Association between hospital accrediting agencies and hospital outcomes of care in the United States

Abstract

Background: Hospital accreditation standards function as the structure to which hospitals must meet to receive reimbursement. There are four independent hospital accrediting organizations in the United States: The Joint Commission, Det Norske Veritas Healthcare (DNV), the Center for Improvement in Healthcare Quality (CIHQ), and the Healthcare Facilities Accreditation Program (HFAP). Methods: A cross-sectional analysis was completed to examine (I) differences in disease-specific 30-day mortality, and various Hospital Acquired Infection (HAI) rates across hospitals accredited by different agencies, and (II) whether one or more of the agencies are associated with any of these outcomes, after controlling for hospital structure characteristics. Results are anticipated to provide invaluable information to hospital decision makers about accreditation agency choices and quality of care. Hospital demographic data was consolidated from the 2018 American Hospital Association (AHA) database and Center for Medicare and Medicaid Services (CMS)’s Hospital Compare database for analysis. Results: According to post-hoc comparisons with Tukey HSD, the mean chronic obstructive pulmonary disease (COPD) and heart failure (HF) mortality differ in a statistically significant way between hospitals accredited by the Joint Commission and DNV, and Joint Commission and HFAP respectively. All other 30-day mortality and HAI outcomes were not found to be different across the three accrediting agencies. After controlling for several hospital structure variables, only the DNV-accreditation status was found to be associated with an increase to the 30-day COPD mortality (b=0.225, P<0.01). No agency was associated with the 30-day HF mortality or the central line-associated bloodstream infection (CLABSI) infection rates. Conclusions: As the healthcare industry looks to reduce costs and improve outcomes, accreditation agencies must play an important role. As CMS, and leaders continue to evaluate and implement policies to improve efficacy, hospital accreditation agencies will need to revisit their focus and the processes they influence in hospitals. The healthcare industry should evaluate the current Conditions of Participation (CoP) and processes to better align the accreditation process with improving patient outcomes.