title: Improvement in quality of hospital care during accreditation: A nationwide stepped-wedge study.
abstract: OBJECTIVE
  To assess changes over time in quality of hospital care in relation to the first accreditation cycle in Denmark.
  
  
  METHODS
  We performed a multi-level, longitudinal, stepped-wedge, nationwide study of process performance measures to evaluate the impact of a mandatory accreditation programme in all Danish public hospitals. Patient-level data (n = 1 624 518 processes of care) on stroke, heart failure, ulcer, diabetes, breast cancer and lung cancer care were obtained from national clinical quality registries.
  
  
  METHODS
  The Danish Healthcare Quality Programme was introduced in 2009, aiming to create a framework for continuous quality improvement.
  
  
  RESULTS
  Changes in week-by-week trends of hospital care during the study period of 269 weeks prior to, during and post-accreditation.
  
  
  RESULTS
  The quality of hospital care improved over time throughout the study period. The overall positive change in trend odds ratio (OR) = 1.002 per week; 95% confidence interval (CI: 0.997-1.006) observed when comparing the period during accreditation with the period prior to accreditation was not significant. However, when restricting the analyses to processes of care where the performance did not meet target values for satisfactory quality prior to accreditation, we found a significant positive change in trend (OR = 1.006 per week; 95% CI: 1.001-1.011). When comparing the post-accreditation period with the period during accreditation, we found a significantly reduced trend (OR = 0.994 per week; 95% CI: 0.988-0.999), indicating the improvement in quality of care continued but at a lower rate than during accreditation.
  
  
  CONCLUSIONS
  These findings support the hypothesis that hospital accreditation leads to improvements in patient care.
authors: 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: Søren Bie
authors: SB
authors: Bogh
authors: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark.
authors: Anne Mette
authors: AM
authors: Falstie-Jensen
authors: 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: Erik
authors: E
authors: Hollnagel
authors: Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3, Odense C DK-5000, Denmark.
authors: René
authors: R
authors: Holst
authors: Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3, Odense C DK-5000, Denmark.|Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia.
authors: Jeffrey
authors: J
authors: Braithwaite
authors: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark.
authors: Søren Paaske
authors: SP
authors: Johnsen
mesh_terms: D000068:Accreditation / Q000706:statistics & numerical data*; D003718:Denmark; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D058996:Quality Improvement / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D059039:Standard of Care / Q000706:statistics & numerical data
keywords: accreditation; patient safety; quality of care; standards of care; stepped-wedge design, segmented regression, external evaluation