Joint Commission List of Top Hospitals Grows Longer

November 18, 2014

The pace of quality improvement for America’s hospitals may not be quite as rapid as it once was, but it’s still respectable, judging by the latest list of top performers compiled by the Joint Commission and released on November 13.

The number of top-performing hospitals increased from 1099 in 2013 to 1224 in 2014 for an 11% increase. That compares with far larger increases of 77% from 2012 to 2013, and 53% from 2011 to 2012. Only 406 hospitals ranked as top performers in 2011.

The honor reflects a hospital's collective scores on measures of evidence-based care during the previous year. The Joint Commission used 46 measures to judge hospital performance in 2013. They fall into 10 core measure sets, or categories, each of which contains at least one measure:

  • Heart attack

  • Heart failure

  • Pneumonia

  • Perinatal care

  • Surgical care

  • Children’s asthma care

  • Inpatient psychiatric services

  • Venous thromboembolism care

  • Stroke care

  • Immunization

Three of the seven individual measures in the heart-attack set, for example, are fibrinolytic therapy within 30 minutes, aspirin at hospital arrival, and aspirin at discharge. There are eight measures for stroke care, including antithrombotic therapy by the end of the second day of hospitalization, and statin therapy upon discharge.

To earn top-performer status, a hospital must submit data in at least four of the 10 categories. In those selected categories, the hospital must score a cumulative 95% or above across all individual quality measures. For each reported individual measure where there were 30 denominator cases, the hospital needs to ace it at least 95% of the time.

Finally, the hospital must hit or exceed the 95% threshold for every individual measure within at least one core measure set. St. Francis Hospital in Litchfield, Illinois, for example, made the list by virtue of excelling in pneumonia care. In contrast, many hospitals were strong in five and six categories. Baptist Hospital of Miami (Florida) led the pack as the only facility earning accolades in seven.

Patient Hand-offs Need Work

The 1224 hospitals named as top performers by the Joint Commission represent 36.9% of the 3300-plus accredited hospitals that reported quality data for 2013 to the commission. The majority were general community hospitals, although the list included children’s, psychiatric, surgical, and cardiac specialty hospitals as well as large academic medical centers.

In other well-known hospital rankings such as those compiled by US News & World Report magazine, academic medical centers tend to rule the roost.

Unlike US News & World Report, the Joint Commission does not factor in an institution's reputation. Its latest list of top performers included only 35 academic medical centers, but that was a substantial increase over 24 in 2013 and four the year before. The Joint Commission noted that quality improvement can be more of a challenge for academic medical centers, given their size and organizational complexity. At the same time, such institutions have more resources to devote to quality improvement than smaller community hospitals.

Academic medical centers that ranked as Joint Commission top performers this year included University of Kentucky Hospital, New York Presbyterian Hospital, and Johns Hopkins Hospital in Baltimore, Maryland. Missing from the list were other big names such as Massachusetts General Hospital in Boston and the Mayo Clinic in Rochester, Minnesota.

As a whole, accredited hospitals reporting quality data to the Joint Commission have significantly boosted their composite scores in each of the core measure sets. The composite score for children's asthma care, for example, increased from 88.1% to 96.2% in a span of four years. For inpatient psychiatric services during the same period, the composite score shot up 9.8 percent points.

Hospitals hit 95% on most individual quality measures, the Joint Commission noted, but there was one group of yardsticks that cried out for improvement — those relating to care plans and discharge instructions. Such documents are crucial for patient hand-offs, regarded by reformers as a weak link in the nation's healthcare system.

Table 1. Room for Quality Improvement

Quality Measure Collective Hospital Performance Score in 2013
Home management care plans for pediatric asthma patients 88.9%
Transmitting continuing- care plans for psychiatric patients 88.3%
Warfarin discharge instructions for venous thromboembolism patients 85.9%

Source: America's Hospitals: Improving Quality and Safety — the Joint Commission's Annual Report 2014

More information about the top-performing hospitals named by the Joint Commission is available on the group's Web site.

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