title: Evaluating the impact of accreditation and external peer review.
abstract: OBJECTIVE
  Accreditation and external peer review play important roles in assessing and improving healthcare quality worldwide. Evidence on the impact on the quality of care remains indecisive because of programme features and methodological research challenges. The purpose of this paper is to create a general methodological research framework to design future studies in this field.
  
  
  METHODS
  A literature search on effects of external peer review and accreditation was conducted using PubMed/Medline, Embase and Web of Science. Three researchers independently screened the studies. Only original research papers that studied the impact on the quality of care were included. Studies were evaluated by their objectives and outcomes, study size and analysis entity (hospitals vs patients), theoretical framework, focus of the studied programme, heterogeneity of the study population and presence of a control group.
  
  
  RESULTS
  After careful selection 50 articles were included out of an initial 2,025 retrieved references. Analysis showed a wide variation in methodological characteristics. Most studies are performed cross-sectionally and results are not linked to the programme by a theoretical framework.
  
  
  CONCLUSIONS
  Based on the methodological characteristics of previous studies the authors propose a general research framework. This framework is intended to support the design of future research to evaluate the effects of accreditation and external peer review on the quality of care.
authors.affiliation: Comprehensive Cancer Centre the Netherlands, Utrecht, The Netherlands and School for Management and Governance, Department of Health Services Research, University of Twente, Enschede, The Netherlands.
authors.forename: Melvin
authors.initials: M
authors.lastname: Kilsdonk
authors.forename: Sabine
authors.initials: S
authors.lastname: Siesling
authors.forename: Renee
authors.initials: R
authors.lastname: Otter
authors.forename: Wim van
authors.initials: Wv
authors.lastname: Harten
mesh_terms: D000068:Accreditation / Q000379:methods*; D006801:Humans; D038622:Internationality; D010380:Peer Review / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000592:standards; D011787:Quality of Health Care / Q000592:standards*; D012107:Research Design / Q000592:standards*
keywords: Accreditation; Peer review; Quality assessment; Quality assurance; Quality healthcare; Quality improvement