By Sonora Hudson
October 13, 1997

Hospitals and long-term care facilities, accredited by the Joint Commission on Accreditation of Healthcare Organizations, have until the end of the year to register for the JCAHO’s new program integrating outcomes and other performance measurement data.

Called Oryx, the program requires facilities to select one of 62 performance measurement systems approved by the JCAHO. At first, facilities must choose at least two measures that together represent 20 percent or more of their patient or resident population. Data collection will begin by the third quarter of 1998, with that quarter’s data to be submitted to the JCAHO via the selected system.

The number of measures is expected to grow by two a year over the next four years, with the proportion of patient/resident population covered increasing to 40 percent over the same period. Ambul atory care behavioral healthcare and home care organizations, clinical laboratories, and long-term care pharmacies will have to choose a system by the end of next year.

The JCAHO’s goal is a data-driven, more continuous accreditation process, according to Deborah Nadzam, PhD, RN, vice president for performance measurement. Nurses and other health professionals will be key players; they’ll help ident ify what’s important to measure, collect and interpret data, and participate in decisions about corrective actions.

"Nurses can play a critical role," said Nadzam, who oversees the Oryx program. "Nurses have been quite diligent about QI [quality improvement] activities and can be resources to healthcare organizations about the QI process."

Approved measurement systems vary in complexity and cost. At the less expensive end of the spectrum is the Maryland Quality Indicator Project (MQIP), the country’s largest comparative clinical database. At the high end are systems such as the CaduCIS clinical care management system for physician executives, offered by Philadelphia-based Care Management Science Corp.

"We’ve had a tremendous amount of interest in our project since JCAHO made the announcement," said Nell Wood, director of marketing and communications for the MQIP. More than 1,100 hospitals are participating. Ten indicators are measured. Data collection has not required participants to add any full-time employees, Wood said.

Care Management Science offers three software packages and levels of participation. CaduCIS Net is an Internet-based clinical outcomes profiling and benchmarking package that uses publicly available diagnoses and procedure databases. CaduCIS Manager provides data-driven reports and a query tool using disease- and outcomes-specific risk assessment methods. CaduCIS Alliance provides episodes-of-care analyses and measures risk assessment and outcomes that run on an organization’s own computer system.

"A lot of companies are obviously marketing right now," said Brenda M. Fix, marketing manager at Care Management Science. "We’re seeing a lot of interest in the CaduCIS Manager package from clients who want to go for the long term, as Oryx requirements get more complicated."

The requirements are extensions of what’s in JCAHO standards, Nadzam said. "Accreditation has to move to analyses of outcomes. In health care we’re expected to be more accountable. The move we’re taking is in sync with the healthcare environment and is in part a reaction to what users of healthcare services expect—results."

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