The evidence base for US joint commission hospital accreditation standards: cross sectional study

Does Hospital Accreditation or Certification Impact Patient Outcomes? Findings From a Scoping Review for Healthcare Industry Leaders

OBJECTIVE

This scoping review describes findings from published literature, evaluates the association between hospital accreditation or certification and patient outcomes, and identifies gaps.

BACKGROUND

Healthcare accreditation and certification organizations set standards and evaluate whether the standards are met. Despite the extensive efforts of both parties to improve healthcare delivery, poor patient health outcomes still exist in the United States.

METHODS

A comprehensive search of published peer-reviewed literature in English, utilizing the databases OVID MEDLINE, EMBASE, and CINAHL, addressing hospital accreditation or certification and patient outcomes, was conducted.

RESULTS

There was inconclusive evidence to support a relationship between hospital accreditation and outcomes in US hospitals, except for bariatric accreditation and stroke specialty certification studies for mortality and length of stay. The heterogeneous reporting of measures made it difficult to draw meaningful conclusions.

CONCLUSION

Understanding the extent to which accreditation is associated with patient outcomes is required. Future research is needed to establish scientific connections between hospital accreditations or certifications and patient outcomes.

Results of the process of implementation of ISO 7101 subclause 8.10.5 Health literacy in specialty consultations

OBJECTIVE

This quasi-experimental, non-randomized study described the process of implementing ISO 7101 subclause 8.10.5 Health literacy in specialty consultations, then determined the effects of implementation on patient general health literacy scores and perceptions of quality of care.

METHOD

Implementation steps were outlined, nurses were trained and used a standardized health literacy checklist with patients. The HLS19-Q12 was used to calculate patients' general health literacy scores pre- and post-implementation of subclause 8.10.5. Paired samples t-test and Wilcoxon signed-rank test determined relationships between implementation, health literacy score, and quality of care perceived.

RESULTS

Mean general health literacy scores increased post-implementation from 66.35 to 76.29, as did the mean score of perception of quality of care received (M=3.87 to M=3.99). Wilcoxon test for both variables was significant (P<.001), and effect size was large (d≥0.8).

CONCLUSIONS

Implementation of ISO 7101, subclause 8.10.5 Health literacy had a positive, statistically significant impact on patient general health literacy scores and perceptions of quality of care. This is valuable information for healthcare management decision makers as they implement new standards and seek to improve patient health outcomes.

A Primer on Private Equity Ownership in ABA

The applied behavior analysis (ABA) service industry is currently estimated to be worth at least $4 billion. As a result of potential profits that can be made from ABA services, for-profit organizations have become more common in the field. One type of for-profit organization that has become especially prominent in the ABA service industry is private equity (PE)-owned ABA companies. As PE ownership has become more common in ABA and other human service industries, concerns about PE ownership have grown across disciplines. The current article focuses specifically on PE's involvement in ABA services. The definition of PE and its fundamental components are discussed, along with their potential benefits and risks. The potential impacts of PE and opportunities for future research are also discussed.

Exploration of Norepinephrine Dose-Capping Practices: Report From an International, Interprofessional Survey of Critical Care Clinicians

Purpose: The Joint Commission standards for titrated infusions require specification of maximum rates of infusion. This practice has led to the development of protocolized maximum doses that can be overridden by provider order ("soft maximums") and to dose caps that cannot be superseded ("hard maximums"). The purpose of this study was to determine the prevalence of and attitudes towards dose capping of norepinephrine. Methods: A 20-item cross-sectional survey assessing norepinephrine dose capping practices, perceptions of norepinephrine protocols, and respondent and practice site demographics was distributed electronically to the mailing list of an international medical podcast. Responses were stratified according to use of weight-based dosing (WBD) or non-WBD of norepinephrine. The primary objective was to characterize norepinephrine dosing practices including protocolized maximum doses and/or dose capping. Categorical and continuous variables were compared using the Chi-square test and Mann-Whitney U test, respectively, with P < .05 indicating statistical significance. Results: The survey was completed by 586 physicians, nurses, pharmacists, and advanced practice providers. WBD was used by 51% and non-WBD by 47%. A standardized titration protocol was reported by 65% and dose capping was reported by 19%. The protocolized maximum dose ranged from 20-400 mcg/min for respondents using non-WBD (median [interquartile range] 30 [30-50]) and ranged from .2-10 mcg/kg/min for respondents using WBD (1 [.5-3]). The dose cap was 50 (40-123) mcg/min with non-WBD and 2 (1-3) mcg/kg/min with WBD. Conclusions: An international, multi-professional survey of critical care and emergency medicine clinicians revealed wide variability in norepinephrine dosing practices including maximum doses allowed.

Teaching Hospital Governance Model for Service Quality Performance: Case Study of Indonesian Central General Hospital

This study aims to investigate the effect of teaching hospital management practices on the quality performance of health services by involving elements such as hospital accreditation standards, quality management, and JCI Academic Hospital-specific standards that are indirectly connected. This study chose a survey-based quantitative approach to clinical professional students in vertical teaching hospitals under the direct management of the Ministry of Health of the Republic of Indonesia. Six proposed hypotheses were tested by Partial Least Square-Structural Equation Modeling (PLS-SEM) analysis. The test results showed a positive influence between hospital teaching governance and hospital accreditation compliance, quality assurance and JCI Academic Hospital standards. Third, compliance with teaching hospital standards was also found to have a significant positive effect on the performance of teaching hospital service quality. Understanding the role of governance in encouraging the performance of teaching hospital service quality can help develop effective managerial strategies in achieving complete service quality for patients and clinical profession participants. This research resulted in contributions to existing practices and literature as governance modeling in dual quality standards charged to teaching hospitals.