Literature Search Report

Reilly, D., Shandilya, S., Streater, B., Aprile, B., & Aprile, J. M.

Cureus. 2024 Feb;16(2).

2024

Hospital

Hospital (HAP)

Not applicable

No

To investigate the impact of the implementation of JCAHO's recommendation of "a standardized approach to 'handoff' communications, including an opportunity to ask and respond to questions.

Uncontrolled Before-After Study

Prior to SAFETIPS (Stats, Assessment, Focused plan, Exam, To do, If/then, Pointers/pitfalls, Sick-o-meter), a clinical process curriculum for handovers, being implemented, residents at a mid-sized Pediatric program were observed giving handovers at various intervals to understand baseline habits. Residents were then educated with the SAFETIPS curriculum and again observed. Trained observers of the handover process completed a validated evaluation form concentrating on seven key domains necessary for effective handover and communication; residents involved in the handover also completed a validated evaluation form.

Mean values on all sections of the handover evaluation Likert scale completed by trained observers tended to increase over time; the variance in responses was likewise much smaller at later time periods. Similarly, all sections of the evaluation tools completed by the resident physicians themselves showed significantly increased scores from pre- to post-implementation of our curriculum. Data revealed a plateauing of results toward later time points suggestive of skills mastery and sustained improvements.

2016-2018

https://pubmed.ncbi.nlm.nih.gov/38435200/

undergraduate and graduate medical education, safety patient, quality improvement research, health, pediatrics communication, medical resident education

Positive

Schmaltz, S. P., Longo, B. A., & Williams, S. C.

The Joint Commission Journal on Quality and Patient Safety. 2024 Jun 1;50(6):425-34.

2024

Hospital

Hospital (HAP)

Not applicable

No

To evaluate the relationship between Joint Commission accreditation and health care–associated infections (HAIs) in long-term care hospitals (LTCHs).

Observational Study

This observational study used Centers for Medicare & Medicaid Services (CMS) LTCH data for the period 2017 to June 2021. The standardized infection ratio (SIR) of three measures used by the Centers for Disease Control and Prevention’s National Healthcare Safety Network were used as dependent variables in a random coefficient Poisson regression model (adjusting for CMS region, owner type, and bed size quartile): catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and central line–associated bloodstream infections (CLABSIs) for the periods 2017 to 2019 and July 1, 2020, to June 30, 2021. Data from January 1 to June 30, 2020, were excluded due to the COVID-19 pandemic. The study also organized the participating hospitals in categories of being overall ranked as worse than, no different than, or better than the national benchmark.

Compared to non–Joint Commission–accredited LTCHs, accredited LTCHs had significantly better (lower) SIRs for CLABSI and CAUTI measures, although no differences were observed for CDI SIRs. There were no significant differences in year trends for any of the HAI measures. For each year of the study period, a greater proportion of Joint Commission–accredited LTCHs performed significantly better than the national benchmark for all three measures (p = 0.04 for CAUTI, p = 0.02 for CDI, p = 0.01 for CLABSI).

2017-2021

https://pubmed.ncbi.nlm.nih.gov/38492986/

long term care hospital, infection control, HAIs

Positive

Chitavi, S. O., Patrianakos, J., Williams, S. C., Schmaltz, S. P., Ahmedani, B. K., Roaten, K., Boudreaux, E. D., & Brown, G. K.

The Joint Commission Journal on Quality and Patient Safety. 2024 Feb 23.

2024

Hospital

Hospital (HAP)

Not applicable

No

To determine the degree to which specific discharge and post-discharge suicide prevention practices have been implemented among Joint Commission–accredited hospitals in the United States and to understand challenges and barriers to implementation.

Cross-Sectional Study

This cross-sectional observational study explored the prevalence of suicide prevention activities among Joint Commission–accredited hospitals. A questionnaire was sent to 1,148 accredited hospitals with a 30.1% response rate (n=346). The authors calculated the percentage of hospitals reporting implementation of four recommended discharge practices for suicide prevention and their specified components.

The majority (n = 212 [61.3%]) of hospitals had implemented formal safety planning, but few of those (n = 41 [19.3%]) included all key components of safety planning. Approximately a third of hospitals provided a warm handoff to outpatient care (n = 128 [37.0%)] or made follow-up contact with patients (n = 105 [30.3%]), and approximately a quarter (n = 97 [28.0%]) developed a plan for lethal means safety. Very few (n = 14 [4.0%]) hospitals met full criteria for implementing recommended suicide prevention activities at time of discharge.

