title: Can we simplify the hospital accreditation process? Predicting accreditation decisions from a reduced dataset of focus priority standards and quality indicators: results of predictive modelling.
abstract: OBJECTIVE
  Accreditation in France relies on a mandatory 4-year cycle of self-assessment and a peer review of 82 standards, among which 14 focus priority standards (FPS). Hospitals are also required to measure yearly quality indicators (QIs-5 in 2010). On advice given by the accreditation committee of HAS (Haute Autorité en Santé), based on surveyors proposals and relying mostly on compliance to standards, accreditation decisions are taken by the board of HAS. Accreditation is still perceived by hospitals as a burdensome process and a simplification would be welcomed. The hypothesis was that a more limited number of criteria might give sufficient amount of information on hospitals overall quality level, appraised today by accreditation decisions.
  
  
  METHODS
  The accuracy of predictions of accreditation decisions given by a model, Partial Least Square-2 Discriminant Analysis (PLS2-DA), using only the results of FPS and QIs was measured. Accreditation decisions (full accreditation (A), recommendations or reservation (B), remit decision or non-accreditation (C)), results of FPS and QIs were considered qualitative variables. Stability was assessed by leave one out cross validation (LOOCV).
  
  
  METHODS
  All French 489 acute care organisations (ACO) accredited between June 2010 and January 2012 were considered, 304 of them having a rehabilitation care sector (RCS).
  
  
  RESULTS
  Accuracy of prediction of accreditation decisions was good (89% of ACOs and 91% of ACO-RCS well classified). Stability of results appeared satisfactory when using LOOCV (87% of ACOs and 89% of ACO-RCS well classified). Identification of worse hospitals was correct (90% of ACOs and 97% of ACO-RCS predicted C were actually C).
  
  
  CONCLUSIONS
  Using PLS2-DA with a limited number of criteria (QIs and FPS) provides an accurate prediction of accreditation decisions, especially for underperforming hospitals. This could support accreditation committees which give advices on accreditation decisions, and allow fast-track handling of 'safe' reports.
authors.affiliation: Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Guérin
authors.forename: Marie-Annick
authors.initials: MA
authors.lastname: Le Pogam
authors.forename: Benjamin
authors.initials: B
authors.lastname: Robillard
authors.forename: Marc
authors.initials: M
authors.lastname: Le Vaillant
authors.forename: Bruno
authors.initials: B
authors.lastname: Lucet
authors.forename: Christine
authors.initials: C
authors.lastname: Gardel
authors.forename: Catherine
authors.initials: C
authors.lastname: Grenier
authors.forename: Philippe
authors.initials: P
authors.lastname: Loirat