Venous thromboembolism performance measurement in the United States: An evolving landscape with many stakeholders.

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a life-threatening, costly, and common preventable complication associated with hospitalization. Although VTE prevention strategies such as risk assessment and prophylaxis are available, they are not applied uniformly or systematically across US hospitals and healthcare systems. Hospital-level performance measurement has been used nationally to promote standardized approaches for VTE prevention and incentivize the adoption of guideline-based care management.

Infection Control Measure Performance in Long-Term Care Hospitals and Their Relationship to Joint Commission Accreditation.

Background: This study evaluated the relationship between Joint Commission accreditation and health care-associated infections (HAIs) in long-term care hospitals (LTCHs).

Methods: This observational study used Centers for Medicare & Medicaid Services (CMS) LTCH data for the period 2017 to June 2021. The standardized infection ratio (SIR) of three measures used by the Centers for Disease Control and Prevention's National Healthcare Safety Network were used as dependent variables in a random coefficient Poisson regression model (adjusting for CMS region, owner type, and bed size quartile): catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and central line-associated bloodstream infections (CLABSIs) for the periods 2017 to 2019 and July 1, 2020, to June 30, 2021.

Clinician Well-Being Assessment and Interventions in Joint Commission-Accredited Hospitals and Federally Qualified Health Centers.

Background: Clinician burnout is a longstanding national problem threatening clinician health, patient outcomes, and the health care system. The aim of this study is to determine the proportion of hospitals and Federally Qualified Health Centers (FQHCs) that are measuring and taking system actions to promote clinician well-being.

Methods: This cross-sectional study used an electronic questionnaire from April 21 to June 27, 2022, to assess the current state of organizational efforts to assess and address clinician well-being among a national sample of 1,982 Joint Commission-accredited hospitals and 256 accredited FQHCs.

Home Health Agency Patient Experience Measures and Their Relationship to Joint Commission Accreditation.

Background: Health care accreditation is a widely accepted mechanism for improving the quality of care and promoting patient safety. An integral dimension of health care quality is the patient experience of care. However, the influence of accreditation on the patient experience is unclear.

Biomolecules in modern and sustainable agriculture.

This review presents scientific findings which indicate biomolecules are excellent candidates for the development of biopesticides. Efforts are being done to find routes to increase their concentrations in the cultivation media because this concentration facilitates applications, storage, and transportation. Some of these routes are co-fermentation and ultrasound-assisted fermentation.

Evaluation of ultrasound waves for the production of chitinase and β-1,3 glucanase by through SSF.

Cell wall degrading enzymes (chitinase and β-1,3-glucanase) were produced by solid-state fermentation (SSF) using the fungus and different agro-industrial products, mainly residues. The influence of temperature (25-35 °C), initial moisture content (50-90% w/w), nutrient solution (1-2% v/w), and yeast extract (1-2% w/w) on enzyme activity was evaluated. The application of ultrasound during fermentation for different times (0-6 h/day) was also studied.

Comparison of electronic versus manual abstraction for 2 standardized perinatal care measures.

Objective: Given that electronic clinical quality measures (eCQMs) are playing a central role in quality improvement applications nationwide, a stronger evidence base demonstrating their reliability is critically needed. To assess the reliability of electronic health record-extracted data elements and measure results for the Elective Delivery and Exclusive Breast Milk Feeding measures (vs manual abstraction) among a national sample of US acute care hospitals, as well as common sources of discrepancies and change over time.

Materials And Methods: eCQM and chart-abstracted data for the same patients were matched and compared at the data element and measure level for hospitals submitting both sources of data to The Joint Commission between 2017 and 2019.

A Multistate Comparison Study of COVID-19 Cases Among Accredited and Nonaccredited Nursing Homes.

Widely acknowledged is the disproportionate number of COVID-19 cases among nursing home residents. This observational study examined the relationship between accreditation status and COVID-19 case rates in states where the numbers and proportions of Joint Commission accredited facilities made such comparisons possible (Illinois (IL), Florida (FL), and Massachusetts (MA)). COVID-19 data were accessed from the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare Public Use File, which included retrospective COVID-19 data submitted by nursing homes to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network.

Extraction of bioactive compounds from using emergent technologies.

Unlabelled: Several plant species synthesize biologically active secondary metabolites. Pyrrolizidine alkaloids are a large group of biotoxins produced by thousands of plant species to protect against the attack of insects and herbivores, but they are highly toxic for humans and animals. In this study, extracts from the aerial part of were obtained using different technologies: ultrasound-assisted extraction (UAE), pressurized liquid extraction (PLE), and microwave hydrodiffusion and gravity (MHG).

Retooling of Paper-based Outcome Measures to Electronic Format: Comparison of the NY State Public Risk Model and EHR-derived Risk Models for CABG Mortality.

Background: Risk adjustment is critical in the comparison of quality of care and health care outcomes for providers. Electronic health records (EHRs) have the potential to eliminate the need for costly and time-consuming manual data abstraction of patient outcomes and risk factors necessary for risk adjustment.

Methods: Leading EHR vendors and hospital focus groups were asked to review risk factors in the New York State (NYS) coronary artery bypass graft (CABG) surgery statistical models for mortality and readmission and assess feasibility of EHR data capture.