2022

https://pubmed.ncbi.nlm.nih.gov/38538500/

suicide prevention, hospital discharge, NPSG.15.01.01

Neutral

Ugwuowo, U. C., Meier, S. K., Franco, P. M., Noe, K. H., Dowdy, S. C., & Pollock, & B. D.

The Journal of Rural Health. 2024 May 1.

2024

Hospital

Hospital (HAP)

Not applicable

No

To assess longitudinal associations between COVID-19 census burdens and hospital characteristics, such as bed size and critical access status, and explore whether pandemic-era hospital quality benchmarking requires risk-adjustment or stratification for hospital-level characteristics.

Descriptive Study

The authors used hospital-level data from the US Department of Health and Human Services including weekly total hospital and COVID-19 censuses from August 2020 to August 2023 and the 2021 American Hospital Association survey. The authors calculated weekly percentages of total adult hospital beds containing COVID-19 patients. They then calculated the number of weeks each hospital spent at Extreme (≥20% of beds occupied by COVID-19 patients), High (10%–19%), Moderate (5%–9%), and Low (<5%) COVID-19 stress. The authors assessed longitudinal hospital-level COVID-19 stress, stratified by 15 hospital characteristics including joint commission accreditation, bed size, teaching status, critical access hospital status, and core-based statistical area (CBSA) rurality.

Among n = 2582 US hospitals, the median (IQR) weekly percentage of hospital capacity occupied by COVID-19 patients was 6.7%(3.6%–13.0%). 80,268/213,383 (38%) hospital-weeks experienced Low COVID-19 census stress, 28 Moderate stress, 22% High stress, and 12% Extreme stress. COVID-19 census burdens were similar across most hospital characteristics, but were significantly greater for critical access hospitals. Joint commission accreditation did not appear to be associated with differential COVID-19 census burdens.

2020-2023

https://pubmed.ncbi.nlm.nih.gov/38693658/#:~:text=COVID%2D19%20census%20burdens%20were,burdens%20across%20multiple%20institutional%20characteristics.

census, COVID-19, critical access hospital, quality, risk adjustment

Neutral

Ma C, Dutton HJ & Wu B

Home Health Care Serv Q. Jan- Mar;42(1):1-13.

2023

Home care

Home Care (OME)

Not applicable

No

To depict characteristics of home health agencies (HHAs) with and without accreditation and to examine the relationship between accreditation status and HHA performance on quality-of-care metrics.

Longitudinal Studies, Cohort Study

A longitudinal cohort study using five years (2015–2019) of data from two national sources in the US: the Centers for Medicare and Medicaid Services (CMS) Home Health Compare Program and Providers of Services file (POS) (Home Health Star Ratings. This study analyzed 7,697 agencies. A home health agency was included if it had 1) five years of data (2015–2019) for at least one of the three quality of care measures of interest in the Home Health Compare dataset, timely initiation of care, hospitalization rate, and emergency department visit rate; 2) complete information of accreditation status for each of the 5 years in the POS dataset; and 3) complete organizational characteristics at baseline year (2015) in the POS dataset. The unit of analysis was the home health agency. Descriptive analysis was performed to describe baseline characteristics of the HHAs, including accreditation status; differences in home health agency characteristics by accreditation status at baseline year, followed by a description of agencies’ changes in accreditation status over time. The quality-of-care measures (timely start of care rate, hospitalization rate, and ED visit rate) by accreditation status and other agency characteristics were also described. Graphs were used to visually present trends in quality of home health care over time by agency accreditation status. To understand the relationship of quality of care with agency accreditation status (Model 1) and changes in accreditation status (Model 2), the authors employed generalized linear regression when controlling for agency characteristics and considering clustering of repeated measures within each agency. All statistical analyses were performed using StataSE version 17.0 (StataCorp LP) with an established alpha level of .05.

The results showed: 1) agencies that were for-profit, urban, not-hospital-affiliated, single-branch, Medicare enrolled only, and without hospice program were more likely to have accreditation; and 2) overall, accredited agencies performed better on the three commonly used quality indicators, timely initiation of care, hospitalization, and emergency department visit.

2015-2019

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9901214/

home health; accreditation; hospitalization; patient outcomes; quality of care

Positive

Longo BA, Schmaltz SP, Barrett SC, Patrianakos J, Williams SC.

