JCAHO accreditation: the importance of outcomes.

The Joint Commission upped the ante on accreditation with Oryx initiative

Last year was a year of milestones for accreditation of long-term care organizations complying with a new outcomes measurement approach sponsored by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). JCAHO's Oryx initiative is a critical link that will integrate outcomes and other performance measures into the current standards-based accreditation process used for long-term care facilities. Facilities seeking JCAHO accreditation began participating in Oryx a year ago, as a requirement for participation in accreditation.

First, these organizations had to select at least two clinical performance measures for data collection by spring and begin collecting these data by fall. This was followed by the selection of two additional measures by the end of last year, with a combined total outcomes measurement target consisting of 25% of the patient population. This January, data collection on the additional measures began.

The reporting of data from the first two performance measures is due at the end of this month (March), so the Joint Commission has not yet had the opportunity to review any data. However, we find that the measures most commonly selected by reporting facilities are those also reported on MDS assessments. Popular measures are the use of restraints and injuries from falls.

One facility has stood out in its use of process and outcomes measures; its focus, indeed, was on reducing the use of physical restraints. The Susquehanna Lutheran Village in Millersburg, Pa., received JCAHO's Ernest A. Codman Award this year, an award that showcases the effective use of performance measures in healthcare. It received the award for creating a totally restraint-free environment, and the facility now serves as a training site for restraint-free care in the state, offering seminars and tours.

This facility's performance improvement initiative began in 1995. Initial data indicated a downward trend in restraint use by the 203-bed facility, leading staff to anticipate an increase in fills. They began to monitor falls and conduct detailed analyses of such incidents. To do so, they developed a fall analysis form to aid in early identification of the causes of falls.

Research had indicated they should expect a reduction in the severity of injuries related to falls and, in fact, the fracture rate for falls dropped from 3.5% in 1995 to 1.5% in 1998. In addition, there was a decrease in the number of psychoactive medications used, especially the hypnotics. The facility also found that staff job satisfaction had increased and that there was a decrease in staff turnover. Concurrently, it was noticed that there was an increase in the number of residents discharged to home, a decrease in complaints relating to care and increased resident participation in activities such as gardening and caring for animals.

The facility credits input from staff, family and residents for its ability to achieve a restraint-free environment, along with help from the Pennsylvania Department of Health's "Untie the Elderly" program and the Joint Commission's accreditation standards.

As part of another accreditation initiative, the Joint Commission announced recently the survey topics it will focus upon in its random unannounced surveys for 1999. These surveys have been conducted with 24-hour notice at organizations at the midpoint of their accreditation cycles. JCAHO selects these areas of focus based on the elements found most problematic in accreditation surveys in the previous year, and they are listed in descending order of frequency.

For example, for review this year in general long-term care, problem areas include assessment, staff credentialing, planning and designing services, education, planning and providing care, and improving organizational performance. For subacute care, problem areas include assessment, credentialing, orientation and training, planning and providing care, and planning and designing services. For dementia units, areas of focus include assessment, planning and designing services, credentialing, planning and providing care, and improving organizational performance. Accredited facilities and relevant departments would do well to focus on their performance in these areas in 1999.

Marianna Kern Grachek is executive director of long-term care accreditation for the Joint Commission on the Accreditation of Healthcare Organizations. For further information, call 650-792-572 or access www.jcaho.org.