title: Accreditation and improvement in process quality of care: a nationwide study.
abstract: OBJECTIVE
  To examine whether performance measures improve more in accredited hospitals than in non-accredited hospital.
  
  
  METHODS
  A historical follow-up study was performed using process of care data from all public Danish hospitals in order to examine the development over time in performance measures according to participation in accreditation programs.
  
  
  METHODS
  All patients admitted for acute stroke, heart failure or ulcer at Danish hospitals.
  
  
  METHODS
  Hospital accreditation by either The Joint Commission International or The Health Quality Service.
  
  
  METHODS
  The primary outcome was a change in opportunity-based composite score and the secondary outcome was a change in all-or-none scores, both measures were based on the individual processes of care. These processes included seven processes related to stroke, six processes to heart failure, four to bleeding ulcer and four to perforated ulcer.
  
  
  RESULTS
  A total of 27 273 patients were included. The overall opportunity-based composite score improved for both non-accredited and accredited hospitals (13.7% [95% CI 10.6; 16.8] and 9.9% [95% 5.4; 14.4], respectively), but the improvements were significantly higher for non-accredited hospitals (absolute difference: 3.8% [95% 0.8; 8.3]). No significant differences were found at disease level. The overall all-or-none score increased significantly for non-accredited hospitals, but not for accredited hospitals. The absolute difference between improvements in the all-or-none score at non-accredited and accredited hospitals was not significant (3.2% [95% -3.6:9.9]).
  
  
  CONCLUSIONS
  Participating in accreditation was not associated with larger improvement in performance measures for acute stroke, heart failure or ulcer.
authors.affiliation: Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3, Odense C DK-5000, Denmark Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark.
authors.forename: Søren Bie
authors.initials: SB
authors.lastname: Bogh
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark.
authors.forename: Anne Mette
authors.initials: AM
authors.lastname: Falstie-Jensen
authors.affiliation: The Danish Clinical Registries, Olof Palmes Allé 15, Aarhus N DK-8200, Denmark.
authors.forename: Paul
authors.initials: P
authors.lastname: Bartels
authors.affiliation: Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3, Odense C DK-5000, Denmark Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Hollnagel
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark.
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
mesh_terms: D000068:Accreditation / Q000706:statistics & numerical data*; D003718:Denmark; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000628:therapy; D006742:Hospital Bed Capacity; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D010437:Peptic Ulcer / Q000628:therapy; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012111:Residence Characteristics; D020521:Stroke / Q000628:therapy
keywords: accreditation; external evaluation; health care; hospitals; quality improvement; quality indicators