TY - JOUR
T1 - Accreditation and Clinical Outcomes
T2 - Shorter Length of Stay After First-Time Hospital Accreditation in the Faroe Islands
AU - Bergholt, Maria Daniella
AU - von Plessen, Christian
AU - Johnsen, Søren Paaske
AU - Hibbert, Peter
AU - Braithwaite, Jeffrey
AU - Brink Valentin, Jan
AU - Falstie-Jensen, Anne Mette
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
PY - 2022/4/15
Y1 - 2022/4/15
N2 - 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.
AB - 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.
KW - Accreditation
KW - Female
KW - Heart Failure
KW - Hospitalization
KW - Hospitals
KW - Humans
KW - Length of Stay
KW - Patient Readmission
KW - length of stay, readmissions, mortality
KW - before and after study, patient outcomes
KW - external quality assessment
KW - certification/accreditation of hospitals
UR - http://www.scopus.com/inward/record.url?scp=85128489323&partnerID=8YFLogxK
U2 - 10.1093/intqhc/mzac015
DO - 10.1093/intqhc/mzac015
M3 - Journal article
C2 - 35323967
SN - 1353-4505
VL - 34
SP - 1
EP - 9
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
IS - 2
M1 - mzac015
ER -