1
|
Decker JA, Schwarz F, Kroencke TJ, Scheurig-Muenkler C. The In-Hospital Care of Patients With Peripheral Arterial Occlusive Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:611-618. [PMID: 35734915 PMCID: PMC9756319 DOI: 10.3238/arztebl.m2022.0235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/25/2021] [Accepted: 05/13/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Studies from Denmark and the USA have shown differences in treatment outcomes for patients with peripheral arterial occlusive disease (PAOD) between hospitals of different size and certification status. For Germany, it is not known whether certification as a specialist center for vascular diseases or hospital size is associated with differences in the primary treatment outcome. METHODS Using data from the German Federal Statistical Office, all hospitalizations due to PAOD of Fontaine stage IIb or higher were included in our study and the hospitals were classified according to their size and certification status. PAOD stage, age, sex, and comorbidities were documented for each hospitalization. Univariate and multivariate logistic regressions were performed to identify independent variables that predict various treatment endpoints. RESULTS A total of 558 785 hospitalizations were included for analysis, of which 29% were in hospitals with certified vascular centers. In multivariate analysis, admissions to certified hospitals were associated with lower rates of major amputation (odds ratio [OR] 0.95, 95% confidence interval [0.92; 0.98], p = 0.003) and higher rates of minor amputation (OR 1.04 [1.01; 1.06], p = 0.004) with no difference observed in mortality (OR 0.99 [0.96; 1.03], p = 0.791). Admissions to larger hospitals were associated with more comorbidities, longer hospital stays, and higher rates of mortality and amputations. CONCLUSION Treatments in certified hospitals are associated with fewer major and more minor amputations. This may reflect intensification of therapy targeting preservation of functional limbs.
Collapse
Affiliation(s)
- Josua A Decker
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg
| | | | | | | |
Collapse
|
2
|
Bergholt MD, von Plessen C, Johnsen SP, Hibbert P, Braithwaite J, Brink Valentin J, Falstie-Jensen AM. Accreditation and Clinical Outcomes: Shorter Length of Stay After First-Time Hospital Accreditation in the Faroe Islands. Int J Qual Health Care 2022; 34:6552202. [PMID: 35323967 DOI: 10.1093/intqhc/mzac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/14/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of accreditation is to improve quality of care and patient safety. However, studies on the effectiveness of accreditation on clinical outcomes are limited and inconsistent. Comparative studies have contrasted accredited with non-accredited hospitals or hospitals without a benchmark, but assessments of clinical outcomes of patients treated at hospitals undergoing accreditation are sparse. The Faroe Islands hospitals were accredited for the first time in 2017, making them an ideal place to study the impact of accreditation. The objective was to investigate the association between first-time hospital accreditation and length of stay (LOS), acute readmission (AR) and 30-day mortality in the unique setting of the Faroe Islands. METHODS A before and after study based on medical record audits in relation to first-time accreditation. All three Faroese hospitals were voluntarily accredited using a modified second version of the Danish Healthcare Quality Program (DDKM) encompassing 76 standards. We included in-patients 18 years or older treated at a Faroese hospital with one of six clinical conditions (stroke/TIA, bleeding gastric ulcer, COPD, childbirth, heart failure and hip fracture) in 2012-2013 designated 'before accreditation' or 2017-2018 'after accreditation'. Main outcome measures were LOS, all-cause AR and all-cause 30-day mortality. We computed adjusted cause specific hazard rate ratios (HR) using Cox Proportional Hazard regression with before accreditation as reference. The analyses were controlled for age, sex, cohabitant status, in-hospital rehabilitation, type of admission, diagnosis and cluster effect at patient and hospital level. RESULTS The mean LOS was 13.4 days (95%CI: 10.8, 15.9) before accreditation and 7.5 days (95%CI: 6.10, 8.89) after accreditation. LOS of patients hospitalized after accreditation was significantly shorter (overall, adjusted HR=1.23 (95% confidence interval (CI): 1.04, 1.46)). By medical condition, only women in childbirth had a significantly shorter LOS (adjusted HR=1.30 (95%CI: 1.04, 1.62)). In total, 12.3% of in-patients before and 9.5% after accreditation were readmitted acutely within 30 days of discharge, and 30-day mortality was 3.3% among in-patients before and 2.8% after accreditation, respectively. No associations were found overall or by medical condition for AR (overall, adjusted HR=1.34 (95%CI: 0.82, 2.18)) or 30-day mortality (overall, adjusted HR=1.33 (95%CI: 0.55, 3.21)) after adjustment for potential confounding factors. CONCLUSION First-time hospital accreditation in the Faroe Islands was associated with significant reduction in LOS, especially of women in childbirth. Notably,shorter LOS was not followed by increased AR. There was no evidence that first-time accreditation lowered the risk of AR or 30-day mortality.
Collapse
Affiliation(s)
- Maria Daniella Bergholt
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Allé 43-45, DK-8200 Aarhus N, Denmark.,Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900 Hellerup, Denmark
| | - Christian von Plessen
- Policlinique Médicale, Unisanté, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland.,Institute for Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, DK-9220 Aalborg, Denmark
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, New South Wales, 2109, Australia.,IIMPACT in Health, Allied Health and Human Performance, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide SA 5001, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, New South Wales, 2109, Australia
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, DK-9220 Aalborg, Denmark
| | | |
Collapse
|
3
|
Peacock WF, Levy PD, Diercks DB, Li S, Wang TY, McCord J, Newby LK, Osborne A, Ross M, Winchester DE, Kontos MC, Deitelzweig S, Bhatt DL. The Impact of American College of Cardiology Chest Pain Center Accreditation on Guideline Recommended Acute Myocardial Infarction Management. Crit Pathw Cardiol 2021; 20:173-178. [PMID: 34494982 DOI: 10.1097/hpc.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whether American College of Cardiology (ACC) Chest Pain Center (CPC) accreditation alters guidelines adherence rates is unclear. METHODS We analyzed patient-level, hospital-reported, quality metrics for myocardial infarction (MI) patients from 644 hospitals collected in the ACC's Chest Pain-MI Registry from January 1, 2019, to December 31, 2020, stratified by CPC accreditation for >1 year. RESULTS Of 192,374 MI patients, 67,462 (35.1%) received care at an accredited hospital. In general, differences in guideline adherence rates between accredited and nonaccredited hospitals were numerically small, although frequently significant. Patients at accredited hospitals were more likely to undergo coronary angiography (98.6% vs. 97.9%, P < 0.0001), percutaneous coronary intervention for NSTEMI (55.4% vs. 52.3%, P < 0.0001), have overall revascularization for NSTEMI (63.5% vs. 61.0%, P < 0.0001), and receive P2Y12 inhibitor on arrival (63.5% vs. 60.2%, P < 0.0001). Nonaccredited hospitals more ECG within 10 minutes (62.3% vs. 60.4%, P < 0.0001) and first medical contact to device activation ≤90 minutes (66.8% vs. 64.8%, P < 0.0001). Accredited hospitals had uniformly higher discharge medication guideline adherence, with patients more likely receiving aspirin (97.8% vs. 97.4%, P < 0.0001), angiotensin-converting enzyme inhibitor (46.7% vs. 45.3%, P < 0.0001), beta blocker (96.6% vs. 96.2%, P < 0.0001), P2Y12 inhibitor (90.3% vs. 89.2%, P < 0.0001), and statin (97.8% vs. 97.5%, P < 0.0001). Interaction by accredited status was significant only for length of stay, which was slightly shorter at accredited facilities for specific subgroups. CONCLUSIONS ACC CPC accreditation was associated with small consistent improvement in adherence to guideline-based treatment recommendations of catheter-based care (catheterization and PCI) for NSTEMI and discharge medications, and shorter hospital stays.
