An uncommon list of top hospitals from the Joint Commission

The Joint Commission, which accredits health care providers, today released its first list of top hospitals, using metrics meant to track quality of care. The results may surprise you.

Nationally and in Massachusetts, the list skewed small and rural. On it was tiny Athol Memorial Hospital, a 25-bed hospital whose operating expenses in the tax year that ended in September 2009 were about $23 million. Absent are the powerhouses that make Boston a world-famous medical city. The state list includes no major teaching hospitals.

Dr. Mark Chassin, president of the Joint Commission, said the metrics measure how well hospitals carry out processes of care that the group thinks should be standard for all patients with certain diagnoses. Examples include giving a person who is having a heart attack aspirin upon arrival at the hospital or the use of corticosteroids in children admitted with asthma.

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The ratings used 22 measures in five categories—heart attack, heart failure, pneumonia, surgical care, and children’s asthma—but not all hospitals report their results on all measures to the commission. To be included on the list of 405 top hospitals, a hospital had to meet each of the measures it reports 95 percent of the time.

Chassin said the organization chose to use process measures rather than metrics that evaluate patient outcomes, such as survival or readmission rates, because it is very difficult to account for differences in patient populations when looking at outcomes. Also, he said, “using process measures tells the organization exactly what they need to improve.”

Chassin acknowledged that it might be more difficult for larger hospital systems, with bigger staffs, busier emergency departments, and more complicated patients, to make sure that the best practices his group has outlined are met with every patient. But he said, they also have more resources to dedicate to the effort.

“I hope (the list) is both a wake-up call to the larger hospitals to put more resources into these types of programs, and a recognition that a small, rural hospital can do an excellent job,” he said.

Starting next year, hospitals that do not meet these criteria 85 percent of the time will not receive accreditation by the Joint Commission. Chassin said 121 hospitals of about 3,800 fall short right now.

“Almost all hospitals are doing very well” and continuing to improve, said David Smith, senior director of the Massachusetts Hospital Association.

He noted that the commission’s report highlights the topmost hospitals, but that the vast majority are well above the bar the group has set.

“I might quibble that the differences are meaningful,” he said.

Asked about why those hospitals with the best reputations in the country were not on the list, Chassin said public impressions of a hospital are built over a long period of time—or lost over a long period of time—and are affected by research, technology, and other things. Branding plays a role, too.

“The factors associated with reputation don’t really have to do with performance on specific measures of quality,” he said.

Here’s the list of Massachusetts hospitals that were recognized. For the full list and an explanation of the measures, see the Joint Commission report:

  • Athol Memorial Hospital, Athol
  • Faulkner Hospital, Boston
  • New England Baptist Hospital, Boston
  • Fairview Hospital, Great Barrington
  • Wing Memorial Hospital and Medical Centers, Palmer
  • Baystate Mary Lane Hospital, Ware

Readers: How do you make sense of the various hospital rankings, including those by US News and Thomson Reuters? Do they confuse you, or are they a helpful tool for deciding where to get care?