Frequency distribution of criteria for appropriateness of days of stay.

*<p>Multiple items selection was possible.</p

Appraising Hospital Performance by Using the JCHAO/CMS Quality Measures in Southern Italy

<div><h3>Objectives</h3><p>The main objective of the present study was to estimate the uptake to quality indicators that reflect the current evidence-based recommendations and guidelines.</p> <h3>Methods</h3><p>A retrospective review of medical records of patients admitted to two hospitals in the South of Italy was conducted. For the purposes of the analysis, a sets of quality indicators has been used from the Joint Commission on Accreditation of Hospital Organizations and Centers for Medicare & Medicaid Services. Four areas of care were selected: acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), and surgical care improvement project (SCIP). Frequency or median was calculated, as appropriate, for each indicator. A composite score was calculated to estimate the overall performance for each area of care.</p> <h3>Results</h3><p>A total of 1772 medical records were reviewed. The adherence rates showed a wide-ranging variability among the selected indicators. The use of aspirin and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) for AMI, the use of ACEI or ARB for HF, the use of appropriate thromboembolism prophylaxis and appropriate hair removal for surgical patients almost approached optimal adherence. At the other extreme, rates regarding adherence to smoking-cessation counseling in AMI and HF patients, discharge instructions in HF patients, and influenza and pneumococcal vaccination in pneumonia patients were noticeably intangible. Overall, the recommended processes of care among eligible patients were provided in 70% for AMI, in 32.4% for HF, in 46.4% for PN, and in 46% for SCIP.</p> <h3>Conclusions</h3><p>The results show that there is still substantial work that lies ahead on the way to improve the uptake to evidence-based processes of care. Improvement initiatives should be focused more on domains of healthcare than on specific conditions, especially on the area of preventive care.</p> </div

Frequency distribution of quality measures evaluated.

<p>AMI = acute myocardial infarction; HF = heart failure; PN = pneumonia; SCIP = surgical care improvement project; ACEI = angiotensin-converting enzyme inhibitors; ARB = angiotensin receptor blockers; LSVD = left systolic ventricular dysfunction; PCI = percutaneous cardiac intervention; ICU = intensive care unit; ED = emergency department; CAP = community-acquired pneumonia.</p><p><i>°</i>In brackets is reported the overall number of patients for each set of measures.</p>§<p>Not documented in 122 (54.5%) medical records.</p>§§<p>Not documented in 367 (93.9%) medical records.</p>§§§<p>Not documented in 72 (84.7%) medical records.</p>a<p>AMI inpatient mortality not included for the calculation of the composite measure.</p>b<p>Values are expressed as mean ± SD.</p

Selected characteristics of the study population.

*<p>Values are expressed as mean ± SD.</p>§<p>ICU/ED = Intensive Care Units/Emergency Departments.</p