Collapse
Affiliation(s)
| | | | | | - Shuang Li
- Duke University/Duke Clinical Research Institute
| | - Tracy Y Wang
- Duke University/Duke Clinical Research Institute
| | | | - L Kristin Newby
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC
| | | | - Michael Ross
- Emory University School of Medicine, Atlanta, GA
| | | | | | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA
| |
Collapse
|
4
|
Shah JN, Murray KM, Lucas FL, Fairfield KM, Cohen MC. Variation in additional testing and patient outcomes after stress echocardiography or myocardial perfusion imaging, according to accreditation status of testing site. J Nucl Cardiol 2021; 28:2952-2961. [PMID: 32676913 DOI: 10.1007/s12350-020-02230-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of the present study was to determine whether patients receiving a stress echocardiogram or myocardial perfusion imaging (MPI) test have differences in subsequent testing and outcomes according to accreditation status of the original testing facility. METHODS AND RESULTS An all-payer claims dataset from Maine Health Data Organization from 2012 to 2014 was utilized to define two cohorts defined by an initial stress echocardiogram or MPI test. The accreditation status (Intersocietal Accreditation Commission (IAC), American College of Radiology (ACR) or none) of the facility performing the index test was known. Descriptive statistics and multivariate regression were used to examine differences in subsequent diagnostic testing and cardiac outcomes. We observed 4603 index stress echocardiograms and 8449 MPI tests. Multivariate models showed higher odds of subsequent MPI testing and hospitalization for angina if the index test was performed at a non-accredited facility in both the stress echocardiogram cohort and the MPI cohort. We also observed higher odds of percutaneous coronary interventions (PCI) performed (OR 1.68, 95% CI 1.13-2.50), if the initial MPI test was done in a non-accredited facility. CONCLUSION Cardiac testing completed in non-accredited facilities were associated with higher odds of subsequent MPI testing, hospitalization for angina, and PCI.
Collapse
Affiliation(s)
- Jay N Shah
- Maine Medical Center, 22 Bramhall St, Portland, ME, 04103, UK.
| | - Kimberly M Murray
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, UK
| | - F L Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, UK
| | | | - Mylan C Cohen
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, UK
- Maine Medical Partners MaineHealth Cardiology, Portland, UK
| |
Collapse
|
5
|
Association Between Hospital Accreditation and Outcomes: The Analysis of Inhospital Mortality From the National Claims Data of the Universal Coverage Scheme in Thailand. Qual Manag Health Care 2021; 29:150-157. [PMID: 32590490 DOI: 10.1097/qmh.0000000000000256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND In Thailand, hospital accreditation (HA) is widely recognized as one of the system tools to promote effective operation of universal health coverage. This nationwide study aims to examine the relationship between accredited statuses of the provincial hospitals and their mortality outcomes. METHOD A 5-year retrospective analysis of the Universal Coverage Scheme's claim dataset was conducted, using 1 297 869 inpatient discharges from 76 provincial hospital networks under the Ministry of Public Health. Mortality outcomes of 3 major acute care conditions, including acute myocardial infarction, acute stroke, and sepsis, were selected. RESULTS Using generalized estimating equations to adjust for area-based control variables, hospital networks with HA-accredited provincial hospitals showed significant associations with lower standardized mortality ratios of acute stroke and sepsis. CONCLUSION Our findings added supportive evidence that HA, as an organizational and health system management tool, could help promote hospital quality and safety in a developing country, leading to better outcomes.
Collapse
|
6
|
Mazzini E, Soncini F, Cerullo L, Genovese L, Apolone G, Ghirotto L, Mazzi G, Costantini M. A focused ethnography in the context of a European cancer research hospital accreditation program. BMC Health Serv Res 2021; 21:446. [PMID: 33975580 PMCID: PMC8111912 DOI: 10.1186/s12913-021-06466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/28/2021] [Indexed: 05/31/2023] Open
Abstract
Background A quality accreditation program (AP) is designed to guarantee predefined quality standards of healthcare organizations. Evidence of the impact of quality standards remains scarce and somewhat challenging to document. This study aimed to investigate the accreditation of a cancer research hospital (Italy), promoted by the Organization of European Cancer Institutes (OECI), by focusing on the individual, group, and organizational experiences resulting from the OECI AP. Methods A focused ethnography study was carried out to analyze the relevance of participation in the accreditation process. Twenty-nine key informants were involved in four focus group meetings, and twelve semistructured interviews were conducted with professionals and managers. Inductive qualitative content analysis was applied to examine all transcripts. Results Four main categories emerged: a) OECI AP as an opportunity to foster diversity within professional roles; b) OECI AP as a possibility for change; c) perceived barriers; and d) OECI AP-solicited expectations. Conclusions The accreditation process is an opportunity for improving the quality and variety of care services for cancer patients through promoting an interdisciplinary approach to care provision. Perceiving accreditation as an opportunity is a prerequisite for overcoming the barriers that professionals involved in the process may report. Critical to a positive change is sharing the values and the framework, which are at the basis of accreditation programs. Improving the information-sharing process among managers and professionals may limit the risk of unmet expectations and prevent demotivation by future accreditation programs. Finally, we found that positive changes are more likely to happen when an accreditation process is considered an activity whose results depend on managers’ and professionals’ joint work.