Jt Comm J Qual Patient Saf. 2023 Jun Jul;49(6-7):313-319.

2023

Home care

Home Care (OME)

No

To examine the association of Joint Commission accreditation on patients' experience of care by comparing HHCAHPS ratings from Joint Commission-accredited and non-Joint Commission-accredited home health agencies (HHAs).

Observational Study

This multiyear observational study used 2015–2019 HHCAHPS data obtained from the Centers for Medicare & Medicaid Services (CMS) website and Joint Commission databases. The data set included 1,454 (23.8%) Joint Commission–accredited and 4,643 (76.2%) non–Joint Commission–accredited HHAs. Dependent variables included three composite measures of care (Care of Patients, Provider-Patient Communications, and Specific Care Issues) and two global rating measures. Data were analyzed using a series of longitudinal random effects logistic regression models.

The results found no association between Joint Commission accreditation and the two global HHCAHPS measures, modest significant increases for Joint Commission–accredited HHAs in measure rates for the Care of Patients and Communication composite measures (p < 0.05), and a more significant increase for the Specific Care Issues composite measure related to medication safety and home safety (p < 0.001).

2015-2019

https://pubmed.ncbi.nlm.nih.gov/37210303/

home health; quality of care; accreditation; patient outcomes; hospitalization

Positive

Singh M, Hsu ES, Polychronopoulou E, Sharma G, Duarte AG

Chronic Obstr Pulm Dis. 2023 Jul 26;10(3):297-307. doi: 10.15326/jcopdf.2022.0366.

2023

Ambulatory clinic general

Ambulatory Health Care (AMB)

Disease-specific Care

No

To compare healthcare outcomes for care received by patients with COPD at Joint Commission accredited disease-specific and primary care clinics at an academic healthcare system.

Cohort Study

This study compared the impact of care received by patients with COPD at Joint Commission-accredited, disease-specific clinics and primary care clinics at an academic health care system from April 2014 to March 2018. Data was extracted from electronic health record (EHR) and patients diagnosed with COPD ≥ 40 years old with ≥ 2 outpatient visits 30 days apart starting 4/1/2014 were identified for the study cohorts. Excluded patients lacking a diagnosis of COPD, without two clinic visits that were > 30 days apart, that received concurrent care in disease-specific specialty and primary care clinics or received health care through the Texas Department of Criminal Justice. Demographics collected included, smoking status, comorbidities, supplemental oxygen prescriptions, primary care provider specialty and insurance status. Comorbidities included obstructive sleep apnea (OSA), congestive heart failure (CHF), coronary artery disease (CAD), diabetes, lung cancer, anxiety, depression, and respiratory failure. Demographics and clinical characteristics were summarized as frequency and percentage or mean ± standard deviation. Continuous variables were compared using t-tests while categorical variables were assessed using chi-square tests. The index date for each patient was determined as the time of the second clinic visit.

Of 4,646 unique patients with COPD, 1,114 were treated at disease-specific and 3,532 at primary care clinics. The entire group was predominantly female (58.8 %), non-Hispanic white (74.2 %) with mean age of 65.4 ± 11.4 years consisting of current (47.6 %) or former smokers (38.4 %). In the disease-specific group, performance measures were performed more frequently, and lower rates of ED visits (HR = 0.31, 95% CI 0.18-0.54) and hospitalizations (HR 0.41, 95% CI 0.21-0.79) noted compared to primary care group.

2014-2018

https://pubmed.ncbi.nlm.nih.gov/37450851/

COPD; Joint Commission; accreditation; chronic disease management; emergency department use; health care utilization; hospitalizations.

Positive

Zhang, H., Bittle, M. J., Chiu, H., Shi, L., & Huang, S. T.

Journal of Radiology and Clinical Imaging. 2023;6(3):138-45.

2023

Hospital

Hospital (HAP)

Not applicable

Yes

To assess the association between JCI accreditation and clinical, operational, and financial performance measures.

Interrupted Time Series

The multiple-group interrupted time series analysis (ITSA) was used to compare intervention Hospital A and comparison Hospital B in terms of eight performance measures based on monthly observations over eight years from January 2015 to December 2022. The clinical quality measures used were the C-section rate, perineal incision rate, the incidence of macrosomia, and the preterm birth rate. The operational performance indicators were the number of outpatient visits and the number of deliveries. The financial performance measures were revenue and earnings before interest, tax, depreciation & amortization (EBITDA). P value of <0.05 was used for statistical significance.

