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The Joint Commission on Accreditation of Heathcare Organizations (JCAHO) is the lead organization in accrediting hospitals in the United States. JCAHO has recently instituted an outcomes-based performance system that includes specific oncology measures and may, over the coming years, improve the relevance of JCAHO certification to individuals with cancer (see below).
Although various organizations collect information related to the quality of hospital-based cancer care, the consumer usually can find out only whether or not a hospital is approved or accredited. The overwhelming majority of hospitals that voluntarily submit to an inspection or review are approved or accredited, but the details of hospital performance on various indicators are not yet publicly available. Even if the information were available, it would be difficult for consumers to evaluate a particular hospital's quality because there are few established links between hospital attributes and quality (see Chapter 5). Standards can, however, help to ensure that hospitals meet minimum infection control, safety, and security standards. If a hospital fails to meet the criteria set forth by professional groups, consumers are justified in searching out more detail about potential problems before agreeing to use the facility.
The news media and the popular press may also be sources of consumer information about the quality of health plans and hospitals. A few widely circulated magazines have sponsored national surveys of consumers regarding their satisfaction with care, and of providers regarding their assessments of the quality of sites of care, that they have used to rank services on the basis of quality. Consumer Reports has, for example, evaluated managed health care plans, and each year U.S. News & Worm Report ranks hospitals, including hospital-based cancer centers (Box 6.1), a feature that has been very popular with consumers and has been used by the high-ranking centers in marketing (Memorial Sloan-Kettering Cancer Center, 1998). While the U.S. News & Worm Report ranking includes indicators for which there is some evidence linking them to good health outcomes (i.e., volume of services, nurse to patient bed ratio), the ranking system itself has not been validated externally and the methodology has been criticized (Teasley, 1996).
BOX 6.1U.S. News and World Report Annual Ranking of Cancer Centers
With a circulation of more than 2 million, the U.S. News & World Report annual ranking of hospital-based cancer programs is perhaps the most widely read source of information on the quality of cancer care. In 1997, 998 hospital-based cancer care programs were ranked according to measures of structure, process, and outcome:
reputation score among board-certified oncologists;
severity-adjusted cancer mortality rate;
membership in the Council of Teaching Hospitals;
availability of cancer-related technology;
number of cancer discharges; and
nurse to patient bed ratio.
The authors of the ranking system concluded that there are a few extremely ''good'' hospitals, many hospitals providing "competent" care, and a few hospitals at the bottom of the curve.