Moffett ML, Bohara A.

Eastern Economic Journal, 31(4), 629-647.

2005

Hospital

Hospital (HAP)

Not applicable

No

To analyze the system of hospital quality regulation in the United States, as minimal attention as been paid to the mechanisms of hospital quality oversight that are currently in place.

Observational Study

Samples on the count of in-hospital deaths per calendar quarter were drawn from 453 hospitals between the years 1995 through 1997. The source for the data was the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample (NIS) [AHRQ HCUP NIS]. The complete NIS sample is yearly observations on six to seven million individual admissions in 900 to 1,000 hospitals that form a 20% sample of the inpatient stays in the U.S. A sample of 5,409 observations was extracted for patients who were classified under medical diagnosis category (MDC) 1, and 5,401 observations for MDC 4 patients.

Joint Commission surveys provide an incentive to hospitals to improve processes of care for the period leading up to an inspection and that incentive gets eliminated after the inspection occurs. Time before/after inspection captures the preparation by hospitals for the Joint Commission inspection team. As an inspection is approaching, hospitals become more compliant with standards. While there is a benefit to hospital compliance in preparation of a survey, the benefit begins to diminish after the survey is over. Hospitals are motivated to prepare heavily for the full survey to minimize the cost of a follow-up inspection. It is likely that the Joint Commission change to the unannounced survey may reduce the preparedness of hospitals so that the expense is to fix performance areas that are identified by the full inspection.

1995-1997

accreditation, hospitals, surveys

Positive