TY - JOUR
T1 - Improvement in quality of hospital care during accreditation
T2 - a nationwide stepped-wedge study
AU - Bogh, Søren Bie
AU - Falstie-Jensen, Anne Mette
AU - Hollnagel, Erik
AU - Holst, René
AU - Braithwaite, Jeffrey
AU - Johnsen, Søren Paaske
N1 - © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: [email protected].
PY - 2016/12
Y1 - 2016/12
N2 - OBJECTIVE: To assess changes over time in quality of hospital care in relation to the first accreditation cycle in Denmark.DESIGN, SETTING AND PARTICIPANTS: We performed a multi-level, longitudinal, stepped-wedge, nationwide study of process performance measures to evaluate the impact of a mandatory accreditation programme in all Danish public hospitals. Patient-level data (n = 1 624 518 processes of care) on stroke, heart failure, ulcer, diabetes, breast cancer and lung cancer care were obtained from national clinical quality registries.INTERVENTION: The Danish Healthcare Quality Programme was introduced in 2009, aiming to create a framework for continuous quality improvement.MAIN OUTCOME: Changes in week-by-week trends of hospital care during the study period of 269 weeks prior to, during and post-accreditation.RESULTS: The quality of hospital care improved over time throughout the study period. The overall positive change in trend odds ratio (OR) = 1.002 per week; 95% confidence interval (CI: 0.997-1.006) observed when comparing the period during accreditation with the period prior to accreditation was not significant. However, when restricting the analyses to processes of care where the performance did not meet target values for satisfactory quality prior to accreditation, we found a significant positive change in trend (OR = 1.006 per week; 95% CI: 1.001-1.011). When comparing the post-accreditation period with the period during accreditation, we found a significantly reduced trend (OR = 0.994 per week; 95% CI: 0.988-0.999), indicating the improvement in quality of care continued but at a lower rate than during accreditation.CONCLUSION: These findings support the hypothesis that hospital accreditation leads to improvements in patient care.
AB - OBJECTIVE: To assess changes over time in quality of hospital care in relation to the first accreditation cycle in Denmark.DESIGN, SETTING AND PARTICIPANTS: We performed a multi-level, longitudinal, stepped-wedge, nationwide study of process performance measures to evaluate the impact of a mandatory accreditation programme in all Danish public hospitals. Patient-level data (n = 1 624 518 processes of care) on stroke, heart failure, ulcer, diabetes, breast cancer and lung cancer care were obtained from national clinical quality registries.INTERVENTION: The Danish Healthcare Quality Programme was introduced in 2009, aiming to create a framework for continuous quality improvement.MAIN OUTCOME: Changes in week-by-week trends of hospital care during the study period of 269 weeks prior to, during and post-accreditation.RESULTS: The quality of hospital care improved over time throughout the study period. The overall positive change in trend odds ratio (OR) = 1.002 per week; 95% confidence interval (CI: 0.997-1.006) observed when comparing the period during accreditation with the period prior to accreditation was not significant. However, when restricting the analyses to processes of care where the performance did not meet target values for satisfactory quality prior to accreditation, we found a significant positive change in trend (OR = 1.006 per week; 95% CI: 1.001-1.011). When comparing the post-accreditation period with the period during accreditation, we found a significantly reduced trend (OR = 0.994 per week; 95% CI: 0.988-0.999), indicating the improvement in quality of care continued but at a lower rate than during accreditation.CONCLUSION: These findings support the hypothesis that hospital accreditation leads to improvements in patient care.
KW - patient safety
KW - standards of care
KW - segmented regression
KW - external evaluation
KW - quality of care
KW - stepped-wedge design
KW - accreditation
UR - http://www.scopus.com/inward/record.url?scp=85014469526&partnerID=8YFLogxK
U2 - 10.1093/intqhc/mzw099
DO - 10.1093/intqhc/mzw099
M3 - Article
C2 - 27578631
SN - 1353-4505
VL - 28
SP - 715
EP - 720
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
IS - 6
ER -