Collapse
Affiliation(s)
- Elisa Mazzini
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Francesco Soncini
- Istituto Ortopedico Rizzoli - IRCCS, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Loredana Cerullo
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Lucia Genovese
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Giovanni Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Luca Ghirotto
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Giorgio Mazzi
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Massimo Costantini
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy.
| |
Collapse
|
7
|
Sun P, Li J, Fang W, Su X, Yu B, Wang Y, Li C, Chen H, Wang X, Zhang B, Li Y, Momin M, Shi Y, Wang H, Zhang Y, Xiang D, Huo Y. Effectiveness of chest pain centre accreditation on the management of acute coronary syndrome: a retrospective study using a national database. BMJ Qual Saf 2020; 30:867-875. [PMID: 33443197 DOI: 10.1136/bmjqs-2020-011491] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Large-scale real-world data to evaluate the impact of chest pain centre (CPC) accreditation on acute coronary syndrome (ACS) emergency care in heavy-burden developing countries like China are rare. METHODS This study is a retrospective study based on data from the Hospital Quality Monitoring System (HQMS) database. This study included emergency patients admitted with ACS to hospitals that uploaded clinical data continuously to the database from 2013 to 2016. Propensity score matching was used to compare hospitals with and without CPC accreditation during this period. A longitudinal self-contrast comparison design with mixed-effects models was used to compare management of ACS before and after accreditation. RESULTS A total of 798 008 patients with ACS from 746 hospitals were included in the analysis. After matching admission date, hospital levels and types and adjusting for possible covariates, patients with ACS admitted to accredited CPCs had lower in-hospital mortality (OR=0.70, 95% CI 0.53 to 0.93), shorter length of stay (LOS; adjusted multiplicative effect=0.89, 95% CI 0.84 to 0.94) and more percutaneous coronary intervention (PCI) procedures (OR=3.53, 95% CI 2.20 to 5.66) than patients admitted in hospitals without applying for CPC accreditation. Furthermore, when compared with the 'before accreditation' group only in accredited CPCs, the in-hospital mortality and LOS decreased and the usage of PCI were increased in both 'accreditation' (for in-hospital mortality: OR=0.86, 95% CI 0.79 to 0.93; for LOS: 0.94, 95% CI 0.93 to 0.95; for PCI: OR=1.22, 95% CI 1.18 to 1.26) and 'after accreditation' groups (for in-hospital mortality: OR=0.90, 95% CI 0.84 to 0.97; for LOS: 0.89, 95% CI 0.89 to 0.90; for PCI: OR=1.36, 95% CI 1.33 to 1.39). The significant benefits of decreased in-hospital mortality, reduced LOS and increased PCI usage were also observed for patients with acute myocardial infarction. CONCLUSIONS CPC accreditation is associated with better management and in-hospital clinical outcomes of patients with ACS. CPC establishment and accreditation should be promoted and implemented in countries with high levels of ACS.
Collapse
Affiliation(s)
- Pengfei Sun
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Weiyi Fang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital Xiamen university, Xiamen, Fujian, China
| | - Chunjie Li
- Emergency Department, Tianjin Chest Hospital, Tianjin, China
| | - Hu Chen
- Corporate Ethics Department, Bureau of Medical Administration National Health Commission of the People's Republic of China, Beijing, China
| | - Xingang Wang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bin Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yuxi Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Mohetaboer Momin
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Ying Shi
- China Standard Medical Information Research Center, Shenzhen, Guangdong, China
| | - Haibo Wang
- Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Dingcheng Xiang
- Department of Cardiology, General Hospital of Southern Theatre Command of PLA, Guangzhou, Guangdong, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| |
Collapse
|
8
|
Abstract
BACKGROUND Adherence to guidelines for the initial treatment of ST-Segment Elevation Myocardial Infarction has been thoroughly studied, whereas the study of emergency department (ED) adherence to guidelines for Non-ST-Segment Elevation Myocardial Infarction-Acute Coronary Syndrome (NSTEMI-ACS) has been much scarcer. The recommended guidelines for the initial prompt workup and treatment of NSTEMI-ACS remains a challenge. AIM We studied adherence to guidelines for NSTEMI in the ED. METHODS A single-center, retrospective study of consecutive patients with NSTEMI admitted to a tertiary hospital and discharged alive between March 2013 and March 2014. ED records were manually reviewed for adherence to prespecified parameters. Cases with sudden death, shock, or type-II NSTEMI were excluded. Canadian Triage and Acuity Scale score system was used for triage in the ED. RESULTS Adherence rates were 33.3%/24.6% of 240 patients for ECG/troponin obtained within 10/60 minutes receptively and 31.3% for anticoagulation within 15 minutes from diagnosis of ACS. Females were less likely to undergo electrocardiography (P = 0.009) or troponin-level tests within the specified timeframe (P = 0.043). Many cardiovascular risk markers were missed. Global Registry of Acute Coronary Events score was not used to risk stratify patients. CONCLUSIONS Prompt identification and early medical treatment of NSTEMI in the ED is lacking. Better computerized medical history assembly, attention to typical and atypical clinical presentation, and the employment of an appropriate cardiologic risk stratification method may unblind the treating teams at the point of care and improve adherence to NSTEMI guidelines.
