The adoption of smoke-free hospital campuses in the United States.

BACKGROUND: The adoption of a smoke-free hospital campus policy is often a highly publicised local event. National media coverage suggests that the trend towards adopting these policies is growing, and this publicity can frequently lead hospital administrators to consider the adoption of such policies within their own institutions. Little is actually known, however, about the prevalence of these policies or their impact. OBJECTIVES: To determine the national prevalence of smoke-free hospital campus policies and the relation between these policies and performance on nationally standardised measures for smoking cessation counselling in US hospitals. METHODS: 4494 Joint Commission-accredited hospitals were invited to complete a web-based questionnaire assessing current smoking policies and future plans. Smoking cessation counselling rates were assessed through nationally standardised measures. RESULTS: The 1916 hospitals responding to the survey (43%) were statistically similar to non-responders with respect to performance measure rates, smoking policies and demographic characteristics. Approximately 45% of responders reported an existing smoke-free hospital campus policy. With respect to demographics, higher proportions of smoke-free campus policies were reported in non-teaching and non-profit hospitals. Smoke-free campus hospitals were also more likely to provide smoking cessation counselling to patients with acute myocardial infarction, heart failure and pneumonia who smoke (p<0.001). CONCLUSIONS: By February 2008, 45% of US hospitals (up from approximately 3% in 1992) had adopted a smoke-free campus policy; another 15% reported actively pursuing the adoption of such a policy. By the end of 2009, it is likely that the majority of US hospitals will have a smoke-free campus.

Adverse-event-reporting practices by US hospitals: results of a national survey.

CONTEXT: Little is known about hospitals' adverse-event-reporting systems, or how they use reported data to improve practices. This information is needed to assess effects of national patient-safety initiatives, including implementation of the Patient Safety and Quality Improvement Act of 2005 (PSQIA). This survey generated baseline information on the characteristics of hospital adverse-event-reporting systems and processes, for use in assessing progress in improvements to reporting. METHODS: The Adverse Event Reporting Survey, developed by Westat, was administered in September 2005 through January 2006, using a mixed-mode (mail/telephone) survey with a stratified random sample of 2050 non-federal US hospitals. Risk managers were the respondents. An 81% response rate was obtained, for a sample of 1652 completed surveys. RESULTS: Virtually all hospitals reported they have centralised adverse-event-reporting systems, although characteristics varied. Scores on four performance indexes suggest that only 32% of hospitals have established environments that support reporting, only 13% have broad staff involvement in reporting adverse events, and 20-21% fully distribute and consider summary reports on identified events. Because survey responses are self-reported by risk managers, these may be optimistic assessments of hospital performance. CONCLUSIONS: Survey findings document the current status of hospital adverse-event-reporting systems and point to needed improvements in reporting processes. PSQIA liability protections for hospitals reporting data to patient-safety organisations should also help stimulate improvements in hospitals' internal reporting processes. Other mechanisms that encourage hospitals to strengthen their reporting systems, for example, strong patient-safety programmes, also would be useful.

The ORYX initiative: goals and potential application to physician quality improvement efforts.

Demands for public accountability in health care are more widespread today than at any time in the past. A number of national performance measurement efforts, including the ORYX initiative of the Joint Commission on Accreditation of Healthcare Organizations, represent an effort to provide stakeholders with the data they need to make judgments about the quality of health care provided to the public. The underlying premise of performance measurement is that organizations and clinicians can only improve what they can measure. Clinicians are the natural leaders in effecting broad-based change because of their direct influence on patient care and the respect they command in the health care environment. As performance measurement initiatives evolve, the ability of health care organizations to implement empirically based, structured improvement will increase and become commonplace.

Integrating performance measure data into the Joint Commission accreditation process.

This article describes the Joint Commission's implementation plans, experience, and results to date of incorporating performance measurement data into the accreditation process. These plans have evolved in response to changes in the health care environment, feedback from accredited organizations, and both technical and political obstacles encountered. During the late 1980s, the Joint Commission developed a national performance measurement system, the IMSystem, to incorporate information about the process and outcomes of care into the accreditation process. In 1995, the ORYX initiative was introduced to offer health care organizations significant flexibility in selecting a measurement system and measures while promoting organizational self-improvement and accountability. Recently, the plans have evolved to incorporate standardized core measures that are known to be valid and reliable. These initiatives have moved the field much closer to the day when quality assessment will reflect a comprehensive view of organizational performance, based, in part, on performance measurement data.

Measuring and improving the performance of health care providers: accreditation in the 21st century.

Outcomes data will become part of the Joint Commission on Accreditation of Healthcare Organizations' accreditation process. Accredited organizations will select a measurement system that they will use to submit data to the Commission. Data trends will be reviewed to determine response by the accreditor. The Joint Commission will work with organizations to assist with improvement opportunities. Accreditation decisions will continue to be based on standards. The Joint Commission's system, the IMSystem, is one of several systems available for use in accreditation activities.

Panel discussion. Data needs in cancer.

A prospective, comprehensive outcomes database was recently initiated by the National Comprehensive Cancer Network (NCCN) after a 2-year study to test data collection methods and systems. It started with data on 400 patients with newly diagnosed breast cancer at five NCCN sites, and over the next 3 years is projected to grow to include more than 12,000 patients with common cancers treated at all eligible NCCN sites. Among the goals of the database are: 1) to establish the capability to select, analyze, and report patterns of care and outcomes; 2) to allow NCCN members to assess their compliance with NCCN clinical practice guidelines and benchmark their performance against the rest of the NCCN; 3) to establish a true databased continuous quality improvement program; 4) to support clinical disease-oriented research and methodologic studies; and 5) to provide the NCCN with a vehicle for forging partnerships with others in the health-care field, such as the pharmaceutical industry, regulatory agencies, and accrediting bodies. Many of those potential partners were represented on this panel. Panelists discussed the data needs of their organizations, what they are doing to meet those needs, and how a comprehensive database will ultimately help improve patient care.

Framework for performance measurement of health care networks and health plans.

Emerging health networks are poised to play an important role in the future American health care delivery system. The trend toward vertical integration, coupled with growing purchaser and consumer demands for information about value, has created an increasingly chaotic measurement environment. This article describes a successful collaborative effort among providers, users, and purchasers of health services and developers of performance measurement tools and databases to develop principles and a framework for measuring the performance of health care networks. Eleven principles and five measurement categories were identified; seven clinical conditions were targeted for performance measurement.

Technology assessment. An American Medical Association perspective.

The contemporary practice of medicine depends on the use of a wide array of technologies that did not exist 40 years ago. An exponential increase in our scientific knowledge base, and the subsequent application of this new information to clinical practice, have dramatically extended longevity, enhanced the quality of life, and improved the overall health status of the American public. Clinical medicine has become "a set of technologies for diagnosis, prevention, treatment, and rehabilitation."

Human gene therapy: a role for the primary care physician.

Human gene therapy, once thought to be the unique province of specialized clinical centers, will be diffusing rapidly into primary care medicine. More than 10 medical centers in the United States and several centers world-wide are beginning to use this potentially curative therapy. Eleven trials of protocols are under way, nine are about to begin, and more than 12 protocols are nearing completion of the approval process. The diseases being treated are not the rare disorders found only in one in 100,000 patients, but instead include various types of cancer, diseases of the cardiovascular and pulmonary systems, and inborn errors of metabolism. Combined, these diseases affect more than half of the American population.