The regression analysis indicated that JCI accreditation is significantly associated with the C-section rate, the number of outpatient visits, the number of deliveries, and revenue. However, JCI accreditation had no statistically significant association with the other three clinical measures, namely, the perineal incision rate, incidence of macrosomia, and preterm birth rate. No evidence demonstrated that JCI accreditation is statistically associated with EBITDA.

2015-2022

https://fortuneonline.org/articles/the-impact-of-jci-accreditation-on-the-clinical-operational-and-financial-performance-of-chinese-private-hospitals.html

Joint Commission International; Impact of Accreditation; Chinese Private Hospitals; Interrupted Time Series Analysis

Positive

Sallam, M. & Hamdan, A.

Journal of Integrated Health. 2023;2(4):68-79.

2023

Hospital

Hospital (HAP)

Not applicable

Yes

To evaluate the impact of JCI surveys on medication safety practices at the Mediclinic Welcare Hospital (MWEL) located in Dubai, United Arab Emirates (UAE).

Cross-Sectional Study

A cross-sectional survey was used to collect data from healthcare providers (HCPs) at MWEL who had previously participated in at least one JCI survey. The study instrument included structured questions to assess HCPs experiences, perceptions, and recommendations regarding the impact of JCI surveys on various aspects of healthcare delivery, including medication safety practices. The final sample consisted of 176 HCPs.

The study findings consistently indicated a positive perception among HCPs regarding the impact of hospital accreditation on medication management and use safety culture, medication-related outcome measures, and overall efficiencies. Most respondents strongly agreed that repeated JCI surveys positively influenced medication safety practices and culture.

2023

https://www.researchgate.net/publication/374629463_Examining_the_Influence_of_Joint_Commission_International_JCI_Accreditation_Surveys_on_Medication_Safety_Practices_A_Cross-Sectional_Study_from_Mediclinic_Welcare_Hospital_in_Dubai_UAE

Healthcare accreditation, quality improvement, medication safety practices, patient safety measures, healthcare professionals perceptions

Positive

Arnetz J. E.

Jt Comm J Qual Patient Saf., 48(4), 241–245.

2022

Hospital, Critical access hospital

Hospital (HAP)

Not applicable

No

To provide a commentary on new standards implemented by TJC regarding workplace violence prevention. The article provides an overview of the scope/magnitude of the problem that workplace violence poses in healthcare, presents a brief history on attempts to address the problem, and describes how new Joint Commission standards will help to address the workplace violence.

Not a Study

N/A

The commentary notes that the new requirements underscore the fact that workplace violence is an organizational issue that necessitates a systems’ approach. The author states that ongoing data collection and analysis are key to violence prevention, and suggests that these standards can help hospitals to establish a strong culture of safety and violence prevention.

2022

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8816837/

joint commission, workplace violence, management

UTD

Gammon RR, Blanton K, Gilstad C, Hong H, Nichols T, Putnam H

Transfusion

2022

Hospital, Laboratory

Not applicable

Disease-specific Care

No

To develop a structured approach to guide patient blood management (PBM) programs through the PBM certification. Program challenges and metrics were reviewed.

Case Study

A team of subject matter experts in PBM formed a working group to develop a structured approach to guide PBM programs through the PBM certification and reviewed program challenges and metrics.

Initial steps to establishing PBM certification include a multidisciplinary working group and hospital administration buy-in. Development of policies and procedures individualized to the facility will standardize practice. An institutional transfusion committee can provide PBM oversight including enforcing compliance.

Using resources such as TJC (The Joint Commission) and AABB (American Association of Blood Banks) standards and tools including electronic medical records (EMR) can track and trend hospital PBM (Patient blood management) performance and identify improvement opportunities. A gap analysis tool helps implementation. Challenges might include maintaining a PBM program during a merger, slow responsiveness of information systems (IS) to requests, PBM education for both the Transfusion Safety Officer (TSO) and hospital staff with constant turnover.

Available metrics from one hospital system showed good compliance with transfusion thresholds (average all products: 97.9%, 2019, 2020). In 2020, through educational efforts the cost savings were $124,856.70 compared to 2019. Regarding single unit transfusion of RBCs, this was 62.25% (2019), 63.75% (2020), 72.00% (2021), and surpassed the target goal of 60%.

