News | May 18, 2008

National Quality Forum Endorses Consensus Standards for Quality of Hospital Care

May 19, 2008 - Recognizing patient safety remains a major hurdle in the U.S., the National Quality Forum (NQF) last week endorsed 48 voluntary consensus standards focused on measuring the performance of acute care hospitals, including measures addressing pediatric safety, hospital readmission, and prevention and care of venous thromboembolism.

“It has been difficult to make real progress in patient safety in this country, despite the efforts of many highly skilled, committed professionals and innovations in technology and treatment,” said Janet Corrigan, president and CEO of the National Quality Forum. “In part, that is because we are all using different yardsticks to measure safety, which makes it difficult to identify and focus efforts on areas most in need of improvement and to measure and quantify progress. NQF-endorsed standards represent consensus of the experts and leaders from all corners of the healthcare industry, and can make a significant difference in helping hospitals measure what matters most to truly improve hospital care.”

NQF-endorsed voluntary consensus standards are widely viewed as the “gold standard” for measurement of healthcare quality.

“This set of NQF-endorsed measures will help hospitals identify where there are safety issues in need of system solutions,” said Dr. Jonathan B. Perlin, chief medical officer of the Hospital Corp. of America. “NQF-endorsed measures are instrumental in guiding hospitals through the complicated maze of measurement and reporting to ensure that quality is constantly addressed and improved in a way that is efficient and effective.”

The set of hospital measures will facilitate broad-based quality improvement by targeting numerous safety and quality issues within hospitals. Given the growing concerns with readmissions in America, particularly in the Medicare population, these important measures will help track progress toward improved transitions in care.

Most of the newly endorsed measures, the Quality Indicators, developed by the Agency for Healthcare Research and Quality (AHRQ), specifically offer hospitals an opportunity to pinpoint safety issues with measurement driven by readily available administrative data, rather than medical record reviews. Carolyn Clancy, M.D., director of AHRQ, believes the new measures can have a real impact.

“Through public reporting these measures should offer needed guidance to purchasers and consumers seeking information about hospitals, as well as an opportunity for benchmarking to peers in the marketplace,” Clancy said.

Six of the measures target the most common preventable cause of hospital death - venous thromboembolism (VTE). There are 900,000 cases of VTE in the U.S. every year, and 300,000 of them are fatal. Annually, more than 600,000 of those cases - and 200,000 of the fatalities - occur in hospitals, which have access to VTE prophylactic measures and treatments. All six NQF-endorsed measures on VTE focus on hospitals; with one measure extending the focus to readiness of patients for discharge. These newly endorsed measures further fill out NQF’s portfolio of VTE measures and practices, including two previously endorsed safe practices.

When a measure is NQF-endorsed, it carries the full weight of formal consensus of more than 375 healthcare providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality improvement organizations. Standards are vetted through NQF’s formal Consensus Development Process to achieve special legal standing as voluntary consensus standards and are evaluated against NQF’s criteria to ensure they are important, scientifically acceptable, useable, and feasible. When the federal government adopts standards, federal law obligates that they are voluntary consensus standards.

Measures endorsed by NQF on May 15 include:

- Length of Stay/Readmission
- Risk-adjusted average length of inpatient hospital stay
- Overall inpatient hospital average length of stay (ALOS) and ALOS by DRG service category
- All-cause readmission index
- Thirty-day all-cause risk standardized readmission rate following heart failure hospitalization
- Severity-standardized average length of stay-routine care
- Severity-standardized average length of stay-special care
- Severity-standardized average length of stay-deliveries
- Patient Safety, Adult
- Accidental puncture or laceration
- Death in low mortality DRGs
- Iatrogenic pneumothorax
- Death among surgical inpatients with serious, treatable complications
- Bilateral cardiac catheterization rate
- Blood cultures performed within 24 hours prior to or 24 hours after hospital arrival for patients who were transferred or admitted to ICU within 24 hours of hospital arrival
- Congestive heart failure mortality
- Hip fracture mortality rate
- Transfusion reaction, age 18 years and older
- Patient Safety, Pediatrics
- Accidental puncture or laceration
- Decubitus ulcer
- Iatrogenic pneumothorax in nonneonates
- Transfusion reaction, age under 18 years
- PICU severity-adjusted length of stay
- PICU unplanned readmission rate
- Review of unplanned PICU readmissions
- Home management plan of care document given to patient/caregiver
- Pediatric heart surgery mortality
- Pediatric heart surgery volume
- PICU pain assessment on admission
- PICU periodic pain assessment
- PICU standardized mortality ratio
- Surgery and Anesthesia
- Abdominal aortic aneurysm volume
- Abdominal aortic aneurysm repair mortality rate
- Esophageal resection mortality rate
- Esophageal resection volume
- Incidental appendectomy in the elderly rate
- Pancreatic resection mortality rate
- Pancreatic resection volume
- Post operative wound dehiscence, age under 18 years
- Post operative wound dehiscence, 18 years and older
- Foreign body left after procedure, age under 18 years
- Foreign body left in during procedure, 18 years and older
- Failure to Rescue In-hospital Mortality
- Failure to Rescue 30-day mortality
- Venous Thromboembolism
- VTE prophylaxis
- Intensive Care Unit (ICU) VTE Prophylaxis
- VTE Patients with Anticoagulation Overlap Therapy
- VTE Patients Unfractionated Heparin (UFH)Dosages/Platelet Count Monitoring by Protocol (or Nomogram)
- VTE Discharge Instructions
- Incidence of Potentially Preventable VTE

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