Impact of Race on Immunization Status in Long-Term Care Facilities.

Objectives: This study examined the relationship between resident race and immunization status in long-term care facilities (LTCFs). Race was captured at the resident and the facility racial composition level.

Design: Thirty-six long-term care facilities varying in racial composition and size were selected for site visits.

Trends in Results of HBIPS National Performance Measures and Association With Year of Adoption.

Objective: Multiple studies demonstrate a consistent pattern of improvement on quality measures among health care organizations after they begin collecting and reporting data. This study compared results on psychiatric performance measures among cohorts of hospitals with different characteristics that elected to begin reporting on the measures at various points in time.

Methods: Quarterly reporting of Hospital-Based Inpatient Psychiatric Services (HBIPS) measures to the Joint Commission was used to examine trends in performance among four hospital cohorts that began reporting in 2009 (N=243), 2011 (N=139), 2014 (N=137), or 2015 (N=372).

Using the Targeted Solutions Tool® to Improve Hand Hygiene Compliance Is Associated with Decreased Health Care-Associated Infections.

Background: In 2010 Memorial Hermann Health System (MHHS) implemented the Joint Commission Center for Transforming Healthcare's (the Center's) Web-based Targeted Solutions Tool ®(TST ®) for improving hand hygiene through-out its 12 hospitals after participating in the Center's first project on hand hygiene, pilot testing the TST, and achieving significant improvement for each pilot unit. Because hand hygiene is a key contributing factor in health care-associated infections (HAIs), this project was an important part of MHHS's strategy to eliminate HAIs.

Methods: MHHS implemented the TST for hand hygiene in 150 inpatient units in 12 hospitals and conducted a system wide process improvement project from October 2010 through December 2014.

Rapid influenza diagnostic test use and antiviral prescriptions in outpatient settings pre- and post-2009 H1N1 pandemic.

Background: Rapid influenza diagnostic tests (RIDTs) can be used at the point-of-care and are often the only influenza tests readily available in outpatient facilities.

Objectives: To determine the use of RIDTs and antiviral prescription practices in outpatient facilities.

Study Design: Surveys were mailed to U.

Hospital performance trends on national quality measures and the association with Joint Commission accreditation.

Background: Evaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS).

Objectives: To examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases.

The perceived impact of public reporting hospital performance data: interviews with hospital staff.

Objective: To assess perceptions about the value and impact of publicly reporting hospital performance measure data.

Design: Qualitative research.

Setting And Participants: Administrators, physicians, nurses and other front-line staff from 29 randomly selected Joint Commission-accredited hospitals reporting core performance measure data.

Evaluation of the predictive value of ICD-9-CM coded administrative data for venous thromboembolism in the United States.

Objective: To determine the positive predictive value of International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) discharge codes for acute deep vein thrombosis or pulmonary embolism.

Materials And Methods: Retrospective review of 3456 cases hospitalized between 2005 and 2007 that had a discharge code for venous thromboembolism, using 3 sample populations: a single academic hospital, 33 University HealthSystem Consortium hospitals, and 35 community hospitals in a national Joint Commission study. Analysis was stratified by position of the code in the principal versus a secondary position.

Case volume and hospital compliance with evidence-based processes of care.

Background: For many complex cardiovascular procedures the well-established link between volume and outcome has rested on the underlying assumption that experience leads to more reliable implementation of the processes of care which have been associated with better clinical outcomes. This study tested that assumption by examining the relationship between cardiovascular case volumes and the implementation of twelve basic evidence-based processes of cardiovascular care.

Method And Results: Observational analysis of over 3000 US hospitals submitting cardiovascular performance indicator data to The Joint Commission on during 2005.

Developing algorithms for healthcare insurers to systematically monitor surgical site infection rates.

Background: Claims data provide rapid indicators of SSIs for coronary artery bypass surgery and have been shown to successfully rank hospitals by SSI rates. We now operationalize this method for use by payers without transfer of protected health information, or any insurer data, to external analytic centers.

Results: We performed a descriptive study testing the operationalization of software for payers to routinely assess surgical infection rates among hospitals where enrollees receive cardiac procedures.

Control limits for p control charts with small subgroup sizes.

The p chart is widely used in health care and other service organizations as well as in manufacturing to monitor the proportion of observations with some particular characteristic for comparing several sources of data or for tracking a single source of data over time. The conventional approach is to use 3sigma limits found by using the normal approximation to the binomial distribution. This article reviews a method for taking into account the fact that 3sigma limits are not always appropriate, and suggests the use of the exact binomial distribution instead of the normal approximation to eliminate the problems associated with small subgroups.

Language proficiency and adverse events in US hospitals: a pilot study.

Objective: To examine differences in the characteristics of adverse events between English speaking patients and patients with limited English proficiency in US hospitals.

Setting: Six Joint Commission accredited hospitals in the USA.

Method: Adverse event data on English speaking patients and patients with limited English proficiency were collected from six hospitals over 7 months in 2005 and classified using the National Quality Forum endorsed Patient Safety Event Taxonomy.