What ORYX means for you
Some practical implications
The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, officially launched ORYX on Feb. 18. By March 31,1999, you will be required to begin submitting third-quarter 1998 data. After that, data will be reported quarterly. In turn, the Joint Commission will provide quarterly reports from its database to all hospitals. Ad hoc reports will be available at an additional cost.
You must, by Dec. 31, 1997, choose an approved performance measurement system, then select at least two clinical performance indicators that relate to at least 20% of your patient population. A list of the approved reporting software manufacturers has been published on the Joint Commission’s World Wide Web site (http://www.jcaho.org). At the site is information profiling each performance measurement system and guidance for selecting one that best meets your needs. The data ultimately come from the measurement systems, not individual hospitals. Hospitals have the option of developing their own programming as long as the Joint Commission can access the data in the required format. Most performance measurement systems approved for the ORYX initiative will produce more than reports for use by the Joint Commission. Hospitals can get hard-copy reports, comparative data, or any other customized data report.
The Joint Commission will review the submitted data and determine if contact is necessary. How you use the data to analyze processes and improve care is of particular interest. A summary of the performance data will be given to surveyors for use during their on-site triennial survey.
The initiative is expected to integrate the use of patient care outcomes and other performance measurement data into the accreditation process. Having objective feedback, according to the Joint Commission, will enable organizations to support their improvement activities and demonstrate accountability to the public.
"We don’t anticipate our indicators changing," says Karen Reeves, RN, vice-president of professional services for South Carolina Hospital Association in Columbia. "Hospitals will choose from among our ten for the two to use for Joint Commission accreditation purposes."
Hospital Peer Review asked Jayne Bassler, RN, quality manager at Volusia Medical Center in Orange City, FL, how that facility will choose its two indicators. "We now report on eighteen," she said. "We’ll evaluate which are the most meaningful among those. For example, mortality rate is an essential benchmark, but it’s not the most effective outcome measure because it doesn’t always reflect lack of quality. Volusia has no obstetric or pediatric services, and about 80% of our patients are over 70, so our mortality rate may be comparatively high.
"We have a multidisciplinary QI committee that includes department directors and physicians. Our physicians will help decide what they think are the most meaningful measures of quality and evaluate our indicators."
Starting small
ORYX’s initial requirement is minimal. "We fully expect that the first two indicators hospitals choose will be ones that make a favorable impression," notes Dennis S. O’Leary, MD, president of the Joint Commission. "But the requirement levels will go up over time, so within a few years it won’t be so easy to identify such positive indicators. Our first priority is to get everyone on the train, then to improve the process."
The Joint Commission will expand the requirements over several years. For example, by the end of 1998, you must select two additional measures, for a total of four that address at least 40% of your patient population The number of indicators and their specificity will be increased for several years. The new requirement timetable applies regardless of when your hospital is due for its next triennial survey.
ORYX is beginning with hospitals and long-term care facilities. The initiative will expand its scope to include integrated delivery networks, health plans, and provider-sponsored organizations. Eventually the Joint Commission will put in place requirements for home care, behavioral health, ambulatory care, and laboratory accreditation programs.
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