May 16, 2003

Dear Colleagues:

As you may know, last year the Maryland Health Care Commission (MHCC) produced the first version of its Maryland Hospital Performance Evaluation Guide, commonly known as the "Maryland Hospital Report Card." This report card seeks to establish a common set of performance measures that will help consumers and others compare hospitals. The initial guide focused on hospital volumes, risk-adjusted length of stay for certain medical conditions, and readmission rates. While no single measure or approach to assessing health care quality is perfect - and it will take time to refine these tools to eliminate all biases - MHCC's report is a welcome, sincere and earnest effort to better inform the public about its choices, and to help guide hospitals in their ongoing commitment to improve quality of care.

On Friday, May 16, the MHCC will release its next report card. It looks at hospital quality indicators for the treatment of heart failure and community-acquired pneumonia (CAP) using hospital discharge data from July through December, 2002. The measure sets for assessing these indicators were developed by the Joint Commission on Accreditation of Healthcare Organizations. The complete report can be viewed at http://www.mhcc.state.md.us

The Johns Hopkins Hospital performed at or above the state average in the following four of the combined eight measures:

· Measuring blood oxygen levels for CAP patients
· Providing recommended blood tests for CAP patients
· Performing recommended heart function testing
· Administering recommended medications for heart failure patients.

Areas in which The Hospital fell below state averages were:

· Providing written discharge instructions on smoking cessation for CAP patients
· Administering antibiotics in a timely fashion for CAP patients
· Providing written discharge instructions with all aspects of care for heart failure patients
· Providing written discharge instructions on smoking cessation for heart failure patients

Action plans are already under way to address each of these areas. For example, forms were revised to simplify the documentation and tracking of interventions; brochures have been developed to assist patient teaching and discharge readiness; and the adult emergency department and pharmacy staff have established a multistep plan to improve the timeliness of the first antibiotic dose for patients with CAP admitted through the emergency department, including:

· Development of a protocol to identify potential CAP patients at the time of triage, with the triage nurse having authority to order chest X-rays before a physician sees the patient
· Identification of potential CAP patients for rapid evaluation
· Stocking of selected antibiotics in the emergency department for rapid administration
· Establishment of a mechanism to monitor antibiotic administration to CAP patients in the emergency department

These steps are being taken in addition to our ongoing performance improvement initiatives. Working groups of physicians, nurses, administrators and other frontline staff, as well as safety and clinical care systems experts have already been working diligently to improve outcomes and provide better methods for documenting those improvements so that measures, like the MHCC report card, will become even more helpful to patients.

We strongly encourage and welcome your involvement and assistance in these and other efforts to improve the already excellent level of care provided to our patients. To learn more about the quality improvement efforts at Hopkins, please contact:

Beryl Rosenstein M.D., V.P. Medical Affairs, ext. 5-0620
Michael Londner, M.D., Physician Advisor, Department of Emergency Medicine, ext. 5-8708
Terry Nelson, R.N., Asst. Director, Department of Medicine Nursing, ext. 5-5148
Dan Wassilchalk, Director, Department of Performance Improvement/Utilization Management, ext. 5-2940

Judy A. Reitz, Sc.D.
Executive Vice President/COO, The Johns Hopkins Hospital
Vice President, Operations Integration, Johns Hopkins Health System