Joint Commission says hospitals lag on key quality measures

Measuring medical quality is no joke. JCAHO has taken a very simplistic approach to quality measurement, be it pneumonia or heart failure. A lot of money has been thrown around with no demonstrable improvement in quality, outcomes or cost of care. Generally all hospitals come out looking like winners with 90-100% compliance with these key quality indicators as suggested by JCAHO. EMR developers focus foolishly on these issues and generate programs to do “clinical support”. To serious, professional physicians, these aphorisms sound like rubbish, particularly when they come out of the mouths of bean counters and quality coordinators of the hospital. Take a few more:
ACE inhibitors on discharge. No sensible doctor would discharge a patient with congestive heart failure without ACE inhibitor unless there is at least a marginal contraindication. It is funny that Cardiologists are the ones who often come out looking like laggards. They tend to see a skewed population with concurrent problems that may contraindicate ACE inhibitor use. They often use alternative, sometimes safer vasodilators. What would perhaps be a better measure is to see how these people are followed after discharge and how often they are readmitted for the same problem. An even better indicator would be to see what percentage of frequently readmitted people are really compliant with instructions and how the underlying causes are being addressed.
Community acquired Pneumonia (CAP): Antibiotic to be administered within X number of minutes after the order. The better quality of service indicator would be the length of time it takes a patient presenting with pneumonia to be assessed by triage nurse and seen by the MD.
CHF patients going home with weighing scales: A better indicator might be CHF patients counseled on the proper use of a food weighing scale before discharge!
We all have a long way to go before saying “Mission accomplished!”