Which core measures are hospitals struggling with?
A Joint Commission expert shares what he sees
Frank Zibrat, associate director, ORYX implementation at The Joint Commission, says one of the areas hospitals are still struggling with regarding the core measures is the surgical care improvement project (SCIP) measures. Specifically, "the issue of the discontinuation of antibiotics and the selection of antibiotics."
"Part of the problem is that the measures are put together and you've got a table of accepted antibiotics based on the clinical literature that was available. And things change. Things change rapidly and very frequently, and you wind up not being able to incorporate those changes into the manual," Zibrat says. He encourages organizations to let The Joint Commission know when these problems occur.
Jerod M. Loeb, PhD, executive vice president for quality measurement and research at The Joint Commission, also recognizes the problem. Though "the evidence is controversial," he says some say the "quest to get antibiotics in sooner is causing antibiotics to be used in situations in which patients are ultimately found not to have pneumonia." He says when The Joint Commission and the Centers for Medicare & Medicaid Services became aware of that issue, they did make a change to the measure. "And more important than making that change in the timing measure, we also added some data elements that reflect the fact that if there is diagnostic uncertainty, you don't get penalized for that diagnostic uncertainty."
With the new venous thromboembolism (VTE) core measure set, global sampling has been added. "It has a potential for a lot more cases," Zibrat says.
"So that becomes a bit problematic from that perspective and that you're dealing with a larger population from which to sample, and where's your data collection being done? Who's doing the data collection? Who's reviewing the record to abstract the data?"
Heart failure patients and discharge
Zibrat says the issue of discharge instructions with heart failure patients also is problematic. "And part of that has to do with the issue of the fact that there are multiple components to the discharge instructions, and the biggest one comes with the issue of medication reconciliation. Being certain that in whatever discharge instructions are provided as it relates to medication: Is everything listed here?"
He attributes the problem to the number of people who touch and write in the record. "You have the primary attending who's looking at certain medications. You may have one of the other consulting physicians who puts a note in the chart that gets lost. And it's just coming to resolution as to: Do you want the medication continued? Is the medication to be discontinued? Was it just for purposes within the hospital? I mean, that's the big issue with those discharge instructions. That's probably the one area that's most problematic."
With the children's asthma care measure, he says the issue is "the whole management plan of care." Being certain all the appropriate information is given to the patient or caregiver to prevent exacerbation of the asthma is difficult "because all of the relevant documentation is there and, again, it's an issue of going back to the specifications manual and the data dictionary in the specifications manual that tries to provide enough information about the data element, what goes into the data element, and what needs to be documented in the record."
He suggests QI directors pay close attention to the data dictionary in the latest specifications manual, which provides "information regarding suggested data sources where one could typically find the information. So it would help direct whoever is abstracting the data to direct them where to look for that data for that data element. And it also provides guidelines as to what should be excluded when looking for this data element and what should be included when you're looking at this data element as to how to respond to the question."
Beyond the data dictionary, also pay attention to the measure information form available with each measure, he says. That form "gives a description of the measure, a rationale for the measure, why the measure is of value basically and it tells you what some of the primary data elements are for that measure. It also gives you references to the clinical literature that underpins the measures."
(Editor's note: The Joint Commission has built a site for questions from the field. Visit http://wikihealthcare.jointcommission.org.)
Frank Zibrat, associate director, ORYX implementation at The Joint Commission, says one of the areas hospitals are still struggling with regarding the core measures is the surgical care improvement project (SCIP) measures. Specifically, "the issue of the discontinuation of antibiotics and the selection of antibiotics."You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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