Collapse
|
9
|
Devkaran S, O’Farrell PN, Ellahham S, Arcangel R. Impact of repeated hospital accreditation surveys on quality and reliability, an 8-year interrupted time series analysis. BMJ Open 2019; 9:e024514. [PMID: 30772852 PMCID: PMC6398692 DOI: 10.1136/bmjopen-2018-024514] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate whether hospital re-accreditation improves quality, patient safety and reliability over three accreditation cycles by testing the accreditation life cycle model on quality measures. DESIGN The validity of the life cycle model was tested by calibrating interrupted time series (ITS) regression equations for 27 quality measures. The change in the variation of quality over the three accreditation cycles was evaluated using the Levene's test. SETTING A 650-bed tertiary academic hospital in Abu Dhabi, UAE. PARTICIPANTS Each month (over 96 months), a simple random sample of 10% of patient records was selected and audited resulting in a total of 388 800 observations from 14 500 records. INTERVENTIONS The impact of hospital accreditation on the 27 quality measures was observed for 96 months, 1-year preaccreditation (2007) and 3 years postaccreditation for each of the three accreditation cycles (2008, 2011 and 2014). MAIN OUTCOME MEASURES The life cycle model was evaluated by aggregating the data for 27 quality measures to produce a composite score (YC) and to fit an ITS regression equation to the unweighted monthly mean of the series. RESULTS The results provide some evidence for the validity of the four phases of the life cycle namely, the initiation phase, the presurvey phase, the postaccreditation slump and the stagnation phase. Furthermore, the life cycle model explains 87% of the variation in quality compliance measures (R2=0.87). The best-fit ITS model contains two significant variables (β1 and β3) (p≤0.001). The Levene's test (p≤0.05) demonstrated a significant reduction in variation of the quality measures (YC) with subsequent accreditation cycles. CONCLUSION The study demonstrates that accreditation has the capacity to sustain improvements over the accreditation cycle. The significant reduction in the variation of the quality measures (YC) with subsequent accreditation cycles indicates that accreditation supports the goal of high reliability.
Collapse
Affiliation(s)
- Subashnie Devkaran
- Quality and Patient Safety Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Patrick N O’Farrell
- Emeritus Professor of Economics, Edinburgh Business School, Heriot-Watt University, Edinburgh, UK
| | - Samer Ellahham
- Quality and Patient Safety Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Randy Arcangel
- Statistical Society-Central Luzon State University, Luzon, The Philippines
| |
Collapse
|
10
|
Bogh SB, Falstie-Jensen AM, Hollnagel E, Holst R, Braithwaite J, Raben DC, Johnsen SP. Predictors of the effectiveness of accreditation on hospital performance: A nationwide stepped-wedge study. Int J Qual Health Care 2018; 29:477-483. [PMID: 28482059 DOI: 10.1093/intqhc/mzx052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To identify predictors of the effectiveness of hospital accreditation on process performance measures. Design A multi-level, longitudinal, stepped-wedge, nationwide study. Participants All patients admitted for acute stroke, heart failure, ulcers, diabetes, breast cancer and lung cancer at Danish hospitals. Intervention The Danish Healthcare Quality Programme that was designed to create a framework for continuous quality improvement. Main outcome Measure(s) Changes in week-by-week trends of hospitals' process performance measures during the study period of 269 weeks prior to, during and post-accreditations. Process performance measures were based on 43 different processes of care obtained from national clinical quality registries. Analyses were stratified according to condition, type of care (i.e. treatment, diagnostics, secondary prevention and patient monitoring) and hospital characteristics (i.e. university affiliation, location, size, experience with accreditation and accreditation compliance). Results A total of 1 624 518 processes of care were included. The impact of accreditation differed across the conditions. During accreditation, heart failure and breast cancer showed less improvement than other disease areas. Across all conditions, diagnostic processes improved less rapidly than other types of processes. However, after stratifying the data by hospital characteristics, process performance measures improved more uniformly. In respect of the measures that had an unsatisfactory level of quality, the processes related to diabetes, diagnostics and patient monitoring all responded to accreditation and showed an increased improvement during the preparatory work. Conclusion Hospital characteristics were not found to be predictors for the effects of accreditation, whereas conditions and types of care to some extent predicted the effectiveness.
Collapse
Affiliation(s)
- Søren Bie Bogh
- Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, Odense C DK-5000, Denmark.,Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark
| | - Anne Mette Falstie-Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark
| | - Erik Hollnagel
- Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, Odense C DK-5000, Denmark.,Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark
| | - René Holst
- Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Australia
| | - Ditte Caroline Raben
- Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, Odense C DK-5000, Denmark.,Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark
| |
Collapse
|
11
|
Falstie-Jensen AM, Bogh SB, Hollnagel E, Johnsen SP. Compliance with accreditation and recommended hospital care—a Danish nationwide population-based study. Int J Qual Health Care 2017; 29:625-633. [DOI: 10.1093/intqhc/mzx104] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/01/2017] [Indexed: 11/14/2022] Open
|
12
|
Engel J, Damen NL, van der Wulp I, de Bruijne MC, Wagner C. Adherence to Cardiac Practice Guidelines in the Management of Non-ST-Elevation Acute Coronary Syndromes: A Systematic Literature Review. Curr Cardiol Rev 2017; 13:3-27. [PMID: 27142050 PMCID: PMC5324326 DOI: 10.2174/1573403x12666160504100025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the management of non-ST-elevation acute coronary syndrome (NSTACS) a gap between guideline-recommended care and actual practice has been reported. A systematic overview of the actual extent of this gap, its potential impact on patient-outcomes, and influential factors is lacking. OBJECTIVE To examine the extent of guideline adherence, to study associations with the occurrence of adverse cardiac events, and to identify factors associated with guideline adherence. METHOD Systematic literature review, for which PUBMED, EMBASE, CINAHL, and the Cochrane library were searched until March 2016. Further, a manual search was performed using reference lists of included studies. Two reviewers independently performed quality-assessment and data extraction of the eligible studies. RESULTS Adherence rates varied widely within and between 45 eligible studies, ranging from less than 5.0 % to more than 95.0 % for recommendations on acute and discharge pharmacological treatment, 34.3 % - 93.0 % for risk stratification, and 16.0 % - 95.8 % for performing coronary angiography. Seven studies indicated that higher adherence rates were associated with lower mortality. Several patient-related (e.g. age, gender, co-morbidities) and organization-related (e.g. teaching hospital) factors influencing adherence were identified. CONCLUSION This review showed wide variation in guideline adherence, with a substantial proportion of NST-ACS patients possibly not receiving guideline-recommended care. Consequently, lower adherence might be associated with a higher risk for poor prognosis. Future research should further investigate the complex nature of guideline adherence in NST-ACS, its impact on clinical care, and factors influencing adherence. This knowledge is essential to optimize clinical management of NSTACS patients and could guide future quality improvement initiatives.
