The association between first-time accreditation and the delivery of recommended care: a before and after study in the Faroe Islands

BMC Health Services Research

Jeffrey Braithwaite¹  Peter Hibbert²  Jan Brink Valentin³  Søren Paaske Johnsen³  Anne Mette Falstie-Jensen⁴  Maria Daniella Bergholt⁵  Tóra Róin⁶  Gunnvá Guttesen⁷  Barbara Joensen Eysturoy⁸  Christian von Plessen⁹ 

[1] Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, 2109, Sydney, New South Wales, Australia;Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, 2109, Sydney, New South Wales, Australia;Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, GPO Box 2471, 5001, Adelaide, SA, Australia;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;Danish Clinical Registries (RKKP), Oluf Palmes Allé 15, DK-8200, Aarhus N, Denmark;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;Department of Quality Improvement and Patient Safety, National Hospital of the Faroe Islands, J.C Svabosgøta 41-49, 100, Tórshavn, Faroe Islands;Medical Centre, National Hospital of the Faroe Islands, J.C Svabosgøta 41-49, 100, Tórshavn, Faroe Islands;Surgical Centre, National Hospital of the Faroe Islands, J.C Svabosgøta 41-49, 100, Tórshavn, Faroe Islands;Unisanté, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland;Institute for Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark;

关键词: Accreditation;    Hospital;    Recommended care;    Before and after study;    Medical record audit;   

DOI  :  10.1186/s12913-021-06952-w

来源: Springer

【 摘 要 】

BackgroundSignificant resources are spent on hospital accreditation worldwide. However, documentation of the effects of accreditation on processes, quality of care and outcomes in healthcare remain scarce. This study aimed to examine changes in the delivery of patient care in accordance with clinical guidelines (recommended care) after first-time accreditation in a care setting not previously exposed to systematic quality improvement initiatives.MethodsWe conducted a before and after study based on medical record reviews in connection with introducing first-time accreditation. We included patients with stroke/transient ischemic attack, bleeding gastric ulcer, diabetes, chronic obstructive pulmonary disease (COPD), childbirth, heart failure and hip fracture treated at public, non-psychiatric Faroese hospitals during 2012–2013 (before accreditation) or 2017–2018 (after accreditation). The intervention was the implementation of a modified second version of The Danish Healthcare Quality Program (DDKM) from 2014 to 2016 including an on-site accreditation survey in the Faroese hospitals. Recommended care was assessed using 63 disease specific patient level process performance measures in seven clinical conditions. We calculated the fulfillment and changes in the opportunity-based composite score and the all-or-none score.ResultsWe included 867 patient pathways (536 before and 331 after). After accreditation, the total opportunity-based composite score was marginally higher though the change did not reach statistical significance (adjusted percentage point difference (%): 4.4%; 95% CI: − 0.7 to 9.6). At disease level, patients with stroke/transient ischemic attack, bleeding gastric ulcer, COPD and childbirth received a higher proportion of recommended care after accreditation. No difference was found for heart failure and diabetes. Hip fracture received less recommended care after accreditation. The total all-or-none score, which is the probability of a patient receiving all recommended care, was significantly higher after accreditation (adjusted relative risk (RR): 2.32; 95% CI: 2.03 to 2.67). The improvement was particularly strong for patients with COPD (RR: 16.22; 95% CI: 14.54 to 18.10).ConclusionHospitals were in general more likely to provide recommended care after first-time accreditation.

【 授权许可】

CC BY