2019-2020

https://pubmed.ncbi.nlm.nih.gov/35616174/

patient blood management, certification, transfusion, hospital

Positive

Longo BA, Barrett SC, Schmaltz SP, Williams SC

Policy, Politics, & Nursing Practice

2022

Nursing home

Nursing Care Center (NCC)

Not applicable

No

To examine the affect of accreditation on COVID-19 rates in nursing homes.

Observational Study

COVID-19 case rates were obtained from the CDC’s NHSN Nursing Home COVID-19 Public Use File. The COVID-19 case rate data included in this dataset was self-reported in two phases, an initial submission phase, and a subsequent weekly submission of data. A Joint Commission dataset was utilized to identify accredited nursing homes in the states of IL, FL, and MA. These specific states were selected because a sufficient number of nursing homes within the state were accredited, and thus could be compared to nonaccredited facilities in the same states. Nursing homes were identified by their CMS Certification Number (CCN), classified as accredited or nonaccredited, then matched to the CMS Nursing Home Compare dataset. Community prevalence of COVID-19 was determined using county-level COVID-19 case data obtained from the New York Times GitHub site which maintains a daily count of COVID-19 cases reported by state and county health departments.

The strongest predictor of COVID-19, for both accredited and nonaccredited nursing homes, was the community prevalence of COVID-19. While the mean COVID-19 case rates among accredited and nonaccredited nursing homes were comparable after correcting for state and county case rates, the proportion of outliers differed. Greater variability in case rates was noted among nonaccredited nursing homes, despite the fact that relatively more nonaccredited nursing homes were located in counties with lower COVID-19 case rates.

2020

https://pubmed.ncbi.nlm.nih.gov/34873980/

accreditation, COVID-19, long-term care, nursing home, skilled nursing facilities

Mixed

Sin JH, Koirala HP, Phyo L and Meleis LA.

Jt Comm J Qual Patient Saf., 2022, ISSN

2022

Hospital, Laboratory

Hospital (HAP)

Not applicable

No

This article describes a Pharmacy Quality and Internal Audit Program to promote continuous survey readiness and sustained compliance with Joint Commission MM standards.

Case Study

A comprehensive MM (Medication management) audit was developed to assess for compliance in all inpatient, ambulatory, and procedural areas that use medications, with each area undergoing the internal auditing process at least twice per calendar year. The audit is performed by an MM subject matter expert from the Department of Pharmacy and incorporates electronic chart review, clinical staff interviews, and observations of area-specific medication practices. Notable findings and recommendations are communicated to area-specific leadership. Institution wide scorecards are compiled to track performance with MM standards, identify opportunities, and determine future focus areas to improve and sustain compliance.

Results revealed consistent compliance (≥ 90%) with a majority of MM standards. These included hazardous medication management, controlled substances compliance, look-alike/sound-alike drugs, medication storage/security, and labeling of medication syringes. Where compliance rates were initially lower, audits and subsequent interventions resulted in improved compliance rates from < 50% to ≥ 90% for awareness of high-alert medications and risk-reduction strategies, from < 60% to ≥ 80% for compliance with pill cutter standards, and from < 90% to ≥ 90% for therapeutic duplication of “as needed” orders.

2018-2020

https://pubmed.ncbi.nlm.nih.gov/35623966/

pharmacy, medication management standards, accreditation, audit program, continuous survey readiness

UTD

Tarieh RRA, Zayyat R, Naoufal RN, Samaha HR

Health Sci Rep. 2022 Jan 19;5(1):e497.

2022

Hospital, Laboratory

Laboratory (LAB)

Not applicable

Yes

To assess the impact of JCI standards implementation on staff motivation and productivity.

Case Study

This study aimed at assessing the impact of JCI standards implementation on staff productivity and motivation at the Clinical Laboratory and Blood bank. It was conducted in one of the largest hospitals in Beirut. Key performance indicators were used to assess staff productivity before JCI standards implementation and throughout the process of implementation and development. An employee engagement survey was distributed and considered different variables present among the staff, including age, educational background, and working experience.

Turn Around Time (TAT) of tests decreased by 3% after JCI standards implementation, which was reflected at two different laboratory sections. The trainings conducted throughout the process of standards implementation resulted in enhanced quality of samples demonstrated by decrease in percentage of rejected samples. JCI standards had no impact on staff retention. Involvement in management decisions increased retention.

