Background: Significant 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. Methods: We 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. Results: We 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). Conclusion: Hospitals were in general more likely to provide recommended care after first-time accreditation.
Bibliografisk noteFunding Information:
The authors would like to thank Pall Rasmussen and Jens Godik H?jen from the administration at the National Hospital in the Faroe Islands for providing the patient extracts and the processor agreements. We would also like to thank Biostatistician Hsuen Pei Ting at Australian Institute of Health Innovation, Macquarie University for statistical support. In addition, thanks to Sunnv? Hanusard?ttir Olsen, Olga Kristina Hansen, Elisabeth Fridleifsd?ttir Henriksen and Bj?rg Krett Hansen for completing the data collections.
This study was supported by Aase and Ejnar Danielsens Fund, Denmark [grant number 20–000044]. The Department of Anesthesiology, Gentofte Hospital, Denmark. The Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. The National Hospital in the Faroe Islands and The Graduate School of Health, Aarhus University, Denmark. The funding bodies have had no role in the design, data collection, analysis, interpretation of data or the writing of the manuscript.