title: Effect of accreditation on the quality of chronic disease management: a comparative observational study.
abstract: BACKGROUND
  Practice accreditation is widely used to assess and improve quality of healthcare providers. Little is known about its effectiveness, particularly in primary care. In this study we examined the effect of accreditation on quality of care regarding diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD).
  
  
  METHODS
  A comparative observational study with two cohorts was performed. We included 138 Dutch family practices that participated in the national accreditation program for primary care. A first cohort of 69 practices was measured at start and completion of a 3-year accreditation program. A second cohort of 69 practices was included and measured simultaneously with the final measurement of the first cohort. In separate multilevel regression analyses, we compared both within-group changes in the first cohort and between-groups differences at follow-up (first cohort) and start (second cohort). Outcome measures consisted of 24 systematically developed indicators of quality of care in targeted chronic diseases.
  
  
  RESULTS
  In the within-group comparison, we found improvements on 6 indicators related to diabetes (feet examination, cholesterol measurement, lipid lowering medication prescription) and COPD (spirometry performance, stop smoking advice). In the between-groups comparison we found that first cohort practices performed better on 4 indicators related to diabetes (cholesterol outcome) and CVD (blood pressure outcome, smoke status registration, glucose measurement).
  
  
  CONCLUSIONS
  Improvements of the quality of primary care for patients with chronic diseases were found, but few could be attributed to the accreditation program. Further development of accreditation is needed to enhance its effectiveness on chronic disease management.
authors.forename: Arna L
authors.initials: AL
authors.lastname: van Doorn-Klomberg
authors.forename: Jozé C C
authors.initials: JC
authors.lastname: Braspenning
authors.forename: René J
authors.initials: RJ
authors.lastname: Wolters
authors.forename: Margriet
authors.initials: M
authors.lastname: Bouma
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000068:Accreditation / Q000706:statistics & numerical data*; D001786:Blood Glucose; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000628:therapy*; D002908:Chronic Disease; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D017719:Diabetic Foot / Q000175:diagnosis; D019468:Disease Management; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D055361:Multilevel Analysis; D009426:Netherlands; D010808:Physical Examination; D011320:Primary Health Care / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D058996:Quality Improvement; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012907:Smoking / Q000628:therapy; D013147:Spirometry / Q000706:statistics & numerical data
chemical_list: D001786:Blood Glucose; D000960:Hypolipidemic Agents