Collapse
Affiliation(s)
- Josien Engel
- EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center. Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
13
|
Musallam E, Johantgen M, Connerney I. Hospital Disease-Specific Care Certification Programs and Quality of Care: A Narrative Review. Jt Comm J Qual Patient Saf 2017; 42:364-8. [PMID: 27456418 DOI: 10.1016/s1553-7250(16)42051-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Disease-specific care certification (DSCC) programs have been developed to improve the quality and performance of programs or services that may be based within or associated with a hospital or other health care organization. A comprehensive summary of evidence for DSCC programs and their reported effect on the quality of care was prepared in a narrative review, the first of its kind on this topic. METHODS A systematic search was performed to identify articles that reported about DSCC. Any article that reported DSCC and certifications, published between 2003 and August 2015 (with an update in March 2016), and conducted in the United States was included. Databases searched included PubMed, MEDLINE, and CINAHL. RESULTS The articles were reviewed in terms of four topics: early development of DSCC, the journey toward DSCC, the relationship between DSCC and organizing process of care, and the relationship between DSCC and outcomes of care. Fifteen articles noted a positive relationship between DSCC programs and quality of care, only 6 of which reported empirical data. Therefore, a systematic review and meta-analysis were not warranted. Only 3 articles involved use of sophisticated statistical modeling with adequate control variables to investigate the effect of DSCC, which makes it difficult to conclude that the change in hospitals' or patients' outcomes were related to the certification. CONCLUSIONS The majority (13) of the articles focused on Joint Commission DSCC, with the remaining assessing Society of Cardiovascular Patient Care "accreditation" (certification). Only two studies, each study using a cross-sectional design, that empirically examined the relationship between DSCC and outcomes of care-mortality of care and readmission. More research studies are needed to evaluate the effectiveness of DSCC programs in improving outcomes of care, particularly patient-centered outcome measures, such as patient satisfaction and self-care.
Collapse
Affiliation(s)
- Eyad Musallam
- Center for Health Outcomes Research, School of Nursing, University of Maryland, Baltimore, USA
| | | | | |
Collapse
|
14
|
Undurraga EA, Nica V, Zhang R, Mensah IC, Godoy RA. Individual health and the visibility of village economic inequality: Longitudinal evidence from native Amazonians in Bolivia. ECONOMICS AND HUMAN BIOLOGY 2016; 23:18-26. [PMID: 27398876 PMCID: PMC5136506 DOI: 10.1016/j.ehb.2016.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 06/06/2023]
Abstract
Mounting evidence suggests that income inequality is associated with worse individual health. But does the visibility of inequality matter? Using data from a horticultural-foraging society of native Amazonians in Bolivia (Tsimane'), we examined whether village inequality in resources and behaviors with greater cultural visibility is more likely to bear a negative association with health than village inequality in less conspicuous resources. We draw on a nine-year annual panel (2002-2010) from 13 Tsimane' villages for our main analysis, and an additional survey to gauge the cultural visibility of resources. We measured inequality using the Gini coefficient. We tested the robustness of our results using a shorter two-year annual panel (2008-2009) in another 40 Tsimane' villages and an additional measure of inequality (coefficient of variation, CV). Behaviors with low cultural visibility (e.g., household farm area planted with staples) were less likely to be associated with individual health, compared to more conspicuous behaviors (e.g., expenditures in durable goods, consumption of domesticated animals). We find some evidence that property rights and access to resources matter, with inequality of privately-owned resources showing a larger effect on health. More inequality was associated with improved perceived health - maybe due to improved health prospects from increasing wealth - and worse anthropometric indicators. For example, a unit increase in the Gini coefficient of expenditures in durable goods was associated with 0.24 fewer episodes of stress and a six percentage-point lower probability of reporting illness. A one-point increase in the CV of village inequality in meat consumption was associated with a 4 and 3 percentage-point lower probability of reporting illness and being in bed due to illness, and a 0.05 SD decrease in age-sex standardized arm-muscle area. In small-scale, rural societies at the periphery of market economies, nominal economic inequality in resources bore an association with individual health, but did not necessarily harm perceived health. Economic inequalities in small-scale societies apparently matter, but a thick cultural tapestry of reciprocity norms and kinship ties makes their effects less predictable than in industrial societies.
Collapse
Affiliation(s)
- Eduardo A Undurraga
- Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA 02454-9110, USA; Center for Intercultural and Indigenous Research, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Santiago, RM 7820436, Chile.
| | - Veronica Nica
- Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA 02454-9110, USA.
| | - Rebecca Zhang
- Federal Reserve Board, 20th Street and Constitution Avenue NW, Washington, DC 20551, USA.
| | - Irene C Mensah
- UNDP, 01 BP506 lot 111, Zone Residentielle, Cotonou, Benin.
| | - Ricardo A Godoy
- Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA 02454-9110, USA.
| |
Collapse
|
15
|
Kilsdonk M, Siesling S, Otter R, Harten WV. Evaluating the impact of accreditation and external peer review. Int J Health Care Qual Assur 2015; 28:757-77. [DOI: 10.1108/ijhcqa-05-2014-0055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Accreditation and external peer review play important roles in assessing and improving healthcare quality worldwide. Evidence on the impact on the quality of care remains indecisive because of programme features and methodological research challenges. The purpose of this paper is to create a general methodological research framework to design future studies in this field.
Design/methodology/approach
– A literature search on effects of external peer review and accreditation was conducted using PubMed/Medline, Embase and Web of Science. Three researchers independently screened the studies. Only original research papers that studied the impact on the quality of care were included. Studies were evaluated by their objectives and outcomes, study size and analysis entity (hospitals vs patients), theoretical framework, focus of the studied programme, heterogeneity of the study population and presence of a control group.
Findings
– After careful selection 50 articles were included out of an initial 2,025 retrieved references. Analysis showed a wide variation in methodological characteristics. Most studies are performed cross-sectionally and results are not linked to the programme by a theoretical framework.
Originality/value
– Based on the methodological characteristics of previous studies the authors propose a general research framework. This framework is intended to support the design of future research to evaluate the effects of accreditation and external peer review on the quality of care.
