Appraising Hospital Performance by Using the JCHAO/CMS Quality Measures in Southern Italy

Abstract

ObjectivesThe main objective of the present study was to estimate the uptake to quality indicators that reflect the current evidence-based recommendations and guidelines.MethodsA retrospective review of medical records of patients admitted to two hospitals in the South of Italy was conducted. For the purposes of the analysis, a sets of quality indicators has been used from the Joint Commission on Accreditation of Hospital Organizations and Centers for Medicare & Medicaid Services. Four areas of care were selected: acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), and surgical care improvement project (SCIP). Frequency or median was calculated, as appropriate, for each indicator. A composite score was calculated to estimate the overall performance for each area of care.ResultsA total of 1772 medical records were reviewed. The adherence rates showed a wide-ranging variability among the selected indicators. The use of aspirin and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) for AMI, the use of ACEI or ARB for HF, the use of appropriate thromboembolism prophylaxis and appropriate hair removal for surgical patients almost approached optimal adherence. At the other extreme, rates regarding adherence to smoking-cessation counseling in AMI and HF patients, discharge instructions in HF patients, and influenza and pneumococcal vaccination in pneumonia patients were noticeably intangible. Overall, the recommended processes of care among eligible patients were provided in 70% for AMI, in 32.4% for HF, in 46.4% for PN, and in 46% for SCIP.ConclusionsThe results show that there is still substantial work that lies ahead on the way to improve the uptake to evidence-based processes of care. Improvement initiatives should be focused more on domains of healthcare than on specific conditions, especially on the area of preventive care.

Quality in perinatal care: applying performance measurement using joint commission on accreditation of healthcare organizations indicators in Italy

“…In conclusion, our findings revealed significant deficiencies in the adherence to recommended processes of perinatal care and, consistently with previous studies conducted by some of us to estimate the adherence to evidence-based processes of care in several settings [7,44,45], suggest that it is essential to increase efforts to implement evaluation processes that reflect the healthcare quality based on current evidence and related practice guidelines. The application of the JCAHO PC indicators has demonstrated to be feasible, intuitive and useful to measure perinatal hospital performance, and, although the poor comparability among multiple available quality measures represents a barrier, these performance metrics can be reliably used within an institution, thus enabling comparisons of performance over time, particularly after the implementation of quality improvement interventions.…”

“…The quality of care provided to the adult hospitalized Italian population has been scrutinized in the past years by use of adequate indicators [7,8], whereas only sparse data is available for perinatal care, although an interesting approach suggesting the use of a set of 19 indicators for the performance assessment in the maternity pathway in one region of Italy has thoroughly taken into account also perinatal care indicators [9]. In this context, the primary aim of this study was to assess the quality of perinatal care in a specific geographical area of Italy using the JCAHO indicators, since, compared with PNE indicators, they involve more aspects of perinatal care and include indicators for which there is no standardized monitoring system in Italy, such as breastfeeding or elective delivery [10].…”

Physicians' adherence to acute coronary syndrome prescribing guidelines in Vietnamese hospital practice: a cross‐sectional study

“…The percentage of patients prescribed beta blockers at arrival was suboptimal and lower than observed in some other studies (65-83%) [40][41][42]. Multivariate analysis showed that patients with STEMI (compared to UA), heart failure or female patients were less likely to receive beta blockers at arrival.…”

Information about management of chronic drug therapies prescribed at hospital discharge: does it affect patients’ knowledge and self-confidence?

“…This result is a concern, as already highlighted by Toren et al, that found that only 40% of patients discharged from hospital had received counselling and that it was associated with knowledge on medications [ 24 ]; moreover Coleman et al reported that discrepancies between prescribed medication and actual old patients’ behaviour were also related to system-associated factors, such as conflicting information from different informational sources [ 25 ]. Although alarming, this finding was not surprising; in a study conducted by some of us to evaluate the adaptability of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Centers for Medicare & Medicaid Services (CMS) quality indicators in our geographical area we found that rates regarding adherence to discharge instructions in heart failure patients, that is one of the patient safety indicators, was “noticeably intangible” [ 26 ], thus confirming low attention to counseling at discharge in our hospitals. The investigation of quality and extent of information provided to patients showed that counselling at discharge performed by hospital physicians on new prescribed therapies dealt mainly on the rationale, dosing, route and timing of medications administration, whereas potential problems and/or actions to take in presence of errors or side effects of medications were not discussed at discharge.…”