Research Shows Link Between Accreditation, Quality
New research published in the Journal of Hospital Medicine shows that hospitals accredited by The Joint Commission outperformed non-accredited hospitals on nationally standardized quality measures of acute myocardial infarction (AMI), heart failure and pneumonia, and that the performance gap between Joint Commission accredited and non-accredited hospitals increased over the years of the study. The study, Hospital Performance Trends on National Quality Measures (S.P. Schmaltz) is the first to show the association between accreditation status and performance improvement over a five-year reporting period.
Taking advantage of the alignment of Joint Commission and Centers for Medicare & Medicaid Services (CMS) quality measures, the researchers found that hospitals accredited by The Joint Commission had greater improvements in hospital performance from 2004 to 2008 than non-accredited hospitals, even though the former started with higher baseline performance levels. This accelerated improvement was broad-based: accredited hospitals were more likely to achieve superior performance (greater than 90 percent adherence to quality measures) in 2008 on 13 of 16 nationally standardized quality-of-care measures, three clinical area summary scores, and an overall score compared to hospitals that were not accredited.
Only 69 percent of hospitals that have never been accredited achieved an adjusted overall 2008 composite rate of greater than 90 percent adherence to quality measures compared to 84 percent for hospitals that have been continuously accredited by The Joint Commission. These results are consistent with other studies that have looked at both process and outcome measures and accreditation.
“This examination of two independent assessments of the quality of care provided by an organization—accreditation and publicly-reported quality measures— over time provides that link between accreditation and significantly better performance on important measures of health care quality,” says Jerod M. Loeb, Ph.D., executive vice president, Division of Healthcare Quality Evaluation, The Joint Commission, and an author of the study.
The other authors from The Joint Commission include lead author of the study Stephen Schmaltz, M.P.H., Ph.D., and co-authors Scott C. Williams, Psy.D., and Mark R. Chassin, M.D., FACP, M.P.P., MPH, president. An additional co-author is Robert M. Wachter, M.D., professor and associate chairman, Department of Medicine, University of California, San Francisco. They call for future research to examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance.
“This study validates that hospitals accredited by The Joint Commission are achieving their goal of continuously improving the quality of care they provide to their patients. By following these evidence-based care processes, hospitals will continue to improve the health outcomes their patients experience,” says Dr. Chassin. “Furthermore, the standardized measures in this study are among the accountability measures that Joint Commission-accredited hospitals will be required to meet a new performance improvement requirement for beginning in January 2012. And, this year for the first time our Annual Report recognized the top performers on these measures as well as children’s asthma and surgical care. This recognition is intended as an incentive for better performance on accountability measures and to support organizations in their quest to do better.”
The 16 measures used in this study of 3,891 hospitals address hospital compliance with evidence-based processes of care recommended by the clinical treatment guidelines of respected professional societies. U.S. hospitals have been collecting data since July 2002 on standardized measures of quality developed by The Joint Commission and CMS.