 The Institute of Medicine released a report, Crossing the Quality Chasm (March 1, 2001), about the quality chasm which exists in healthcare in our country. Medical research has provided answers to what are the best medications and therapies for certain diseases and illnesses. This is called evidence-based medicine. Despite this knowledge of best treatments, it is not uncommon for patients to enter and leave hospitals without receiving the best care. This is true regardless of the hospital's prestige, location, or size. Thus, there is a chasm between knowledge and what is actually performed. If certain medications, procedures, or processes are followed, then a patient's mortality is decreased and their functional quality of life upon discharge of the hospital is improved. These medications, procedures, or processes can be measured and are called quality indicators. How a hospital and it's associated medical staff score on these quality indicators may be used to measure and reflect the quality of care delivered to patients. CMS (Centers for Medicare and Medicaid Services) and some insurance companies have requested hospitals to release their quality data to them. In order to be more accountable to the public, in December 2002, the American Hospital Association, the Association of American Medical Colleges, and the Federation of American Hospitals publically agreed to take a leadership role of making information public about the quality of hospital care. They formed the National Quality Project to encourage and facilitate release of hospital quality data to the public and CMS. Ten quality indicators were chosen to represent hospital performance measures for public reporting. These ten indicators have been endorsed by the government through CMS, hospital accreditating organizations, and the National Quality Forum. The National Quality Forum is a private/public partnership started in May 1999 as a result of the President's 1998 National Advisory Commission on Quality to set the national agenda on healthcare quality. These ten quality indicators have gone through years of testing for validity and reliability. Pneumonia, heart failure, and heart attack (acute myocardial infarction) are the illnesses chosen, since they are three of the most common admissions to hospitals across our country. There is solid evidence-based medical research to show that performing these ten quality indicators will result in better outcomes for patients, decrease in mortality, and improved quality of life after hospital discharge. These illnesses were also chosen since most hospitals provide care for these illnesses and can thus be used for comparisons from hospital to hospital in their quality of care. For several years, the government, through their QIOs (Quality Improvement Organizations) and accreditation organizations, such as JCAHO through their ORYX project, have involved and encouraged hospitals to incorporate these quality indicators, measure and report them, compare them with other hospitals' performance and then use this information to effect improvement. In 2003, a nationwide system was set up for hospitals to voluntarily disclose and publicly report their data. CMS stated they were disappointed in the number of hospitals who were willing to voluntarily disclose their data. Thus, starting in 2005, hospitals will receive a smaller payment from Medicare if they do not report all ten quality measures. Though Medicare is predominantly for consumers above age 65, the quality data released to CMS/Medicare are for patients of all ages treated in the hospitals. Publically reported quality data serves several purposes: Individual patients, CMS/Medicare, insurers, and private payer groups have objective evidence of the quality provided for the services they pay for. As shown by previous studies, as hospitals and their associated medical staffs compare their performance with other hospitals and associated medical staffs state and nationwide, this creates competitive initiative for them to improve their quality of services. Objective data helps consumers make educated decisions and informed choices as to where they want their healthcare to be delivered. This is similar to a Consumer's Report guide. DeKalb Memorial Hospital and its associated medical staff have followed the medical research for evidence-based best practices and the development of these quality indicators. These were implemented at the Hospital many years ago, even before they became part of the National Quality Project, since they were shown to improve patient outcomes. Redundant systems and systems reengineering were performed to help assure high performance on these quality indicators, which in turn benefits patients' health. Some of this reengineering was borrowed from aviation, nuclear labs, and space shuttle programs where high performance to prevent failure is important in order to save lives. 
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DeKalb Memorial Hospital Inc.
