Beginning Jan. 1, 2023, The Joint Commission — in collaboration with the American College of Obstetricians and Gynecologists (ACOG) — will offer Advanced Certification in Perinatal Care (ACPC) to accredited and nonaccredited hospitals and critical access hospitals with perinatal care programs.
Currently, The Joint Commission certifies perinatal care programs in almost 60 healthcare organizations through its Perinatal Care (PNC) Certification Program. However, the new ACPC will replace the current PNC certification.
ACPC goes beyond the current certification to encompass all pregnancies while focusing on high-risk areas for maternal morbidity and mortality, such as mental health disorders, including substance use; addressing social needs; and identifying health care disparities. This new program will ensure that organizations provide integrated, coordinated, patient-centered care that begins with prenatal care and continues through postpartum care.
The ACPC program was developed with a Technical Advisory Panel of clinical experts with knowledge in this type of care. ACPC standards incorporate the latest research, best practices, and federal regulations to improve quality and safety for pregnant or postpartum patients and newborns.
Components of the new program include the following:
- Conducting tracer activities during review.
- Evaluating consistent communication and effective collaboration among all healthcare providers involved in the care of the pregnant or postpartum patients and newborns starting during prenatal care through postpartum care.
- Demonstrating the application of and compliance with clinical practice guidelines or evidence-based practices, which may include practice bulletins and recommendations published by organizations such as ACOG; Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN); Society for Maternal-Fetal Medicine (SMFM); and American Academy of Pediatrics (AAP).
- Collecting data on the following Perinatal Care program measures, including compliance with measure thresholds for applicable measures at initial application and recertification:
- PC-01: Elective Delivery
- PC-02: Cesarean Birth (Compliance with threshold criteria required.)
- PC-05: Exclusive Breast Milk Feeding
- PC-06.1: Unexpected Complications in Term Newborns (Compliance with threshold criteria required.)
Organizations may apply for this certification if they meet general eligibility requirements that include having a minimum of 40 deliveries per year and compliance with the measure threshold criteria for performance rates on PC-02 and PC-06.1 (severe rate only):
- PC-02: Cesarean Birth — Threshold will be set at fewer than or equal to 30%.
- PC-06.1: Unexpected Complications in Term Newborns — Severe rate threshold will be set at 50 complications per 1,000 live births, which is a rate of 5%.
The performance rates used will be an aggregate performance rate (sum of numerators divided by sum of denominators). The aggregate denominator cases must total no fewer than 30 cases for each performance rate calculated for PC-02, and PC-06.1 (severe rate). Data for the performance rates will be due on the application and must be provided at the initial certification review. No fewer than four months of data for all Perinatal Care core measures must be available at the initial certification review (for recertification, 24 months of data are required).
Hospitals and critical access hospitals may pre-apply for this certification in July 2022 to indicate their commitment to pursuing certification and entering the queue for reviews beginning in 2023. The official application will be available on Jan. 1, 2023.
Learn more or view the prepublication standards.
Hospital safety is routinely measured via patient safety indicators (PSIs), which can influence public perception, hospital rankings and reimbursement rates. A new study from the August issue of The Joint Commission Journal on Quality and Patient Safety, “Variation in the Reporting of Elective Surgeries and Its Influence on Patient Safety Indicators,” suggests that some hospitals may classify admissions in a way that exempts them from elective-based PSI scores, a practice that may lead to less reliable PSIs.
PSIs, a set of metrics used to measure rates of preventable safety events, enable hospitals to identify opportunities for improvement and allow the public to make informed decisions when seeking safe care. However, PSIs have been criticized for insufficient risk adjustment, inadequate capture of preventable outcomes, and sensitivity to surveillance bias. In particular, the classification of admissions as elective or non-elective can influence some PSIs and may even influence whether a hospital is exempted from PSIs based on elective admissions. Admission classification is based on the internal definitions of hospitals and, therefore, may represent a major source of discrepancy among hospitals.
Researchers at Rush University Medical Center, Chicago, analyzed Medicare inpatient claims data reported by 3,484 hospitals during the 2015-2017 PSI measurement period. They examined the average percentage of elective (APE) admissions across surgical diagnosis-related groups (DRGs) in relation to hospital characteristics, surgical claims volumes, and numbers and types of surgical DRGs. The study asked whether hospitals with exceptionally low APE shared particular characteristics, reported claims for similar DRGs or were disproportionately exempted from elective based PSIs.
The researcher’s intersection of machine learning and traditional statistics explained a 73.9% variation in APE among hospitals. Surgical claims volume and 16 surgical DRGs were identified as the only consistently important variables and, by themselves, explained 70% of variation in APE. Moreover, hospitals with exceptionally low APE were disproportionately exempt from elective-based PSI scores. These outlier hospitals were not explained by their characteristics, geography, or surgical claims volume, or the types of surgical DRGs among claims. Due to the depth and extent of their analyses and the lack of any tenable explanation for APE outliers, the researchers suggest that some hospitals may have classified admissions in a way that exempted them from elective-based PSI scores.
The study shows that transparency into admission classification policies is needed to ensure fair and reliable use of PSIs when ranking hospitals and adjusting payments. Alternatively, PSIs may need modifications to rely on externally validated criteria.
Also featured in the August issue are:
- Beyond Screening: An Interim Report and Analysis of a Multimodal Initiative to Decrease Colon Cancer Mortality (Kaiser Permanente Southern California, Pasadena, California)
- Diagnostic Trajectories in Primary Care at 12 Months: An Observational Cohort Study (University of California, San Francisco)
- A Pharmacy Quality and Internal Audit Program Promoting Continuous Survey Readiness with Medication Management Standards (Massachusetts General Hospital, Boston)
- Professionalism, Leadership, and a Pilfered Apple (open access commentary)
Additionally, the achievements of the 2021 John M. Eisenberg Patient Safety and Quality Award recipients are highlighted in four, open-access articles through Aug. 31.
Access the Journal.
Dateline @ TJC — The Critical Workforce Element in Safe + Sound Workplaces: Every year, The Joint Commission supports the Occupational Safety and Health Administration’s (OSHA) Safe + Sound Week. The theme of the awareness week — recognizing the successes of workplace health and safety programs — offers information and ideas on how to keep America's workers safe and aligns with The Joint Commission’s mission and recent work. In fact, this year’s Safe + Sound Week, Aug. 15-21, is the perfect time to introduce our new Healthcare Workforce Safety and Well-Being website, writes Lisa DiBlasi-Moorehead, EdD, MSN, RN, CNEP, Field Director, and Barbara Braun, Associate Director, Department of Research.
“Fundamentals of Health Care Improvement: A Guide to Improving Your Patients’ Care, 4th edition,” is designed to help health-profession learners shape high-quality systems of care. This book, co-published by Joint Commission Resources (JCR) and the Institute of Healthcare Improvement (IHI), explores performance improvement (PI) concepts to help clinicians and students understand how to apply them to patient care activities.
Updated topics on health equity and disparities of care, brought to light by the COVID-19 pandemic, are included with a focus on how improvement methods can help identify and close disparity gaps in systems of care.
Also new to this edition is an expanded discussion of effective teamwork and the importance of creating multidisciplinary healthcare teams that partner with patients and families.
Key features of the book include:
- Clinical problem-solving and teamwork vignettes.
- Chapter objectives and study questions to assess learning.
- Comparisons of the types of measurement tools and ideas for practical application.
- Updated SQUIRE publishing guidelines and presentation strategies.
- Downloadable tools, worksheets, and resources.