Outcome measures may be included at a future point, but only if they "pass a stringent test," he said.
Asked why the report includes so many smaller, non-academic hospitals, Chassin acknowledged that small and rural hospitals are overrepresented and academic medical centers are underrepresented.
"I think that should be, number one, a notification or announcement that you don't have to be a big hospital to do well, and if you're a big hospital, it doesn't mean you're doing well (if you're not) paying attention to these very important processes of care..."
He said it should be "a wake-up call to larger hospitals to put more resources into these programs, and a recognition that small, rural and community hospitals can do an excellent job."
Chassin said that in reporting these process measures over the last several years, performance has remarkably improved because of these measures and the improvements they stimulate. For example, care for heart attack patients 98.4%, up from 86.9% in 2002, for process measures including giving aspirin to each patient at arrival and discharge, fibronolytic therapy within 30 minutes and percutaneous coronary intervention within 90 minutes.
The Joint Commission criteria for performance excellence will continue to expand, Chassin said. For example, it is now in the second year of measuring performance for inpatient psychiatric care and in the first year of reporting results for patients with stroke and the prevention of venous thromboembolism.
Next year, a new set of measures will focus on care of moms and babies before, during, and after childbirth.