Quality

Providing high quality care to every patient in a safe environment is the goal of all hospitals and a daily focus of their activities. Hospitals are highly regulated by federal and state governments, and their oversight makes sure that hospitals follow accepted safety and quality standards. The Texas Department of State Health Services licensees hospitals for a two-year period, and investigates all complaints promptly. During regular inspections of health care facilities, the Medicare program and the Joint Commission on Accreditation of Healthcare Organizations evaluate records and procedures to be sure that the performance improvement process is working. Failure to comply with standards can result in loss of accreditation and inability to participate in the Medicare program, fines or even loss of license.

Hospitals and other health care providers have long been involved in ensuring patient safety through performance improvement activities:

• Various multidisciplinary committees oversee critical departments within the hospital or other health care facility. Physicians, nurses, pharmacists and other health professionals participate in these committees, with the goal of identifying problems and making corrections before an error occurs.
• Physicians and nurses participate in peer review of their practice. The goal of these activities is to determine if there is a problem with a licensed professional’s performance, and if so, the appropriate next steps to remedy it. While the licensing board may take action related to the individual's license, facilities also have some recourse. Health care facilities may restrict or suspend a physician's clinical privileges. A hospital or ambulatory surgery center may take disciplinary action against an employee – a nurse, technician, therapist, etc. – ranging from mandatory education or increased supervision to discharge.
• Hospitals and ASCs accredited by the Joint Commission on the Accreditation of Healthcare Organizations perform root cause analyses on unexpected events/outcomes and may report their finding to the Joint Commission. Through the Joint Commission, best practices to enhance patient safety are shared among hospitals across the country.

Consumers and purchasers have a right to expect quality health care and effective public reporting of performance indicators. Hospitals support public disclosure, and are dedicated to accomplishing it in a meaningful way.  Numerous Web sites offer quality information on hospitals. In addition, two government-sponsored sites offer good resources and data are analyzed using proven methodologies.

Hospital Compare
The Hospital Compare Web site was created through the efforts of the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services, along with the Hospital Quality Alliance, a public-private collaboration established to promote reporting on hospital quality of care. The information on this Web site will be useful to adults needing hospital care for heart attack, heart failure, pneumonia or surgery.

You will see some of the recommended care that an adult should get if being treated for a heart attack, heart failure or pneumonia, or having surgery. Hospital Compare has quality measures on how often hospitals provide some of the recommended treatment for these specific conditions to produce the best results for most patients.

This information helps you compare the quality of care provided in the hospitals that submit data. This quality information not only helps you make good decisions about your health care, but also encourages hospitals to improve the quality of health care they provide.

Texas Health Care Information Collection
The Texas Health Care Information Collection was created by the Texas Legislature in 1995 to gather information from hospitals and health maintenance organizations and publish reports to help consumers compare and choose their hospitals and health plans. The annual hospital-specific reports published show how Texas hospitals performed in calendar year 2004, based on indicators of hospital quality developed by the federal government.

The volume measures report the number of times the procedure is performed in the hospital. Medical articles and journals have suggested that, for some complex medical and surgical procedures, outcomes for patients may be better in hospitals where doctors perform such procedures regularly, rather than occasionally. While better quality generally may be associated with greater volume, low-volume providers may have excellent outcomes also. Since volume is not an outcome measure, where possible, volume indicators should be evaluated along with mortality indicators (outcome measures) for the same procedure.

The mortality indicators report the percentage of patients who died at a hospital while being treated for a specific condition or after undergoing a specific type of surgery.  Better quality may be associated with lower mortality rates.

The utilization indicators reflect the use of certain procedures about which questions have been raised about possible over- or under-use. While there is no "correct" frequency for performing procedures included in this section of the report, high or low rates may raise questions that should be discussed with your doctor and hospital.

Texas Department of State Health Services
The Texas Department of State Health Services has a number of links to state and government agencies that monitor specific aspects of quality in hospitals.

Joint Commission’s Quality Check The Joint Commission evaluates the quality and safety of care for nearly 15,000 health care organizations. To earn and maintain accreditation, organizations must have an extensive on-site review by a team of Joint Commission health care professionals at least once every three years. The team evaluates the organization's performance in areas that affect your care. Accreditation then may be awarded based on how well the organization met Joint Commission’s standards.