The Joint Commission
Quality Check


  Symbol Key
This organization achieved the best possible results
This organization’s performance is above the target range/value.
This organization’s performance is similar to the target range/value.
This organization’s performance is below the target range/value.
Not displayed
Quality Report
Hospital
Covenant Med Ctr/Covenant Med Ctr - Lakeside/Children Hosp.
Org ID: 266567

National Quality Improvement Goals: Heart Attack Care

Reporting Period: January 2009 - December 2009

  Compared to other Joint Commission Accredited Organizations
Measure Area
Nationwide Statewide
Heart Attack Care
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This organization’s performance is above the target range/value.
This organization’s performance is above the target range/value.

  Compared to other Joint Commission Accredited Organizations
  Nationwide Statewide
Measure Hospital
Results
Top 10% Scored at Least: Average Rate: Top 10% Scored at Least: Average Rate:
ACE inhibitor or ARB for LVSD*
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(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 96% 100% 95%
89% of
72 eligible Patients
Adult smoking cessation advice/counseling*
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(See Quarterly Results)
This organization achieved the best possible results.
100% 99% 100% 100%
100% of
196 eligible Patients
Aspirin at arrival*
Read More


(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 98% 100% 98%
98% of
202 eligible Patients
Aspirin prescribed at discharge*
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(See Quarterly Results)
This organization’s performance is above the target range/value.
100% 98% 100% 98%
97% of
461 eligible Patients
Beta blocker prescribed at discharge*
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(See Quarterly Results)
This organization’s performance is above the target range/value.
100% 98% 100% 98%
99% of
472 eligible Patients
Fibrinolytic therapy received within 30 minutes of hospital arrival*
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(No Quarterly Results are available)
Not displayed.
3
100% 55% 100% 68%
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Primary PCI received within 90 minutes of hospital arrival*
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(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 87% 100% 86%
80% of
50 eligible Patients
Center for Medicare and Medicaid (CMS)
Hospital 30-Day Risk Adjusted Death (Mortality) compared to U.S. National Rate
The rates displayed in this table are from data reported for discharges July 2005 through June 2008
Last Updated: March 18, 2010
The U.S. National 30-day Death Rate from Heart Attack = 17%
  Better Than U.S. National Rate
(Adjusted mortality is lower than U.S. rate)
No Different Than U.S. National Rate
(Adjusted mortality is about the same as U.S. rate or difference is uncertain)
Worse Than U.S. National Rate
(Adjusted mortality is higher than U.S. Rate)
30-Day Death (Mortality) Rates from Heart Attack  
(See Rate Details)
 
Out of 4609 hospitals in U.S. 131 hospitals in the U.S. Better than U.S. National Rate 2814 hospitals in the U.S. No different than U.S. National Rate 54 hospitals in the U.S. Worse than U.S. National Rate
1610 hospitals in the United States did not have enough cases to reliably tell how well they are performing
Out of 341 hospitals in Texas 5 hospitals in Texas Better than U.S. National Rate 207 hospitals in Texas No different than U.S. National Rate 2 hospitals in Texas Worse than U.S. National Rate
127 hospitals in the United States did not have enough cases to reliably tell how well they are performing
For technical information on 30 Day Risk Adjusted Mortality measures read more.
Center for Medicare and Medicaid (CMS)
Hospital 30 Day Rate of Readmission compared to U.S. National Rate
The rates displayed in this table are from data reported for discharges July 2005 through June 2008
Last Updated: March 18, 2010
The U.S. Rate for Readmissions for Heart Attack Patients = 20%
  Better Than U.S. National Rate
(Adjusted readmissions are lower than U.S. rate)
No Different Than U.S. National Rate
(Adjusted readmissions are about the same as U.S. rate or difference is uncertain)
Worse Than U.S. National Rate
(Adjusted readmissions are higher than U.S. Rate)
30 Day Hospital Readmission Rates for Heart Attack Patients  
(See Rate Details)
 
Out of 4520 hospitals in U.S. 36 hospitals in the U.S. Better than U.S. National Rate 2488 hospitals in the U.S. No different than U.S. National Rate 52 hospitals in the U.S. Worse than U.S. National Rate
1944 hospitals in the United States did not have enough cases to reliably tell how well they are performing
Out of 333 hospitals in Texas 2 hospitals in Texas Better than U.S. National Rate 187 hospitals in Texas No different than U.S. National Rate 0 hospitals in Texas Worse than U.S. National Rate
144 hospitals in the United States did not have enough cases to reliably tell how well they are performing
For technical information on Hospital Readmission Rates read more.
National Quality Forum The Joint Commission only reports measures endorsed by the National Quality Forum.  
* This information is part of the Hospital Quality Alliance. This information can also be viewed at www.hospitalcompare.hhs.gov.
---- Null value or data not displayed.

1 - The measure or measure set was not reported.
2 - The measure set does not have an overall result.
3 - The number of patients is not enough for comparison purposes.
4 - The measure meets the Privacy Disclosure Threshold rule.
5 - The organization scored above 90% but was below most other organizations.
6 - The measure results are not statistically valid.
7 - The measure results are based on a sample of patients.
8 - The number of months with measure data is below the reporting requirement.
9 - The measure results are temporarily suppressed pending resubmission of updated data.


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