Joint Commission's Top-Hospital List Still Missing Big Names

September 20, 2012 — The Joint Commission yesterday released its annual list of top-performing hospitals in 2011 based on their faithfulness to proven processes of care such as giving aspirin to heart attack patients on arrival. The list of hospitals that did not make the cut is just as interesting as the list of those that did.

Stonewall Jackson Memorial Hospital in Weston, West Virginia, is 1 of the 620 hospitals on the list. Another is Ponca City (Oklahoma) Medical Center. Massachusetts General Hospital in Boston, however, did not make the cut. Neither did Johns Hopkins Hospital in Baltimore, Maryland. Household names in healthcare, both hospitals missed last year's list as well.

In general, the Joint Commission's top performers during 2011 consist of hospitals such as Stonewall Jackson Memorial that are little known outside their community. However, some of the nation's most prestigious hospitals are missing from the list — even those that lead the pack in other ratings.

Massachusetts General, for example, was number 1 in the 2012 list of best hospitals compiled by US News & World Report. Johns Hopkins was number 2. Of the top 10 hospitals in the latest US News ranking, only 1 — Duke University Medical Center in Durham, North Carolina — numbers among the 620 spotlighted by the Joint Commission, which accredits 82% of the nation's hospitals.

Overall, only 5% of teaching hospitals qualified as top performers.

In a press conference yesterday, Joint Commission President Mark Chassin, MD, MPH, cut the big name hospitals some slack, saying that because of their larger size and complexity and the greater number of performance measures they report to the Joint Commission, it is harder for them "to achieve this kind of consistent excellence." But Dr. Chassin did not let them off the hook, either.

"On the other hand, they also have more resources to devote to improvement," he said. "I think we'll see more of these academic medical centers stepping up to this plate. I would hope and expect that we'll see some of them...get to the list next year."

Unlike US News, the Joint Commission does not rank hospitals 1-2-3 in its evaluation. The different methodologies used by the 2 organizations help explain why a hospital may appear in the magazine's top 10 but not be one of the commission's top performers. The Joint Commission goes strictly by evidence-based performance measures. In contrast, US News bases its rankings partly on a hospital's reputation.

Using Data to Drive Performance

The 620 hospitals that the Joint Commission rated as top performers earned that distinction in at least 1 of 8 care categories:

heart attack,
heart failure,
pneumonia,
surgical care,
children's asthma,
inpatient psychiatric services,
venous thromboembolism, and
stroke.

Except for heart failure, each care category consisted of 3 or more individual performance measures. For pneumonia, the measures were pneumococcal vaccination, blood cultures in the intensive care unit (ICU), blood cultures in the emergency department, antibiotics for patients in the ICU, antibiotics for non-ICU patients, and influenza vaccination.

The 7 measures for heart attack include fibrinolytic therapy within 90 minutes and aspirin at both arrival and discharge. The heart failure category involves just 1 measure: an ACE inhibitor or angiotensin receptor blocker at discharge. In all, the 7 categories make up 45 individual performance measures linked to positive patient outcomes.

The Joint Commission has reported performance data for all of its accredited hospitals since 2007, with the first report covering 15 process-of-care measures from 2002 through 2005. The report in 2010 was the first to break out the top performing hospitals, which adhere to process-of-care measures at least 95% of the time in 2 different calculations that the Joint Commission performs.

Dr. Chassin cautioned that excellence in selected categories of care in a given hospital "does not necessarily translate into quality of care elsewhere."

Using data to drive performance really works.

At the same time, he said he was heartened by the progress that hospitals were making. In 2011, 88.8% of the 3300-plus accredited hospitals that reported performance data achieved a composite score of more than 90% across all measures, with the exception of 2 for inpatient psychiatric care. In 2002, only 20.4% of hospitals surpassed that threshold.

Likewise, composite scores for individual care categories have risen dramatically — in surgery, for example, from scores have gone from 82.1% in 2005 to 97.6% in 2011 — and the number of top-performing hospitals rose 50% from 2010 to 2011.

"Using data to drive performance really works," said Dr. Chassin. "It leads to improved performance and improved patient outcomes."

"Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety, 2012." Full text