Collapse
|
16
|
Bogh SB, Falstie-Jensen AM, Bartels P, Hollnagel E, Johnsen SP. Accreditation and improvement in process quality of care: a nationwide study. Int J Qual Health Care 2015; 27:336-43. [PMID: 26239473 DOI: 10.1093/intqhc/mzv053] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To examine whether performance measures improve more in accredited hospitals than in non-accredited hospital. DESIGN AND SETTING A historical follow-up study was performed using process of care data from all public Danish hospitals in order to examine the development over time in performance measures according to participation in accreditation programs. PARTICIPANTS All patients admitted for acute stroke, heart failure or ulcer at Danish hospitals. INTERVENTION Hospital accreditation by either The Joint Commission International or The Health Quality Service. MEASUREMENTS The primary outcome was a change in opportunity-based composite score and the secondary outcome was a change in all-or-none scores, both measures were based on the individual processes of care. These processes included seven processes related to stroke, six processes to heart failure, four to bleeding ulcer and four to perforated ulcer. RESULTS A total of 27 273 patients were included. The overall opportunity-based composite score improved for both non-accredited and accredited hospitals (13.7% [95% CI 10.6; 16.8] and 9.9% [95% 5.4; 14.4], respectively), but the improvements were significantly higher for non-accredited hospitals (absolute difference: 3.8% [95% 0.8; 8.3]). No significant differences were found at disease level. The overall all-or-none score increased significantly for non-accredited hospitals, but not for accredited hospitals. The absolute difference between improvements in the all-or-none score at non-accredited and accredited hospitals was not significant (3.2% [95% -3.6:9.9]). CONCLUSIONS Participating in accreditation was not associated with larger improvement in performance measures for acute stroke, heart failure or ulcer.
Collapse
Affiliation(s)
- Søren Bie Bogh
- Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3, Odense C DK-5000, Denmark Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark
| | - Anne Mette Falstie-Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark
| | - Paul Bartels
- The Danish Clinical Registries, Olof Palmes Allé 15, Aarhus N DK-8200, Denmark
| | - Erik Hollnagel
- Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3, Odense C DK-5000, Denmark Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark
| |
Collapse
|
17
|
Metting A, Binz D, Colbert CY, Song J, Chiles C, Mirkes C. Comparison of documentation and evidence-based medicine use for non-ST-segment elevation myocardial infarction among cardiology, teaching, and nonteaching teams. Proc (Bayl Univ Med Cent) 2015; 28:312-6. [PMID: 26130875 DOI: 10.1080/08998280.2015.11929259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Non-ST-segment elevation myocardial infarctions (NSTEMI) are common and cause significant morbidity and mortality. Following evidence-based medicine (EBM) guidelines is one way to ensure that these patients are cared for appropriately. This pilot study examined data from patients with NSTEMI to assess both documentation quality and use of EBM across multiple teams. Medical records were reviewed for significant differences in documentation quality in areas including history and physical exam, treatment, and inpatient mortality. While total documentation quality and mortality were not significantly different between groups, cardiology teams adhered to evidence-based recommendations more often than other teams.
Collapse
Affiliation(s)
- Austin Metting
- Scott & White Healthcare and Texas A&M Health Science Center College of Medicine. Dr. Binz is currently with the University of Oklahoma Health Sciences Center, Tulsa, Oklahoma; Dr. Colbert is currently with the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; and Dr. Song is currently with MD Anderson Cancer Center, Houston, Texas
| | - Daniel Binz
- Scott & White Healthcare and Texas A&M Health Science Center College of Medicine. Dr. Binz is currently with the University of Oklahoma Health Sciences Center, Tulsa, Oklahoma; Dr. Colbert is currently with the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; and Dr. Song is currently with MD Anderson Cancer Center, Houston, Texas
| | - Colleen Y Colbert
- Scott & White Healthcare and Texas A&M Health Science Center College of Medicine. Dr. Binz is currently with the University of Oklahoma Health Sciences Center, Tulsa, Oklahoma; Dr. Colbert is currently with the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; and Dr. Song is currently with MD Anderson Cancer Center, Houston, Texas
| | - Juhee Song
- Scott & White Healthcare and Texas A&M Health Science Center College of Medicine. Dr. Binz is currently with the University of Oklahoma Health Sciences Center, Tulsa, Oklahoma; Dr. Colbert is currently with the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; and Dr. Song is currently with MD Anderson Cancer Center, Houston, Texas
| | - Chris Chiles
- Scott & White Healthcare and Texas A&M Health Science Center College of Medicine. Dr. Binz is currently with the University of Oklahoma Health Sciences Center, Tulsa, Oklahoma; Dr. Colbert is currently with the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; and Dr. Song is currently with MD Anderson Cancer Center, Houston, Texas
| | - Curtis Mirkes
- Scott & White Healthcare and Texas A&M Health Science Center College of Medicine. Dr. Binz is currently with the University of Oklahoma Health Sciences Center, Tulsa, Oklahoma; Dr. Colbert is currently with the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; and Dr. Song is currently with MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
18
|
Falstie-Jensen AM, Larsson H, Hollnagel E, Norgaard M, Svendsen MLO, Johnsen SP. Compliance with hospital accreditation and patient mortality: a Danish nationwide population-based study. Int J Qual Health Care 2015; 27:165-74. [DOI: 10.1093/intqhc/mzv023] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 01/15/2023] Open
|
19
|
Devkaran S, O'Farrell PN. The impact of hospital accreditation on quality measures: an interrupted time series analysis. BMC Health Serv Res 2015; 15:137. [PMID: 25889013 PMCID: PMC4421919 DOI: 10.1186/s12913-015-0784-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/11/2015] [Indexed: 01/19/2023] Open
Abstract
Background Developing countries frequently use hospital accreditation to guarantee quality and patient safety. However, implementation of accreditation standards is demanding on organisations. Furthermore, the empirical literature on the benefits of accreditation is sparse and this is the first empirical interrupted time series analysis designed to examine the impact of healthcare accreditation on hospital quality measures. Methods The study was conducted in a 150-bed multispecialty hospital in Abu Dhabi, United Arab Emirates. The quality performance outcomes were observed over a 48 month period. The quality performance differences were compared across monthly intervals between two time segments, 1 year pre- accreditation (2009) and 3 years post-accreditation (2010, 2011 and 2012) for the twenty-seven quality measures. The principal data source was a random sample of 12,000 patient records drawn from a population of 50,000 during the study period (January 2009 to December 2012). Each month (during the study period), a simple random sample of 24 percent of patient records was selected and audited, resulting in 324,000 observations. The measures (structure, process and outcome) are related to important dimensions of quality and patient safety. Results The study findings showed that preparation for the accreditation survey results in significant improvement as 74% of the measures had a significant positive pre-accreditation slope. Accreditation had a larger significant negative effect (48% of measures) than a positive effect (4%) on the post accreditation slope of performance. Similarly, accreditation had a larger significant negative change in level (26%) than a positive change in level (7%) after the accreditation survey. Moreover, accreditation had no significant impact on 11 out of the 27 measures. However, there is residual benefit from accreditation three years later with performance maintained at approximately 90%, which is 20 percentage points higher than the baseline level in 2009. Conclusions Although there is a transient drop in performance immediately after the survey, this study shows that the improvement achieved from accreditation is maintained during the three year accreditation cycle.
