Is hospital accreditation associated with more recommended patient care? A before and after study on the Faroe Islands

Introduction:
Today, significant resources are spent on accreditation in over 70 countries. Yet the
documentation of the effects of accreditation on processes and outcomes of healthcare is
still scarce. Thus, robust empirical studies are needed to justify the expense of time and
money.
Objectives:
To examine the delivery of recommended patient care before and after the first-time
hospital accreditation in the Faroe Islands.
Hypothesis:
Patients will receive more recommended patient care when treated in a hospital that has
undergone accreditation.
Methods:
We conducted a before and after study on the Faroe Islands in connection with introducing
accreditation in 2017. We compared the fulfillment of process performance measures
through audit of patient records. The recommended patient care was evaluated against 67
process performance measures reflecting the national clinical guidelines. Process
performance measures were calculated, as an opportunity-based composite score
(percentage adherence to process performance measures) and an all-or-none score (100%
adherence to process performance measures).
All three hospitals participated. A random sample of patients ≥18 years, with one of seven
clinical conditions (stroke/transient ischemic attack (TIA); bleeding ulcer; diabetes; chronic
obstructive pulmonary disease (COPD); child birth; congestive heart failure; hip fracture)
were included if they were in- or outpatients from 2012 to 2013 (before accreditation) or
2017 to 2018 (after accreditation).
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We calculated the relative risk, risk difference and percentage difference for receiving
recommended patient care using Poisson and linear regression, respectively. In all cases, we
used mixed effects analyses with a random intercept at patient and hospital level.
Results:
A total of 475 inpatients and 392 outpatients from the three Faroese hospitals participated.
The total opportunity-based composite score, including all clinical conditions, was slightly
higher after hospital accreditation (adjusted difference percentage risk (adj. diff. % risk),
4.4% [95% CI -0.7;9.6]) though the increase was not statistically significant. The probability
of receiving all recommended patient care was significantly higher after accreditation (total
all-or-none adjusted RR, 2.32 [95% CI 2.03;2.67]).
According to clinical conditions, patients with stroke/TIA (adj. diff. % risk, 17.6% [95% CI
9.7;25.4]), bleeding ulcer (adj. diff. % risk, 22.5% [95% CI 18.9;26.2]), COPD (adj. diff. % risk,
14.3% [95% CI 5.5;23.1]) and child birth (adj. diff. % risk, 27.9% [95% CI 24.8;31.0]) all
received significantly more recommended patient care after accreditation. In contrast
patients with diabetes (adj. diff. % risk, -4.3% [95% CI -6.2; -2.4]), hip fractures (adj. diff. %
risk, -5.9% [95% CI -8.7; -3.1]) and heart failure (adj. diff. % risk, -1.2% [95% CI -4.2;1.7])
received less recommend patient care, however the difference was not statistically
significant for heart failure.
Conclusion:
Hospitals were more likely to provide recommended patient care after undergoing
accreditation. However, the overall improvement of process performance measures was
modest. These findings provide support for the hypothesis that accreditation is associated
with better health care.