Compliance with hospital accreditation and patient mortality: a Danish nationwide population-based study.
OBJECTIVE
To examine the association between compliance with hospital accreditation and 30-day mortality.


METHODS
A nationwide population-based, follow-up study with data from national, public registries.


METHODS
Public, non-psychiatric Danish hospitals.


METHODS
In-patients diagnosed with one of the 80 primary diagnoses.


METHODS
Accreditation by the first version of The Danish Healthcare Quality Programme for hospitals from 2010 to 2012. Compliance were assessed by surveyors on an on-site survey and awarded the hospital as a whole; fully (n = 11) or partially accredited (n = 20). A follow-up activity was requested for partially accredited hospitals; submitting additional documentation (n = 11) or by having a return-visit (n = 9).


METHODS
All-cause mortality within 30-days after admission. Multivariable logistic regression was used to compute odds ratios (ORs) for 30-day mortality adjusted for six confounding factors and for cluster effect at hospital level.


RESULTS
A total of 276 980 in-patients were identified. Thirty-day mortality risk for in-patients at fully (n = 76 518) and partially accredited hospitals (n = 200 462) was 4.14% (95% confidence interval (CI):4.00-4.28) and 4.28% (95% CI: 4.20-4.37), respectively. In-patients at fully accredited hospitals had a lower risk of dying within 30-days after admission than in-patients at partially accredited hospitals (adjusted OR of 0.83; 95% CI: 0.72-0.96). A lower risk of 30-day mortality was observed among in-patients at partially accredited hospitals required to submit additional documentation compared with in-patients at partially accredited hospitals requiring a return-visit (adjusted OR 0.83; 95% CI: 0.67-1.02).


CONCLUSIONS
Admissions at fully accredited hospitals were associated with a lower 30-day mortality risk than admissions at partially accredited hospitals.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Anne Mette
AM
Falstie-Jensen
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Heidi
H
Larsson
Center for Quality, Region of Southern Denmark, P.V. Tuxensvej 5, Middelfart 5500, Denmark.
Erik
E
Hollnagel
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Mette
M
Nørgaard
Datamangement, Central Denmark Region, Olof Palmes Allé 13, Aarhus N 8200, Denmark.
Marie Louise Overgaard
ML
Svendsen
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Søren Paaske
SP
Johnsen
D000068:Accreditation / Q000592:standards / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006779:Hospitals, Public / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012308:Risk Management
certification/accreditation of hospitals; external quality assessment; measurement of quality; patient outcomes (health status, quality of life, mortality)