title: Is compliance with hospital accreditation associated with length of stay and acute readmission? A Danish nationwide population-based study.
abstract: OBJECTIVE
  To examine the association between compliance with hospital accreditation and length of stay (LOS) and acute readmission (AR).
  
  
  METHODS
  A nationwide population-based follow-up study from November 2009 to December 2012.
  
  
  METHODS
  Public, non-psychiatric Danish hospitals.
  
  
  METHODS
  In-patients admitted with one of 80 diagnoses.
  
  
  METHODS
  Accreditation by the first version of The Danish Healthcare Quality Programme. Using an on-site survey, surveyors assessed the level of compliance with the standards. The hospital was awarded either fully (n = 11) or partially accredited (n = 20).
  
  
  METHODS
  LOS including transfers between hospitals and all-cause AR within 30 days after discharge. The Cox Proportional Hazard regression was used to compute hazard ratios (HRs) adjusted for potential confounding factors and cluster effect at hospital level.
  
  
  RESULTS
  For analyses of LOS, 275 589 in-patients were included of whom 266 532 were discharged alive and included in the AR analyses. The mean LOS was 4.51 days (95% confidence interval (CI): 4.46-4.57) at fully and 4.54 days (95% CI: 4.50-4.57) at partially accredited hospitals, respectively. After adjusting for confounding factors, the adjusted HR for time to discharge was 1.07 (95% CI: 1.01-1.14). AR within 30 days after discharge was 13.70% (95% CI: 13.45-13.95) at fully and 12.72% (95% CI: 12.57-12.86) at partially accredited hospitals, respectively, corresponding to an adjusted HR of 1.01 (95% CI: 0.92-1.10).
  
  
  CONCLUSIONS
  Admissions at fully accredited hospitals were associated with a shorter LOS compared with admissions at partially accredited hospitals, although the difference was modest. No difference was observed in AR within 30 days after discharge.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark.
authors.forename: Anne Mette
authors.initials: AM
authors.lastname: Falstie-Jensen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Nørgaard
authors.affiliation: Center for Quality, Region of Southern Denmark, P.V. Tuxensvej 5, Middelfart 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 8200, Denmark.
authors.forename: Heidi
authors.initials: H
authors.lastname: Larsson
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark.
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
mesh_terms: D000068:Accreditation; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D016016:Proportional Hazards Models
keywords: certification/accreditation of hospitals; external quality assessment, readmissions; length of stay