursed at as low as $200 a use.
As a weird offshoot from this incentivization, Fauber found that the “Primary Stroke Center” certification has enough cachet that physicians while go through the motions of t-PA certification just to get the fancy label, yet have no intention of really using the drug.
AHCJ: Joint Commission site obscures information
In a letter to Mark R. Chassin , M.D., the Joint Commission’s president and CEO, the Association of Health Care Journalists has suggested improvements to the commission’s Quality Check Web site, where many people go to find out whether to trust their local hospital.
The Web site also is a potentially useful tool for health-care journalists. “In a time of change in health care, the ability to do comprehensive research on local hospitals is more important than ever before,” the association’s letter said.
Among the problems identified:
- Hospitals with any level of accreditation are given “The Gold Seal of Approval” – even those whose accreditation is conditional or at risk of being denied.
- It’s difficult to find out which hospitals in a given region have less-than-full accreditation. To check on a hospital’s accreditation status, one has to open each individual profile. The Joint Commission once had a mechanism to sort hospitals by accreditation status, but that is no longer available.
- After a hospital loses accreditation, its past Accreditation Quality Reports are eventually removed from the site, leaving only the facility’s name with no historical record.
- There is no easy way to do a side-by-side comparison of more than six facilities simultaneously.
“The organization that accredits hospitals around the country, and voices support for transparency about hospital quality, has a Web site that obscures the reality of many hospitals’ performance,” said Charles Ornstein, AHCJ president.
Read more about AHCJ’s letter to the Joint Commission.
Joint Commission finds improved hospital quality
Filed under: Conflicts of interest, Health data, Hospitals, Pharmaceuticals, Studies
The latest report from The Joint Commission, a hospital accrediting organization, finds that “overall, hospitals are following evidence-based standards for treatment of myocardial infarction, heart failure, and pneumonia,” as MedPage Today reports.
The report, which looks at 31 evidence-based measures, did find decreases in two areas: measuring oxygen in blood for pneumonia patients and administering antibiotics to pneumonia patients in the intensive care unit within 24 hours.
The report, “Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2009,” (PDF) and those from three previous years are available on the commission’s Web site. Among the key findings:
- Hospitals accredited by The Joint Commission have significantly improved the quality of care provided to heart attack, heart failure and pneumonia patients over a seven-year period.
- Hospitals have steadily improved on individual surgical care performance measures – as well as on additional individual heart attack and pneumonia care measures - over a two-, three- or four-year period.
- Hospital performance on two individual measures of quality relating to inpatient care for childhood asthma is excellent after only one year of measurement.
- Improvement is still needed.
- Where a patient receives care makes a difference.
As ProPublica’s Charles Ornstein explains in his tip sheet, The Joint Commission does routine inspections of participating hospitals to ensure they meet the standards required for accreditation. It compiles public reports on each hospital, which are available on the qualitycheck.org Web site. These reports include the hospital’s accreditation status, as well as some data on hospital outcomes and practices.
It does not release its detailed inspection reports to the public, and many states’ open records laws specifically exempt the reports from public disclosure. In the past, these inspections have not been surprises, and the group has been faulted for being slow to act against hospitals with problems Also, The Joint Commission rarely takes punitive steps against hospitals, preferring to work with them to improve.
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