Managing to improve quality: The relationship between accreditation standards, safety practices, and patient outcomes

School of Nursing, Duke University, Durham, North Carolina, USA.
Health care management review (Impact Factor: 1.3). 07/2009; 34(3):262-72. DOI: 10.1097/HMR.0b013e3181a16bce
Source: PubMed


Given the trend toward eliminating reimbursement for "never events," hospital administrators are challenged to implement practices designed to prevent their occurrence. Little evidence exists, however, that patient safety practices, as evaluated using accreditation criteria, are related to the achievement of patient safety outcomes.
The aim of this study was to examine the relationship between patient safety practices, as measured by accreditation standards, and patient safety outcomes as measured by hospital rates of infections, decubitus ulcers, postoperative respiratory failure, and failure to rescue.
Secondary data were used to examine relationships between patient-safety-related accreditation standards and patient outcomes in U.S. acute care hospitals. Accreditation performance areas were reduced into subscores to represent patient safety practices. Outcome rates were calculated using the Agency for Healthcare Research and Quality Patient Safety Indicator software. Multivariate regression was performed to determine the significance of the relationships.
Three of four multivariate models significantly explained variance in hospital patient safety indicator rates. Accreditation standards reflecting patient safety practices were related to some outcomes but not others. Rates of infections and decubitus ulcers occurred more frequently in hospitals with poorer performance in utilizing patient safety practices, but no differences were noted in rates of postoperative respiratory failure or failure to rescue.
Certain adverse events, such as infections and decubiti, may be reduced by preventive protocols that are reflected in accreditation standards, whereas other events, such as failure to rescue and postoperative respiratory failure, may require multifaceted strategies that are less easily translated into protocols. Our approach may have influenced the observed associations yet represents progress toward assessing whether safety practices, as measured by accreditation standards, are related to patient outcomes.

1 Follower
100 Reads
  • Source
    • "Other studies gave arguments for the impact of accreditation programmes such as the standardisation of processes and better guideline adherence but did not explicitly rely on a theoretical framework. Thornlow and Merwin (2009) refer to the Quality Health Outcomes Model to structure the relationships between system, intervention and outcomes (based on Donabedian's structure, process and outcomes model). System variables were hospital characteristics, intervention variables were defined as utilisation of patient safety practices and outcomes were defined by the Agency for Healthcare Research and Quality. "
    [Show abstract] [Hide abstract]
    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.
    International Journal of Health Care Quality Assurance 10/2015; 28(8):757-777. DOI:10.1108/IJHCQA-05-2014-0055
  • Source
    • "The study content was categorised according to the focus of the papers, that is, program, clinical or workplace issues. Program issues was the topic that most studies examined via four different program sub-topics: reviews of programs (n = 5) [18,20,28,29,31]; policy compliance (n = 4) [17,32-34]; program impacts (n = 3) [26,27,30]; and organisational environment (n = 1) [35]. Just five studies had content relating to clinical care [17,18,20,26,34] and one on staff workplace issues [35]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Healthcare accreditation standards are advocated as an important means of improving clinical practice and organisational performance. Standard development agencies have documented methodologies to promote open, transparent, inclusive development processes where standards are developed by members. They assert that their methodologies are effective and efficient at producing standards appropriate for the health industry. However, the evidence to support these claims requires scrutiny. The study’s purpose was to examine the empirical research that grounds the development methods and application of healthcare accreditation standards. Methods A multi-method strategy was employed over the period March 2010 to August 2011. Five academic health research databases (Medline, Psych INFO, Embase, Social work abstracts, and CINAHL) were interrogated, the websites of 36 agencies associated with the study topic were investigated, and a snowball search was undertaken. Search criteria included accreditation research studies, in English, addressing standards and their impact. Searching in stage 1 initially selected 9386 abstracts. In stage 2, this selection was refined against the inclusion criteria; empirical studies (n = 2111) were identified and refined to a selection of 140 papers with the exclusion of clinical or biomedical and commentary pieces. These were independently reviewed by two researchers and reduced to 13 articles that met the study criteria. Results The 13 articles were analysed according to four categories: overall findings; standards development; implementation issues; and impact of standards. Studies have only occurred in the acute care setting, predominately in 2003 (n = 5) and 2009 (n = 4), and in the United States (n = 8). A multidisciplinary focus (n = 9) and mixed method approach (n = 11) are common characteristics. Three interventional studies were identified, with the remaining 10 studies having research designs to investigate clinical or organisational impacts. No study directly examined standards development or other issues associated with their progression. Only one study noted implementation issues, identifying several enablers and barriers. Standards were reported to improve organisational efficiency and staff circumstances. However, the impact on clinical quality was mixed, with both improvements and a lack of measurable effects recorded. Conclusion Standards are ubiquitous within healthcare and are generally considered to be an important means by which to improve clinical practice and organisational performance. However, there is a lack of robust empirical evidence examining the development, writing, implementation and impacts of healthcare accreditation standards.
    BMC Health Services Research 09/2012; 12(1):329. DOI:10.1186/1472-6963-12-329 · 1.71 Impact Factor
  • Source
    • "Few studies have attempted to draw causal inferences about the direct influence of accreditation on patients' health outcomes, so further research is warranted. For this purpose, Donabedian's " structure-process-outcomes model " or the resultant Quality Health Outcomes Model (QHOM) could be particularly useful (Thornlow & Merwin, 2009). "
Show more