Introduction
Assessing the performance of medical institutions is critical to improving the quality of care provided to patients. Detailed assessment ensures that medical institutions understand their strengths and weaknesses and can take action required for enhancing the quality of service. The Joint Commission’s Annual Report is a document presenting the results of the regular quality assessment of American hospitals. This document is essential for gaining insight into how hospital performance is evaluated and compared. The present paper will outline some of the performance indicators used by the Joint Commission and describe the steps for gathering meaningful data on Aspirin on Arrival. Also, the essay will review the importance of comparing performance and explain the critical challenges of comparing data in the UAE.
Process Indicators
Process indicators are designed to determine the extent to which the facility adheres to evidence-based guidelines for promoting and maintaining patient health. According to the AHRQ (2015), “Process measures indicate what a provider does to maintain or improve health, either for healthy people or for those diagnosed with a health care condition” (para. 3). Process indicators can thus differ across diseases and units. For instance, PCI therapy within 90 minutes is among the main process indicators used for heart attack care measure (The Joint Commission 2014). This process indicator is based on clinical guidelines, as the use of PCI therapy for the treatment of heart attack is recommended to improve blood flow to the heart and prevent lasting damage.
Another process indicator is antibiotics to ICU patients. This process indicator is applied in pneumonia care evaluation and is based on guidelines for managing pneumonia, which recommend the use of antibiotics. In surgical care, the use of antibiotics is also important in measuring processes. For instance, antibiotics within one hour before the first surgical cut is a vital process indicator applied to all types of surgeries (The Joint Commission 2014). The use of antibiotics is critical to preventing surgical site infections and is thus included in performance measures. Process indicators can also involve the use of other medications recommended for specific conditions. For instance, the Joint Commission (2014) includes systemic corticosteroids for inpatient asthma as one of the critical process indicators in children’s asthma care assessment. Lastly, influenza immunization is an important process measure that affects the overall quality of care in medical facilities.
Outcome Indicators
Outcome indicators are used to measure the results of care provided by the facility. According to the AHRQ (2015), “Outcome measures reflect the impact of the health care service or intervention on the health status of patients” (para. 5). The Joint Commission (2014) uses fewer outcome indicators than process indicators, as the former are often difficult to measure and may not reflect the quality of care correctly due to the influence of other factors. The incidence of potentially preventable VTE and newborn bloodstream infections are among the outcome indicators applied in the report. Physical restraint and seclusion are also included as outcome measures for inpatient psychiatric services, as these indicators can be influenced by effective therapy. Lastly, exclusive breast milk feeding is an outcome indicator, as it reflects the influence of patient education and health care provided in the facility on mothers’ choice of feeding options.
Aspirin on Arrival
To collect meaningful data on Aspirin on Arrival, it is critical to follow the appropriate data collection procedure. The manual of the Joint Commission (2010) details the process of data collection for this process indicator. First of all, it would be critical to establish the scope of data required. According to the Joint Commission (2010), the data should include admission date, arrival date, birthdate, clinical trial, comfort measures, contraindications to Aspirin on Arrival, discharge date, discharge status, ICD diagnosis code, the point of origin for admission or visit, and transfer from another ED.
Secondly, it is essential to exclude patients who do not meet the criteria established in the manual. These include age (under 18), length of stay (over 120 days), enrollment in clinical trials, contraindications to aspirin, and more (The Joint Commission 2010). After the data is limited to patients who meet the criteria for inclusion, their medical records should be reviewed for Aspirin on Arrival. The results should be presented as the percentage of patients with acute myocardial infarction who received aspirin within the first 24 hours before or after arriving at the facility.
Performance Comparison in the UAE
Performance comparison is an essential practice that benefits businesses operating in a variety of sectors, including healthcare. First of all, performance comparison encourages facilities to collect data on performance measures, thus contributing to internal quality control processes. The information gathered as part of the performance comparison process can also outline areas that require improvement. For example, if the hospital’s rate of Aspirin on Arrival is significantly smaller than in other facilities, the management can take action to address the problem.
Another significant benefit of performance comparison is that it allows establishing benchmarks for specific quality indicators. As shown by Paddock (2014), benchmarking is a powerful tool in improving performance outcomes, as it sets a clear goal. Moreover, facilities achieving the highest results in specific performance indicators could share practices and recommendations for improving performance in the chosen area. Performance comparison is also beneficial for patients. Comparing data across hospitals allows patients to make informed choices about care providers, while also enhancing the competition in the healthcare sector, thus leading to improved quality of care.
Applying a performance comparison in the UAE could play an essential role in improving care quality. Moreover, it would assist the government in its efforts to improve healthcare in the state, thus contributing to the recent healthcare reforms (Koornneef, Robben & Blair 2017). However, there are two main challenges to implementation. First of all, the healthcare system in the UAE is somewhat fragmented, consisting of public and private hospitals, as well as internationally- and locally-owned facilities (Mahate & Hamidi 2016). This could cause difficulties, as the introduction of a performance comparison system would require universal legislation covering all types of facilities. Also, the share of patients treated in different types of facilities varies a lot: “public hospitals represent about a third of the total number of facilities but treat about 60% of the total number of patients” (Mahate & Hamidi 2016, p. 7). Thus, the performance of different types of hospitals could be associated with their workload, which could be a barrier to adequate data comparison.
Secondly, there is a lack of scientific research on hospital performance assessment and data comparison in the UAE (Koornneef, Robben & Blair 2017). This could pose obstacles to implementation, as the facilities will have little guidance on collecting and reporting data. Furthermore, care providers might resist the change due to the lack of evidence-based rationale for performance comparison in the UAE. Thus, extensive research on the subject is required before any efforts to initiate performance comparison are undertaken.
Conclusion
Overall, performance comparison of hospitals is a highly beneficial practice. It allows facilities to improve the quality of service provided and encourages healthy competition in the sector. The Joint Commission (2014) uses critical performance indicators to compare processes and outcomes in different facilities. The UAE would benefit from a similar system of performance comparison. However, it would be essential to overcome barriers to implementation, including the fragmentation of the healthcare sector and the lack of adequate research on the subject.
Reference List
Agency for Healthcare Research and Quality (AHRQ) 2015,Types of quality measures, Web.
The Joint Commission 2010, Measure information form, Web.
The Joint Commission 2014, America’s hospitals: improving quality and safety, Web.
Koornneef, E, Robben, P & Blair, I 2017, ‘Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review’, BMC Health Services Research, vol. 17, no. 1, pp. 672-684.
Mahate, A & Hamidi, S 2015, ‘Frontier efficiency of hospitals in United Arab Emirates: an application of data envelopment analysis’, Journal of Hospital Administration, vol. 5, no. 1, pp. 7-17.
Paddock, SM 2014, ‘Statistical benchmarks for health care provider performance assessment: a comparison of standard approaches to a hierarchical Bayesian histogram‐based method’, Health Services Research, vol. 49, no. 3, pp. 1056-1073.