Introduction:

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires accredited hospitals to collect and submit performance data on three diagnoses:

  • Acute Myocardial Infarction (AMI)

  • Heart Failure (HF)

  • Community Acquired Pneumonia (CAP)

These are evidence‐based measures designed to improve the quality of care provided to patients, while providing a system with which to compare hospitals throughout the country. Compliance with these measures across hospitals is variable but may play an ever‐greater role in determining hospital and provider reimbursement. Hospitalists are in a unique position to provide insight and leadership in improving compliance with such measures.

Methods:

Specialized committees (or “triads”) for each core measure set established the following methods to enhance compliance beginning in early 2005:

  • 1)

    A core measure worksheet was placed in front of every chart that highlights the three core measures and their components. If a patient is identified as having a medical condition included in the JCAHO core measures, a clinician or nurse is required to fill out sections of the form to ensure that no measures are overlooked.

  • 2)

    Computerized order sets for the core measure diagnoses were designed and placed prominently within the computer order system. Order sets included all aspects of the core measures.

  • 3)

    Standing orders for influenza and pneumonia vaccine were established which could be activated without clinician intervention. 20% of all HF/CAP/AMI cases were reviewed and assessed for compliance with the JCAHO core measures.

Summary of Results:

Compliance with HF, CAP, and AMI JCAHO core measures were calculated and compared from 2004 and the 2nd and 3rd quarter of 2005. A trend toward improvement was seen for CHF‐adult tobacco cessation 40‐82% from 2004 to 2005. HF D/C instructions improved 30 to 65%, and influenza vaccine administration improved from 12 to 28% from 4th q 2004 to 3rd q 2005. No significant differences were found between quarters of 2005.

Statement of Conclusions:

Effectiveness of our strategies to improve compliance with the JCAHO core measures has been uneven. Nursing interventions for the HF core measure showed promise of improvement; increased automation for ordering core measure standards for nursing issues such as HF education may partly explain this result. Future efforts may need to focus on giving nurses additional involvement in core measure compliance. Strategies targeted towards physicians' interventions do not appear successful at this time. Physicians may be resistant to automating medical decision making and alternative strategies to make physicians more compliant with core measures are needed.

Author Disclosure Block:

B. Markoff, None; R. Jervis, None; N. Kathuria, None.