Collapse
Affiliation(s)
- Subashnie Devkaran
- Cleveland Clinic Abu Dhabi, P.O. Box 112412, Abu Dhabi, United Arab Emirates.
| | - Patrick N O'Farrell
- Edinburgh Business School, Heriot-Watt University, Riccarton, Edinburgh, EH14 4AS, UK.
| |
Collapse
|
20
|
Assessment of adherence to ACC/AHA guidelines in primary management of patients with NSTEMI in a referral cardiology hospital. Crit Pathw Cardiol 2015; 14:36-8. [PMID: 25679086 DOI: 10.1097/hpc.0000000000000040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute coronary syndromes are considered as a global major health-care problem, and Iran as a developing country is of no exception. We aimed to investigate the degree of adherence to American College of Cardiology and American Heart Association (ACC/AHA) guideline for the management of non-ST-segment elevation myocardial infarction (NSTEMI) in patients who presented to the emergency department at Tehran Heart Center. Data of the patients who presented with acute chest pain to the emergency department of Tehran Heart Center within 1 year and were diagnosed as NSTEMI by the cardiologist in charge were included. The details of the initial managements based on the ACC/AHA guideline for NSTEMI of the patients were recorded from the patients' files in the emergency department for this study. Then, the frequency of guideline-related management in the study population was calculated and reported. A total of 684 patients [mean age = 62.95 ± 12.19 years; male gender = 460 (67.3%)] were diagnosed as NSTEMI at the emergency department of our center. Initial management based on the current guideline including administration of aspirin and clopidogrel was performed in 98.4% and 95.0%, respectively. Intravenous heparin was administered in 67.0% of the patients, whereas 30.8% of patients received enoxaparin. Following the initial management, coronary angiography was performed in 563 (82.3%) patients within 48 hours from the admission. Adherence to ACC/AHA guideline for the management of NSTEMI in patients who presented to a tertiary health-care center was in a high degree.
Collapse
|
21
|
Devkaran S, O'Farrell PN. The impact of hospital accreditation on clinical documentation compliance: a life cycle explanation using interrupted time series analysis. BMJ Open 2014; 4:e005240. [PMID: 25095876 PMCID: PMC4127940 DOI: 10.1136/bmjopen-2014-005240] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To evaluate whether accredited hospitals maintain quality and patient safety standards over the accreditation cycle by testing a life cycle explanation of accreditation on quality measures. Four distinct phases of the accreditation life cycle were defined based on the Joint Commission International process. Predictions concerning the time series trend of compliance during each phase were specified and tested. DESIGN Interrupted time series (ITS) regression analysis of 23 quality and accreditation compliance measures. SETTING A 150-bed multispecialty hospital in Abu Dhabi, UAE. PARTICIPANTS Each month (over 48 months) a simple random sample of 24% of patient records was audited, resulting in 276,000 observations collected from 12,000 patient records, drawn from a population of 50,000. INTERVENTIONS The impact of hospital accreditation on the 23 quality measures was observed for 48 months, 1 year preaccreditation (2009) and 3-year postaccreditation (2010-2012). MAIN OUTCOME MEASURES The Life Cycle Model was evaluated by aggregating the data for 23 quality measures to produce a composite score (YC) and fitting an ITS regression equation to the unweighted monthly mean of the series. RESULTS The four phases of the life cycle are as follows: the initiation phase, the presurvey phase, the postaccreditation slump phase and the stagnation phase. The Life Cycle Model explains 87% of the variation in quality compliance measures (R(2)=0.87). The ITS model not only contains three significant variables (β1, β2 and β3) (p≤0.001), but also the size of the coefficients indicates that the effects of these variables are substantial (β1=2.19, β2=-3.95 (95% CI -6.39 to -1.51) and β3=-2.16 (95% CI -2.52 to -1.80). CONCLUSIONS Although there was a reduction in compliance immediately after the accreditation survey, the lack of subsequent fading in quality performance should be a reassurance to researchers, managers, clinicians and accreditors.
Collapse
Affiliation(s)
| | - Patrick N O'Farrell
- Department of Economics, Edinburgh Business School, Heriot-Watt University, Edinburgh, UK
| |
Collapse
|
22
|
Steinberg BA, Beckley PD, Deering TF, Clark CL, Amin AN, Bauer KA, Cryer B, Mansour M, Scheiman JM, Zenati MA, Newby LK, Peacock WF, Bhatt DL. Evaluation and management of the atrial fibrillation patient: a report from the Society of Cardiovascular Patient Care. Crit Pathw Cardiol 2014; 12:107-15. [PMID: 23892939 DOI: 10.1097/hpc.0b013e31829834ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac dysrhythmia, and its prevalence is growing. The care of patients with AF is complex and involves multiple specialties and venues of care. Guideline recommendations are available for AF therapy; however, their implementation can be challenging. The Society of Cardiovascular Patient Care has developed an accreditation program, formulated by an expert committee on AF. Accreditation is based on specific criteria in 7 domains: (1) community outreach, (2) prehospital care, (3) early stabilization, (4) acute care, (5) transitions of care, (6) clinical quality measures, and (7) governance. This document presents the rationale, discussion, and supporting evidence for these criteria, in an effort to maximize effective and efficient AF care.