2019-2020

https://pubmed.ncbi.nlm.nih.gov/35229051/

laboratory and blood Bank, motivation, productivity, quality management

Positive

Rogers M, Cousin-Peterson E, Barry T, Baker M, Kuo PC, Janjua HM

Surgery Open Science, Volume 7, 2022, Pages 12-17, ISSN 2589-8450

2022

Hospital

Hospital (HAP)

Not applicable

No

To identify critical elements of the care delivery environment, including hospital infrastructure and patient clinical profiles that contribute to 30-day unplanned readmission following CABG.

Observational Study

The Healthcare Cost and Utilization Project-State Inpatient Database, American Hospital Association Annual Health Survey Database, and Healthcare Information Management Systems Society data sets were merged to create a single data set of patient-and hospital-level data from 8 states. Isolated coronary artery bypass grafting procedures were queried for all-cause 30-day readmission, and backwards stepwise logistic regression was performed. Readmission rate was then used to categorize hospitals into quartiles, and analysis focused on the hospitals with the lowest (Q1) and highest (Q4) readmission rates. Univariate analysis was performed comparing Q1 and Q4 hospitals.

A total of 150,215 patients underwent isolated coronary artery bypass grafting with 23,244 (15.5%) readmitted patients among 903 hospitals. Model area under the curve was 0.709 (95% confidence interval, 0.702–0.716), with the top 3 readmission determinants related to discharge disposition. Compared to Q1, Q4 patients more often were female, were >70 years of age, and had Medicare as a primary payor (P < .001). Low re-admission rate hospitals were characterized by higher costs; not-for-profit status; having Joint Commission accreditation; and higher total admissions, operative volume, hospital/ICU beds, full-time physicians, nurses, and ancillary personnel (P < .001).

2009-2015

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8577072/

Coronary artery bypass, re-admission rates, patient factors, hospital factors

Positive

Longo, B. A., Schmaltz, S. P., & Williams, S. C.

Home Health Care Management & Practice.

2022

Home care

Home Care (OME)

Not applicable

No

This study sought to replicate a previous study by Williams et al. that compared the performance of TJC-accredited HHAs with non-TJC-accredited HHAs using CMS measure data from 2013 to 2015. This replication study was conducted to assess whether the impact of TJC-accreditation could still be observed after CMS modified measures and the star rating calculation methodology. It also provided the potential to empirically support the results of the original study thereby extending its generalizability.

Descriptive Study

Data from the CMS Home Health Compare website was downloaded representing home health organization performance data from 2016-2018. A general linear model, with accreditation, ownership type, year and year by accreditation interaction as fixed effects, was used to analyze the quality measures. From each measure model, least squares means estimates were used to compare rates of TJC-accredited organizations versus non–TJC-accredited organizations. For the analysis of the star ratings, the ratings were grouped into 3 categories (1, 1.5, 2, 2.5 stars; 3 and 3.5 stars; 4, 4.5 and 5 stars). To evaluate the relationship between accreditation and this grouped star rating category, a Cochran-Mantel-Haenszel (CMH) test was used to evaluate differences between accreditation status and grouped rating after controlling for year. A similar approach was taken to assess differences in the risk-adjusted outcome categories for the claims based measures ()"better than", "the same as" or "worse than" expected).

Compared to the original study, there was an increase in the proportion of accredited organizations. In the current study, 19.3% of organizations in the home health compare data set were accredited by TJC (versus 13.6% of organizations in the previous time period). Using the ownership designations in the HHC data set, TJC-accredited HHAs were less likely to be for-profit and more likely to be not-for-profit (p<.001) compared to non–TJC-accredited HHAs (see Table 1). Government-owned HHAs had a lower proportions of high ratings (4, 4.5, and 5 star) and a greater proportion of low ratings (1, 1.5, 2, and 2.5 star) than both for-profit and not-for-profit HHAs. Not-for-profit HHAs had a lower proportion of high-performing HHAs compared to for-profit HHAs (27% vs 36%), although they were similar in their proportions of low-performing HHAs (25% for not-for-profit vs 29% for-profit). When categories were collapsed to evaluate differences, the analysis revealed that a significantly larger proportion of TJC-accredited HHAs were clustered within the higher ratings (41% for TJC-accredited vs 32% for non-TJC accredited), and fewer TJC-accredited HHAs were clustered within the lower ratings (22% for TJC-accredited vs 30% for non-TJC-accredited; p<.001).

