- MEDICAL NOTE
Battle of the Studies: Hospital accreditation is a poor predictor of the quality of patient outcomes, according to a new study by two University of Michigan School of Public Health researchers. The study, by Professors John R. Griffith and Jeffrey A. Alexander, published in the January issue of the peer-reviewed journal Quality Management in Health Care, shows no relationship between Medicare-based measures of mortality and complications and the scores assigned to hospitals by the Joint Commission on Accreditation of Hospitals (JCAHO).
Griffith and Alexander's study suggests a serious need to review the system that assures quality in 95 percent of U.S. acute care hospitals, and which is used for Medicare certification and often for state licensure. The JCAHO system, in use for 50 years, almost exclusively uses structural and process measures and does not track newer, more direct performance measures such as the number of deaths or unexpected complications, the hospital's financial strength, or its ability to adapt to the latest treatment approaches.
Griffith and Alexander examined Medicare outcomes by comparing JCAHO scores, submitted by JCAHO, against Medicare inpatient data prepared annually for “The 100 Top Hospitals: Benchmarks for Success” study by Solucient LLC. Evanston, Ill.-based Solucient, which does not compete with JCAHO, provided $10,000 in funding for a detailed analysis of the stability of its “100 Top” criteria and recommendations on changes.
Performance data like Solucient's suggest that America's hospitals need real improvement, Griffith said. “The differences between best and worst are too big to ignore. Most hospitals make a huge effort to raise their accreditation scores. If they put that energy in a smarter direction, we'd be better off.”
In a formal statement, the JCAHO said that it “categorically rejects the findings and conclusions of this recently published study…because the researchers' determinations regarding the relationship of hospital accreditation to outcomes are flawed.
“The two measures alleged by the authors to be indices of the quality and safety of health care — mortality index and complications index — have long since been dismissed by credible researchers and other experts in performance measurement. This is because both measures arein nature (that is, they apply to a wide variety of patients who present to hospitals with everything from non-urgent conditions to extreme emergencies), and both are very difficult to adjust for risk (that is, to adjust outcomes expectations based on how sick patients are and how many co-existing diseases they have.”
- CME NOTE On the Podium
The American College of Gastroenterology National's Bureau has developed a new series of slide and lecture note packages that are free to ACG members who enroll in the program and agree to give presentations in their local communities. To learn more, call the ACG at (703) 820-7400.
- ASSOCIATION NOTE Nurses Take On Capitol Hill
Leaders of organizations representing 70,000 registered nurses and allied professionals have created a new national nurses' organization. Meeting in San Diego, the group adopted a name — the American Association of Registered Nurses — targeted priorities for legislative and workplace changes, and hired a national advocate to press for gains in Congress.
“Nurses in this country need a voice that is not afraid to take on the health care industry as it continues to promote policies and practices that endanger patients and harm nurses,” said Karen Higgins, president the Massachusetts Nurses Association, which is a member organization.
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