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National Quality Forum Endorses Consensus Standards for Quality of Hospital Care

Patient safety in hospitals focus of 48 NQF-endorsed measures

WASHINGTON, May 15 /PRNewswire-USNewswire/ -- Recognizing that patient safety remains a major hurdle in the United States, the National Quality Forum (NQF) today endorsed 48 voluntary consensus standards focused on measuring the performance of acute care hospitals, including measures addressing pediatric safety, hospital readmission, and prevention and care of venous thromboembolism.

"It has been difficult to make real progress in patient safety in this country, despite the efforts of many highly skilled, committed professionals and innovations in technology and treatment," said Janet Corrigan, president and CEO of the National Quality Forum. "In part, that is because we are all using different yardsticks to measure safety, which makes it difficult to identify and focus efforts on areas most in need of improvement and to measure and quantify progress. NQF-endorsed standards represent consensus of the experts and leaders from all corners of the healthcare industry, and can make a significant difference in helping hospitals measure what matters most to truly improve hospital care."

NQF-endorsed voluntary consensus standards are widely viewed as the "gold standard" for measurement of healthcare quality.

"NQF provides a great service to patients, purchasers, and the hospital community by providing the reference set of standard measures that improve safety, quality, and efficiency.

This set of NQF-endorsed measures will help hospitals identify where there are safety issues in need of system solutions," said Dr. Jonathan B. Perlin, Chief Medical Officer of the Hospital Corporation of America. "NQF-endorsed measures are instrumental in guiding hospitals through the complicated maze of measurement and reporting to ensure that quality is constantly addressed and improved in a way that is efficient and effective."

The set of hospital measures endorsed today will facilitate broad-based quality improvement by targeting numerous safety and quality issues within hospitals. Given the growing concerns with readmissions in America, particularly in the Medicare population, these important measures will help track progress toward improved transitions in care.

Most of the newly endorsed measures, the Quality Indicators, developed by the Agency for Healthcare Research and Quality (AHRQ), specifically offer hospitals an opportunity to pinpoint safety issues with measurement driven by readily available administrative data, rather than medical record reviews. Carolyn Clancy, M.D., director of AHRQ, believes the new measures can have a real impact. "Through public reporting," said Dr. Clancy, "these measures should offer needed guidance to purchasers and consumers seeking information about hospitals, as well as an opportunity for benchmarking to peers in the marketplace."

Six of the measures target the most common preventable cause of hospital death -- venous thromboembolism (VTE). There are 900,000 cases of VTE in the United States every year, and a stunning 300,000 of them are fatal. Annually, over 600,000 of those cases -- and 200,000 of the fatalities -- occur in hospitals, which have access to VTE prophylactic measures and treatments. The need for hospital-focused measures is very clear. All six NQF-endorsed measures on VTE focus on hospitals; with one measure extending the focus to readiness of patients for discharge. These newly endorsed measures further fill out NQF's portfolio of VTE measures and practices, including two previously endorsed Safe Practices.

When a measure is NQF-endorsed(TM), it carries the full weight of formal consensus of more than 375 healthcare providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality improvement organizations. Standards are vetted through NQF's formal Consensus Development Process to achieve special legal standing as voluntary consensus standards and are evaluated against NQF's criteria to ensure they are important, scientifically acceptable, useable, and feasible. When the federal government adopts standards, federal law obligates that they are voluntary consensus standards.


Length of Stay/Readmission

-- Risk-adjusted average length of inpatient hospital stay

-- Overall inpatient hospital average length of stay (ALOS) and ALOS by DRG service category

-- All-cause readmission index

-- 30-day all-cause risk standardized readmission rate following heart failure hospitalization

-- Severity-standardized average length of stay-routine care

-- Severity-standardized average length of stay-special care

-- Severity-standardized average length of stay-deliveries

Patient Safety, Adult

-- Accidental puncture or laceration

-- Death in low mortality DRGs

-- Iatrogenic pneumothorax

-- Death among surgical inpatients with serious, treatable complications

-- Bilateral cardiac catheterization rate

-- Blood cultures performed within 24 hours prior to or 24 hours after hospital arrival for patients who were transferred or admitted to ICU within 24 hours of hospital arrival

-- Congestive heart failure mortality

-- Hip fracture mortality rate

-- Transfusion reaction, age 18 years and older

Patient Safety, Pediatrics

-- Accidental puncture or laceration

-- Decubitus ulcer

-- Iatrogenic pneumothorax in nonneonates

-- Transfusion reaction, age under 18 years


-- PICU severity-adjusted length of stay

-- PICU unplanned readmission rate

-- Review of unplanned PICU readmissions

-- Home management plan of care document given to patient/caregiver

-- Pediatric heart surgery mortality

-- Pediatric heart surgery volume

-- PICU pain assessment on admission

-- PICU periodic pain assessment

-- PICU standardized mortality ratio

Surgery and Anesthesia

-- Abdominal aortic aneurysm volume

-- Abdominal aortic aneurysm repair mortality rate

-- Esophageal resection mortality rate

-- Esophageal resection volume

-- Incidental appendectomy in the elderly rate

-- Pancreatic resection mortality rate

-- Pancreatic resection volume

-- Post operative wound dehiscence, age under 18 years

-- Post operative wound dehiscence, 18 years and older

-- Foreign body left after procedure, age under 18 years

-- Foreign body left in during procedure, 18 years and older

-- Failure to Rescue In-hospital Mortality

-- Failure to Rescue 30-day mortality

Venous Thromboembolism

-- VTE prophylaxis

-- Intensive Care Unit (ICU) VTE Prophylaxis

-- VTE Patients with Anticoagulation Overlap Therapy

-- VTE Patients Unfractionated Heparin (UFH)Dosages/Platelet Count Monitoring by Protocol (or Nomogram)

-- VTE Discharge Instructions

-- Incidence of Potentially Preventable VTE

NQF is a voluntary consensus standard-setting organization. Any party may request reconsideration of the recommendations, in whole or part, by notifying NQF in writing via email no later than June 15, 2008 ( For an appeal to be considered, the notification email must include information clearly demonstrating that the appellant has interests that are directly and materially affected by the NQF-endorsed(TM) recommendations and that the NQF decision has had (or will have) an adverse effect on those interests.

Support for the larger portion of these measures was provided by the Agency for Healthcare Research and Quality (AHRQ), with additional funds provided by the Alliance for Pediatric Quality, America's Health Insurance Plans, and Blue Cross Blue Shield Association. Sanofi-aventis provided an unrestricted educational grant in support of the VTE project.

The mission of the National Quality Forum is to improve the quality of American healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs. NQF, a non-profit organization ( with diverse stakeholders across the public and private health sectors, was established in 1999 and is based in Washington, DC.

SOURCE National Quality Forum
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