Collapse
|
23
|
Will JC, Valderrama AL, Yoon PW. Preventable hospitalizations and emergency department visits for angina, United States, 1995-2010. Prev Chronic Dis 2013; 10:E126. [PMID: 23886045 PMCID: PMC3725848 DOI: 10.5888/pcd10.120322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Preventable hospitalizations for angina have been decreasing since the late 1980s - most likely because of changes in guidance, physician coding practices, and reimbursement. We asked whether this national decline has continued and whether preventable emergency department visits for angina show a similar decline. METHODS We used National Hospital Discharge Survey data from 1995 through 2010 and National Hospital Ambulatory Medical Care Survey data from 1995 through 2009 to study preventable hospitalizations and emergency department visits, respectively. We calculated both crude and standardized rates for these visits according to technical specifications published by the Agency for Healthcare Research and Quality, which uses population estimates from the US Census Bureau as the denominator for the rates. RESULTS Crude hospitalization rates for angina declined from 1995-1998 to 2007-2010 for men and women in all 3 age groups (18-44, 45-64, and ≥65) and age- and sex-standardized rates declined in a linear fashion (P = .02). Crude rates for preventable emergency department visits for angina declined for men and women aged 65 or older from 1995-1998 to 2007-2009. Age- and sex-standardized rates for these visits showed a linear decline (P = .05). CONCLUSION We extend previous research by showing that preventable hospitalization rates for angina have continued to decline beyond the time studied previously. We also show that emergency department visits for the same condition have also declined during the past 15 years. Although these declines are probably due to changes in diagnostic practices in the hospitals and emergency departments, more studies are needed to fully understand the reasons behind this phenomenon.
Collapse
Affiliation(s)
- Julie C Will
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | | | | |
Collapse
|
24
|
Hinchcliff R, Greenfield D, Moldovan M, Westbrook JI, Pawsey M, Mumford V, Braithwaite J. Narrative synthesis of health service accreditation literature. BMJ Qual Saf 2012; 21:979-91. [PMID: 23038406 DOI: 10.1136/bmjqs-2012-000852] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To systematically identify and synthesise health service accreditation literature. METHODS A systematic identification and narrative synthesis of health service accreditation literature published prior to 2012 were conducted. The search identified 122 empirical studies that examined either the processes or impacts of accreditation programmes. Study components were recorded, including: dates of publication; research settings; levels of study evidence and quality using established rating frameworks; and key results. A content analysis was conducted to determine the frequency of key themes and subthemes examined in the literature and identify knowledge-gaps requiring research attention. RESULTS The majority of studies (n=67) were published since 2006, occurred in the USA (n=60) and focused on acute care (n=79). Two thematic categories, that is, 'organisational impacts' and 'relationship to quality measures', were addressed 60 or more times in the literature. 'Financial impacts', 'consumer or patient satisfaction' and 'survey and surveyor issues' were each examined fewer than 15 times. The literature is limited in terms of the level of evidence and quality of studies, but highlights potential relationships among accreditation programmes, high quality organisational processes and safe clinical care. CONCLUSIONS Due to the limitations of the literature, it is not prudent to make strong claims about the effectiveness of health service accreditation. Nonetheless, several critical issues and knowledge-gaps were identified that may help stimulate and inform discussion among healthcare stakeholders. Ongoing effort is required to build upon the accreditation evidence-base by using high quality experimental study designs to examine the processes, effectiveness and financial value of accreditation programmes and their critical components in different healthcare domains.
Collapse
Affiliation(s)
- Reece Hinchcliff
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | | | | | | | | | | | | |
Collapse
|
25
|
Alkhenizan A, Shaw C. Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Ann Saudi Med 2011; 31:407-16. [PMID: 21808119 PMCID: PMC3156520 DOI: 10.4103/0256-4947.83204] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Accreditation is usually a voluntary program in which trained external peer reviewers evaluate a healthcare organization's compliance and compare it with pre-established performance standards. The aim of this study was to evaluate the impact of accreditation programs on the quality of healthcare services METHODS We did a systematic review of the literature to evaluate the impact of accreditation programs on the quality of healthcare services. Several databases were systematically searched, including Medline, Embase, Healthstar, and Cinhal. RESULTS Twenty-six studies evaluating the impact of accreditation were identified. The majority of the studies showed general accreditation for acute myocardial infarction (AMI), trauma, ambulatory surgical care, infection control and pain management; and subspecialty accreditation programs to significantly improve the process of care provided by healthcare services by improving the structure and organization of healthcare facilities. Several studies showed that general accreditation programs significantly improve clinical outcomes and the quality of care of these clinical conditions and showed a significant positive impact of subspecialty accreditation programs in improving clinical outcomes in different subspecialties, including sleep medicine, chest pain management and trauma management. CONCLUSIONS There is consistent evidence that shows that accreditation programs improve the process of care provided by healthcare services. There is considerable evidence to show that accreditation programs improve clinical outcomes of a wide spectrum of clinical conditions. Accreditation programs should be supported as a tool to improve the quality of healthcare services.
Collapse
|
26
|
Fonarow GC, Gregory T, Driskill M, Stewart MD, Beam C, Butler J, Jacobs AK, Meltzer NM, Peterson ED, Schwamm LH, Spertus JA, Yancy CW, Tomaselli GF, Sacco RL. Hospital certification for optimizing cardiovascular disease and stroke quality of care and outcomes. Circulation 2010; 122:2459-69. [PMID: 21098429 DOI: 10.1161/cir.0b013e3182011a81] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiovascular disease and stroke remain leading causes of mortality, disability, and rising healthcare expenditures in the United States. Although a number of organizations provide hospital accreditation, recognition, and certification programs, existing programs do not address cardiovascular disease and stroke care in a comprehensive way. Current evidence suggests mixed findings for correlation between accreditation, recognition, and certification programs and hospitals' actual quality of care and outcomes. This advisory discusses potential opportunities to develop and enhance hospital certification programs for cardiovascular disease and stroke. The American Heart Association/American Stroke Association is uniquely positioned as a patient-centered, respected, transparent healthcare organization to help drive improvements in care and outcomes for patients hospitalized with cardiovascular disease and stroke. As a part of its commitment to promoting high-quality, evidence-based care for cardiovascular and stroke patients, it is recommended that the American Heart Association/American Stroke Association explore hospital certification programs to develop truly meaningful programs to facilitate improvements in and recognition for cardiovascular disease and stroke quality of care and outcomes. Future strategies should standardize objective, unbiased assessments of hospital structural, process, and outcome performance while allowing flexibility as technology and methodology advances occur.
Collapse
|