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Monday 10:22 CST, April 23, 2018

Joint Commission FAQ Page

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Hospital - Accountability Measures

What are “Accountability Measures?”

Why is The Joint Commission reclassifying the core measures as accountability measures and how will this help hospitals?

When will The Joint Commission begin assessing performance on accountability measures?

Have both process and outcome measures been re-categorized?

Have all measures within the 10 core measure sets been re-categorized?

Why not remove non-accountability measures from use?

How will The Joint Commission utilize accountability measures in future accreditation activities?

Will accountability measures impact current Joint Commission data uses?

Will The Joint Commission continue to categorize measures as accountable and non-accountable measures?

How many accountability measures are there?

Where can I locate additional information on accountability measures?

Of the 28 measures, how did you arrive at the list of 22?


Hospital - Accountability Measures

Q: What are “Accountability Measures?”
A:

Accountability measures are quality measures that meet four criteria that produce the greatest positive impact on patient outcomes when hospitals demonstrate improvement on them. 

The criteria for classifying accountability measures include:

  • Research:  Strong scientific evidence exists demonstrating that compliance with a given process of care improves health care outcomes (either directly or by reducing the risk of adverse outcomes).
  • Proximity:  The process being measured is closely connected to the outcome it impacts; there are relatively few clinical processes that occur after the one that is measured and before the improved outcome occurs.
  • Accuracy:  The measure accurately assesses whether the evidence-based process has actually been provided.  That is, the measure should be capable of judging whether the process has been delivered with sufficient effectiveness to make improved outcomes likely. If it is not, then the measure is a poor measure of quality, likely to be subject to workarounds that induce unproductive work instead of work that directly improves quality of care.
  • Adverse Effects:  The measure construct is designed to minimize or eliminate unintended adverse effects.

These criteria are based on The Joint Commission’s experience implementing and evaluating the outcomes of quality measures for more than a decade. The criteria provide a more rational approach to the process of collecting and reporting quality data. 


 

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Q: Why is The Joint Commission reclassifying the core measures as accountability measures and how will this help hospitals?
A:

The Joint Commission wants to help hospitals improve performance on accountability measures in an effort to promote excellence in the delivery of care and maximize health outcomes, and in anticipation of the Centers for Medicare & Medicaid Services incentive payments that become effective in 2013.  The Joint Commission will eliminate measures that do not work well, include performance on accountability measures in accreditation standards and include only accountability measures in the ORYX program.:

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Q: When will The Joint Commission begin assessing performance on accountability measures?
A:

The Joint Commission will actively engage the field to determine how performance on the accountability measures will be assessed.  Performance assessment on accountability measures will not begin before January 1, 2012.
 

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Q: Have both process and outcome measures been re-categorized?
A:

Based upon The Joint Commission’s experience with standardized hospital quality measures, the conceptual framework for the categorization of the current measures was limited.  It focused on process measures because they account for the majority of the measures currently in use.  Since outcome measures have additional scientific challenges surrounding the need for case mix adjustment, additional criteria for evaluation need to be established.
 

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Q: Have all measures within the 10 core measure sets been re-categorized?
A:

Evaluation of the measures currently used for public reporting purposes is complete.  The Joint Commission is now evaluating the remaining sets of hospital core measures that meet ORYX performance measure reporting requirements (e.g., perinatal care and hospital based inpatient psychiatric services).
 

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Q: Why not remove non-accountability measures from use?
A:

Measures that do not meet the accountability measures criteria can still prove to be a valuable source of information to hospitals.  These measures are also currently used by other initiatives as standardized performance measures for assessing and reporting on hospital performance.
 

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Q: How will The Joint Commission utilize accountability measures in future accreditation activities?
A:

The Joint Commission currently is considering a variety of innovative approaches to integrating hospital performance on the accountability measures into its survey and accreditation activities.  To promote improved performance on accountability measures, and help hospitals prepare for the increasing reliance on attaining high performance on quality measures.  The Joint Commission will be engaging accredited hospitals through focus groups and online surveys over the next few months.
 

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Q: Will accountability measures impact current Joint Commission data uses?
A:

As of March 2010, accountability measures have already been integrated into the information reported on Quality Check.™  Starting with the third quarter 2009 core measure data, only accountability measures are being used to calculate the overall performance rate for each measure set. However, the categorization of the measures into accountability and non-accountability measures will not affect individual measure information reported on Quality Check.  Accountability measures also will be integrated into the Priority Focus Process and The Joint Commission’s Strategic Surveillance System (S3) Performance Risk Assessment beginning with the July release of the S3 Performance Risk Assessment.  In these tools, accountability measures will be weighted differently (i.e., higher) than non-accountability measures. When a hospital’s performance on an accountability measure is determined to be unsatisfactory, one (1) point will continue to be assigned to each of the related Priority Focus Areas (PFAs) and Clinical/Service Groups (CSGs). When performance on a non-accountability measure is determined to be unsatisfactory, 0.33 point will be assigned to each of the related PFAs and CSGs.
 

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Q: Will The Joint Commission continue to categorize measures as accountable and non-accountable measures?
A:

In the future, The Joint Commission will only adopt accountability measures for use in its ORYX initiative.
 

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Q: How many accountability measures are there?
A:

The Joint Commission has classified 22 of its 28 hospital core measures as accountability measures.  These measures are aligned with the Centers for Medicare & Medicaid Services measures and include the children’s asthma care measures which are reported on the Centers for Medicare & Medicaid Services Hospital Compare Web site.  For a list of both the accountability and non-accountability measures see the June 23, 2010 special issue of Joint Commission Online.
 

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Q: Where can I locate additional information on accountability measures?
A:

Additional information on accountability measures can be found in the June 23, 2010 special issue of Joint Commission Online and the June 23, 2010 on-line issue of the New England Journal of Medicine, “Accountability Measures: Using Measurement to Promote Quality Improvement.”  Additional information will be posted on The Joint Commission’s Web site and in the August 2010 issue of Joint Commission Perspectives.
 

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Q: Of the 28 measures, how did you arrive at the list of 22?
A:

All 28 measures were vetted against the four evaluation criteria.  To learn more about the criteria and which of the six measures did not meet the criteria for accountability measures, see the June 23, 2010 online issue of the New England Journal of Medicine, “Accountability Measures:  Using Measurement to Promote Quality Improvement,” of which Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission, is the lead author. 
 

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