Consecutive cycles of accreditation and quality of in-hospital care: a Danish population-based study

BACKGROUND

Little is known about whether repeated cycles of hospital accreditation are a robust method to improve quality of care continuously.

OBJECTIVE

We aimed to examine the association between compliance with consecutive cycles of accreditation and quality of in-hospital care.

METHODS

We conducted a Danish nationwide population-based study including patients aged 18 years treated for acute stroke, chronic obstructive pulmonary disease, diabetes, heart failure or hip fracture at public, non-psychiatric hospitals. From 2012 to 2015, two cycles of national hospital accreditation were completed, resulting in 12 high and 14 low compliant hospitals (Low = partially accredited in both cycles). Our outcome measure was quality of in-hospital care measured by 39 process performance measures (PPMs), reflecting recommendations from the national clinical guidelines by adherence to (i) individual PPMs and (ii) the full bundle of PPMs (all-or-none). We computed adjusted odds ratios (ORs) using logistic regression based on robust standard error estimation for cluster sampling of data at hospital level.

RESULTS

In total, 78 387 patient pathways covering 508 816 processes were included, of which 47% had been delivered at high compliant hospitals and 53% at low compliant hospitals, respectively. Compliance with consecutive cycles was not associated with improved quality of in-hospital care (individual: OR = 0.92, 95% confidence interval (CI): 0.77-1.10; All-or-none: OR = 0.87, 95% CI: 0.66-1.15). However, in the second cycle alone, patients treated at partially accredited hospitals had a lower adherence than patients treated at fully accredited hospitals (Individual: OR = 0.84, 95% CI: 0.71-0.99; All-or-none: OR = 0.78, 95% CI: 0.59-1.03). The association was particularly strong among patients treated at partially accredited hospitals required to submit additional documentation.

CONCLUSION

Compliance with consecutive cycles of hospital accreditation in Denmark was not associated with improved quality of in-hospital care. However, compliance with the second cycle alone was associated with improved quality of in-hospital care.

High quality of care did not imply increased hospital spending- nationwide cohort study among hip fracture patients

OBJECTIVE

To examine whether fulfilment of process performance measures reflecting national guidelines is associated with in-hospital costs among hip fracture patients.

DESIGN

Nationwide, population-based follow-up study.

SETTING

Public hospitals in Denmark.

PARTICIPANTS

A total of 20 458 patients 65 years or older admitted with a hip fracture between 2010 and 2013.

INTERVENTION

Quality of care defined as fulfilment of process performance measures reflecting recommendations from national clinical guidelines, which previously have been shown to be associated with lower mortality and readmission risk. The measures included systematic pain assessment; mobilisation within 24 h post-operatively; assessment of basic mobility before admission and discharge; and receiving a rehabilitation programme before discharge, anti-osteoporotic medication and fall prevention.

MAIN OUTCOME MEASURES

Total costs defined as the sum of hospital costs used for treating the individual patients according to the Danish Reference Cost Database.

RESULTS

Within the index admission, fulfilling 50 to >75% of the performance measures was associated with lower adjusted costs (EUR 2643) than was fulfilling 0-50% of these measures (EUR 3544). The lower costs were mainly due to savings on further treatment and fewer bed days. Mobilisation within 24 h after surgery and assessment for need of anti-osteoporotic medication were associated with the largest cost differences, corresponding to adjusted cost differences of EUR 3030 and EUR 3538, respectively. The cost difference was lower when all costs related to hospitalisation within the first year were considered.

CONCLUSIONS

These findings indicate that high quality of care does not imply higher hospital spending and may be associated with cost savings.