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Study: Consumer Ranking Systems for Hospitals May Rely on Faulty Data Sets and Performance Metrics

Added on October 6, 2016 in General News, Press Releases


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Study: Consumer Ranking Systems for Hospitals May Rely on Faulty Data Sets and Performance Metrics

New Article in The Joint Commission Journal on Quality & Patient SafetyCalls for Greater Transparency & Validation  

(OAK BROOK, Illinois, October 6, 2016) – Joint Commission Resources, Inc. today released the October 2016 issue of The Joint Commission Journal on Quality and Patient Safety, featuring the article “Consumer Rankings and Health Care: Toward Validation and Transparency” by Bala Hota, MD, MPH, and co-authors, Rush University Medical Center (RUMC), Chicago. After RUMC received the lowest ranking for patient safety (1 out of 5) in the 2015–16 U.S. News & World Report’s (USNWR) “Best Hospitals” rankings, the authors compared the data that USNWR used for their hospital to their own internal data.

The authors found that theUSNWR data showed many more patient safety events, such as pressure ulcers, almost all of which had actually been present at the patient’s admission. Suspecting a broader problem, Hota et al. analyzed data on a sample of hospitals and found that RUMC was not the only organization with discrepancies in data. False-positive event rates were common among high-transfer and high-volume hospitals. 

The authors conclude more transparency and validation is needed for consumer-based benchmarking methods. In response to these findings and concerns raised by others, USNWR made changes to its methodology and data sources in 2016.

In an accompanying editorial, “The Quality Measurement Crisis: An Urgent Need for Methodological Standards and Transparency,” David M. Shahian, MD, Elizabeth Mort, MD, MPH, and Peter J. Pronovost, MD, PhD, reflect on the Hota et al. article to conclude, “Just as health care providers have ethical and moral responsibilities to the public they serve, rating organizations and journalists that grade providers have similar obligations—in their case, to ensure measure validity and methodological transparency.”   

Additional articles featured in the October 2016 issue are:

Performance Improvement

Viewing Prevention of Catheter-Associated Urinary Tract Infection as a System: Using Systems Engineering and Human Factors Engineering in a Quality Improvement Project in an Academic Medical Center

Chanhaeng Rhee, MD, MBA; M. Eleanor Phelps, BSN, MA, RN; Bruce Meyer, MD, MBA; W. Gary Reed, MD, MS

Systems engineering and human factors engineering methods were used to reduce urinary catheter utilization and catheter-associated urinary tract infections (CAUTIs) in a three-year quality improvement project in a 610-bed academic medical center. The total systemwide CAUTI count decreased from 135 cases at baseline to 74 cases at the end of the project’s Year 1, to 59 cases at the end of Year 2, and 25 cases at the end of Year 3. By the project’s completion, the estimated annual avoidable CAUTI costs decreased from approximately $135,945 to $25,175.

Methods, Tools and Strategies

A New Performance Improvement Model: Adding Benchmarking to the Analysis of Performance Indicator Data

Ahmed Al-Kuwaiti, PhD; Karen Homa, PhD; Thennarasu Maruthamuthu, PhD

A performance improvement model was developed that focuses on the analysis and interpretation of performance indicator data using statistical process control and benchmarking. Performance indicators are suitable for comparison with benchmarks only if the data show random rather than special-cause variation. The model’s steps are illustrated through the use of two years of a hospital’s health care–associated infection data.

Creating a Professional Ladder for Interpreters for Improvement of Care

Lori Marshall, PhD, MSN, RN; Anna Fischer, MS, MPP; Allison Noyes Soeller, MA, PhD; Richard Cordova, FACHE; Yvonne R. Gutierrez, MD, FAAP; Luis Alford, MD

A metropolitan academic medical center for pediatric care recognized limitations in how professional interpreters were used to support effective patient-provider communication across the organization. More than 60 percent of the patient population had limited English proficiency. In a restructuring of the Diversity Services Department, the language staff role was redesigned to fit a four-level professional career ladder with progressive requirements for performance, leadership and accountability for patient care outcomes. The result of this work was a positive culture change resulting in service efficiencies, care improvements and improved access to language services.

Field Notes

Using Human Factors Design Principles and Industrial Engineering Methods to Improve Accuracy and Speed of Drug Selection with Medication Trays

Dar-Wei Chen, BSE, MS; Valerie J. Chase, MSE; Mary E. Burkhardt, MS, RPh, FASHP, FSMSO; Alma Z. Agulto, BSN, RN, CCRN-K

At the hospital at which this study was conducted, customized medication trays were used to hold specific forms and sizes of products, limiting flexibility in responding to changes in the availability of the medications. A Capstone student team of four industrial engineering students used human factors engineering principles and industrial engineering methods to analyze and document the problems with the medication trays. The students then developed a prototype medication tray with a “spice rack” design, which in usability testing was associated with faster and more accurate medication selection.


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