Managing to improve quality: the relationship between accreditation standards, safety practices, and patient outcomes.
ABSTRACT 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.
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ABSTRACT: Objectives: To explore Australian General Practice Accreditation Limited (AGPAL) surveyors' perceptions of the impact of accreditation on patient safety and to elicit suggestions for improving patient safety in Australian general practices. Design, setting and participants: We conducted semi-structured telephone interviews with a purposive national sample of 10 AGPAL surveyors from 2 July to 14 December 2012. All interviews were audio recorded, transcribed and summarised. Results: All participants agreed that accreditation has improved general practices' performance in quality and safety. Participants noted specific areas that need further attention, including sufficient evidence for clinical risk management, which half the participants estimated occurs in about 5%-10% of Australian general practices. Tangible evidence of patient safety activities included having a significant incidents register, providing documentation of near misses, slips, lapses or mistakes, and engaging in regular clinical meetings to discuss incidents and how to avoid them in the future. Participants agreed that the accreditation process could be improved through the inclusion of tighter clinical safety indicators and the requirement of verifiable evidence of a working clinical risk management system. Conclusions: Accreditation has had a positive role in improving quality and safety in general practice. The inclusion of tighter indicators that require verifiable evidence will be a step forward. The Australian Primary Care Collaboratives (APCC) Program has an opportunity to build on its previous success in general practice quality improvement to further enhance patient safety in general practice.The Medical journal of Australia 07/2014; 201(3):S56-9. DOI:10.5694/mja14.00198 · 3.79 Impact Factor
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ABSTRACT: /st>To identify and analyse research on the use of economic evaluation in health services accreditation. /st>Seven online health and economic databases, and key accreditation agency and health department websites were searched between June and December 2011. /st>The selection criteria were English language and published empirical research studies on the topic of economic evaluation of health service accreditation. No formal economic evaluation of health services accreditation has been carried out to date. Empirical data on costs and benefits were analysed in 6 and 15 studies, respectively.Data extractionMeta-analysis was unsuitable due to output variability. Attributes relating to STUDY DESIGN: scalability and independence of outcome data were collected. For the benefit studies, we also assessed the strength of claim that accreditation improved patient safety and quality, and sources of potential bias. /st>The incremental costs ranged from 0.2 to 1.7% of total costs averaged over the accreditation cycle. The benefit studies were inconclusive in terms of showing clear evidence that accreditation improves patient safety and quality of care. /st>The lack of formal economic appraisal makes it difficult to evaluate accreditation in comparison to other methods to improve patient safety and quality of care. The lack of a clear relationship between accreditation and the outcomes measured in the benefit studies makes it difficult to design and conduct such appraisals without a more robust and explicit understanding of the costs and benefits involved.International Journal for Quality in Health Care 08/2013; DOI:10.1093/intqhc/mzt059 · 1.58 Impact Factor