The Joint Commission's annual report on quality initiatives in American hospitals could be more valuable to hospitalist groups if they look at where rankings show room for improvement, one hospitalist says.
Eduard Vasilevskis, MD, assistant professor of medicine in the Section of Hospital Medicine at Vanderbilt University and the Tennessee Valley-Nashville VA Hospital, says substantial gains in core-measure categories are great in aggregate but do little to spur QI in individual hospitals.
"As a group, we're doing pretty well with these core measures," Dr. Vasilevskis says. "But at an institution, it's critical you understand your individual numbers."
"Improving America’s Hospitals” (PDF), released in September, reported composite 2009 care results of 97.7% for heart attacks and 92.9% for pneumonia. Both were the highest measures since the report began tabulating the data in 2002.
Dr. Vasilevskis sees the news as a great sign for patient care but thinks the value of QI is to apply the techniques that have boosted those measures to other issues, such as interdisciplinary and transitional care. Those areas are more difficult to quantify and study, but that makes them ripe for HM group leaders to tackle, he says.
“This is going to take leadership; we need a quarterback on the team,” he adds. “Hospitalists can step up and be that quarterback.”
Dr. Vasilevskis also advocates for stiffer compliance requirements. For example, he says, while the current report lists a 99.4% compliance rate for physicians giving smoking cessation advice, the report includes no data or follow-up to show how that advice pans out. He notes that approach would be costly and time-consuming but could reap a valuable return on the investment.
"The first step is data," he says. "Then it's going to take leadership."