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History of Performance Measures  

In early 1999, the Joint Commission solicited input from a wide variety of stakeholders (e.g., clinical professionals, health care provider organizations, state hospital associations, health care consumers) and convened a Cardiovascular Conditions Clinical Advisory Panel about the potential focus areas for core measures for hospitals. In May 2001, the Joint Commission announced four initial core measurement areas for hospitals, which included acute myocardial infarction (AMI) and heart failure (HF).

Simultaneously, the Joint Commission worked with the Centers for Medicare & Medicaid Services (CMS) on the AMI, and HF sets that were common to both organizations. CMS and the Joint Commission worked to align the measure specifications for use in the 7th Scope of Work and for Joint Commission accredited hospitals. Hospitals began collecting AMI measures for patient discharges beginning July 1, 2002.

In November of 2003, CMS and the Joint Commission began to work to precisely and completely align these common measures so that they are identical.  This resulted in the creation of one common set of measure specifications documentation known as the Specifications Manual for National Hospital Inpatient Quality Measures to be used by both organizations. The manual contains common (i.e., identical) data dictionary, measure information forms, algorithms, etc. The goal is to minimize data collection efforts for these common measures and focus efforts on the use of data to improve the health care delivery process.

Accountability Measures

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 Joint Commission categorizes its process performance measures into accountability and non-accountability measures. This approach places more emphasis on an organization’s performance on accountability measures — quality measures that meet four criteria designed to identify measures that produce the greatest positive impact on patient outcomes when hospitals demonstrate improvement:

  • Research: Strong scientific evidence demonstrates that performing the evidence-based care process improves health outcomes (either directly or by reducing risk of adverse outcomes).
  • Proximity: Performing the care process is closely connected to the patient outcome; 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 or not the care process has actually been provided. That is, the measure should be capable of indicating whether the process has been delivered with sufficient effectiveness to make improved outcomes likely.
  • Adverse Effects: Implementing the measure has little or no chance of inducing unintended adverse consequences.

Measures that meet all four criteria should be used for purposes of accountability (e.g., for accreditation, public reporting, or pay-for-performance). Those measures that have not been designated as accountability measures may be useful for quality improvement, exploration and learning within individual health care organizations, and are good advice in terms of appropriate patient care. The Joint Commission has a primary focus on adopting accountability measures for its ORYX® program. The Joint Commission will continue to re-examine all process (i.e., proportion and ratio) measures categorized as accountability measures to ensure they continue to meet the accountability criteria.