JNP Urges Prevention Focus for 2010

Abstract

It has been well documented that it takes some time for research knowledge to diffuse and affect clinical practice. For many years we have heard about the need for clinicians to help obese patients lose weight. This topic is now on the national policy agenda—including that of First Lady Michelle Obama as she focuses on prevention of childhood obesity. Almost everywhere we look there is information to help clinicians assist patients in losing weight. Another policy initiative of a few years ago that seems to be maturing and beginning to show change is that of disease prevention. JNP is very interested in supporting prevention initiatives and is actively focusing journal content on disease prevention this year. We hope this emphasis will inspire NPs nationwide to recommit themselves to this important clinical task. This special issue of JNP includes information that focuses on prevention for the pediatric population. Progress in disease prevention in the inpatient arena is highlighted by the recent release of the American Hospital Association's “Improving America's Hospitals: The Joint Commission's Report on Quality and Safety 2009.” The report summarizes objective statistics documenting quality of care in 31 core areas and how the statistics relate to common medical conditions and procedures. The report also shows that there was “continual improvement between 2002 and 2008 on 12 quality measures reflecting the best evidence-based treatments for heart attack, heart failure, and pneumonia—practices demonstrated by scientific evidence to lead to the best outcomes. The magnitude of national improvement on these measures ranged from 4.9% to 58.8%.” Hospital performance also improved in 13 other measures. Pneumococcal vaccination and smoking cessation advice measures show the greatest rates of improvement for this period. Among the areas evaluated, there are 8 measures of care relating to heart attack, 4 to heart failure, 9 to pneumonia, 8 to surgical care, and 2 to children's asthma care. The report is based on data from more than 3,000 Joint Commission– accredited hospitals. A summary of the report highlights some of the findings: •Hospital performance on two individual measures of quality relating to inpatient care for childhood asthma show that 99.8% of the time “relievers” were provided to childhood asthma inpatients and 99.1% of the time systematic corticosteroids were provided to childhood asthma inpatients.•Hospitals provided an evidence-based treatment for heart attack 96.7% of the time in 2008, up from 86.9% in 2002.•The overall heart failure care result improved to 91.6%, up from 59.7% in 2002.•The overall 2008 pneumonia care result is 92.9%, up from 72.3% in 2002. Areas indicating a need for improvement showed that only 52.4% of hospitals provided fibrinolytic therapy to heart attack patients within 30 minutes of arrival and that only 60.3% of hospitals provided antibiotics to intensive care unit pneumonia patients within 24 hours of arrival. The report documents that variability is still present in the level of quality of patient care delivered. Results of quality, safety, and patient satisfaction for specific hospitals can be found at www.qualitycheck.org. For a complete copy of the report, visit www.jointcommission.org.