Magazine article Drug Topics

Pharmacists Likely Winners as IG Report Criticizes JCAHO

Magazine article Drug Topics

Pharmacists Likely Winners as IG Report Criticizes JCAHO

Article excerpt

Pharmacists may be unexpected beneficiaries from a report by the Inspector General that criticized the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) hospital survey procedures. As a result of the findings, Health Care Financing Administration officials are planning to turn toward another set of standardized performance measures for future hospital evaluation. These new quality indicators, under development by a nationwide system of peer review organizations, or PROs, are based on specific drug-therapy measures.

"PROs are the best-kept secret in health care," said David Schulke, executive v.p. of the American Health Quality Association, the national group that coordinates PRO programs. "PROs don't make headlines. All they do is improve clinical outcomes in the real world."

A two-year probe by the IG, released in July, concluded that procedures used by JCAHO to accredit hospitals for Medicare participation are inadequate to uncover systemic problems in patient care, fraud, and abuse. The Joint Commission accredits about 80% of the 6,200 Medicare-eligible hospitals in the country. The other 20% are certified by state agencies.

The report notes that JCAHO surveys seldom uncover either individual practitioners with questionable skills or patterns of substandard care.

State agencies seldom conduct routine, not-for-cause surveys of nonaccredited hospitals. In 1997, about half of nonaccredited hospitals had not been surveyed within the three-year industry standard. Some institutions had not been surveyed in eight years.

A spokeswoman for JCAHO said it will stop giving hospitals advance notice of "unannounced random surveys." Institutions will also no longer be advised of the standards to be reviewed prior to surveys. The new policy will take effect Jan.1, 2000.

Schulke, former head of the American Pharmaceutical Association's policy and regulatory affairs group, said pharmacists can expect to play a leading role in the future, since five of the six quality indicators Medicare PROs will focus on for the next three years are based on utilization of specific drug therapies:

Quality indicators for acute myocardial infarction include use of aspirin on admission and discharge, prescribing of beta blockers at discharge, the use of ACE inhibitors for low LVEF (left ventricular ejection fraction), time to thombolysis, time to reperfusion, and lipid testing and treatment.

Congestive heart-failure treatment will be evaluated based on the use of ACE inhibitors for low LVEF and achievement of specific dose targets. …

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