2016-2018

https://journals.sagepub.com/doi/10.1177/10848223211073900

home health, Home Health Compare, star ratings, quality measures

Positive

Harsono AB, Rumanti RT, Efendi JS, Hidayat YM, Anwar r, Hidayat D, Winarno GNA

Asian Pac J Cancer Prev. 2022 Nov 1;23(11):3611-3616. doi: 10.31557/APJCP.2022.23.11.3611

2022

Hospital

Hospital (HAP)

Not applicable

Yes

To analyze the relationship between quality of life with the JCAHO and the Edmonton Symptom Assessment System (ESAS) scoring system, and to compare the JCAHO and the ESAS scoring systems in determining the palliative care needs of gynecological cancer patients treated at RSHS.

Cross-Sectional Study

This was an analytical descriptive cross-sectional study. Data sources were obtained from female gynecologic malignancy patients (60 respondents) admitted to Alamanda B Ward Hasan Sadikin Hospital between May to August 2020. Two groups of patients were compared: patients with total score of the JCAHO palliative score < 7 and ≥ 7. Each patient fulfilled 3 questionnaires: JCAHO palliative score, ESAS, and FACT-G version 4. The data of this study were obtained through interviews, questionnaires, and patient medical records. The study applied bivariate data analysis using chi-square with α = 0.05.

The results showed that the quality of life of patients with gynecological cancer was associated with the JCAHO palliative score (p <0.05), the better the patient's quality of life, the better the JCAHO palliative score. The quality of life of gynecological cancer patients was also related to ESAS (p <0.05).

2020

https://pubmed.ncbi.nlm.nih.gov/36444571/

gynecological cancer, quality of life, palliative care

Positive

Yang, L., Xun, Q., Xu, J., & Hua, D.

Annals of Translational Medicine. 2022 Feb;10(3).

2022

Hospital

Hospital (HAP)

Not applicable

Yes

To evaluate the application of the defect management improvement mode of the Joint Commission International (JCI) standard in improving the cleaning and disinfection effect as well as the management quality of instruments in the central sterile supply department (CSSD).

Randomized Controlled Trial

From January 2020 to December 2020, 32 medical staff in the hospital CSSD of Wuxi No. 2 People’s Hospital were divided into control and observation groups according to the random number table method, with 16 staff members in each group. The control group adopted the standardized management mode and the observation group adopted the defect management improvement mode based on the JCI standard. During the management period, we compared the disinfection effect and incidence of adverse events of the instruments and articles in the CSSD of the two groups, and evaluated the work and satisfaction of both groups of subjects. Linear correlation analysis and multiple linear regression analysis were used to determine the influencing factors of satisfaction.

During the standardized management, the instruments and articles were used 611 times in the control group and 602 times in the observation group. The cleaning qualified rate, infection awareness rate, standard implementation rate, hand hygiene implementation rate, theoretical knowledge score, and practical operation ability of the observation group were significantly higher than those of the control group (P<0.05). The incidence of adverse events in the observation group was significantly lower compared to the control group (P<0.05), and the satisfaction scores of the observation group were significantly higher than those of the control group (P<0.05). The total satisfaction score was independently related to the training method, educational background, and professional title.

2020

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904978/

Central sterile supply department (CSSD), Joint Commission International (JCI), defect improvement, cleaning and disinfection effect, management quality

Positive

Fontalvo, H. R., Calvano, F. A. R., De La Puente, M., Arias, E. L., & Cardenas, E. A.

Journal of Legal, Ethical & Regulatory Issues. 2022;25:1.

2022

Ambulatory clinic general

Ambulatory Health Care (AMB)

Not applicable

Yes

To analyze whether clinics accredited by the Joint Commission International Hospital Program in ambulatory medical care protocols located in Latin America achieve a higher quality perception from foreign patients compared to others treated in non-accredited ones.

Cross-Sectional Study

This research examined foreign patients' perceptions of the quality of care in five ambulatory procedures received in three certified Hospital Program clinics in Bogota, Mexico City, and Quito, as well as three non-certified ones based on the three variables on which the Hospital Program accreditation is based (the length of an outpatient visit, follow-up attention, and a clear explanation of the medical condition identified by doctors to patients). Changes in perception were analyzed in 121 patients seen in accredited clinics in the three cities mentioned and 115 seen in non-accredited ones. A quasi-experimental approach based on a pre-test and post-test was applied to conduct a descriptive-analytical examination. In 236 patients, a t-test with Welch correction, chi-square test, Tau Kendall correlation coefficient, pre-test, post-test, supplemental questionnaire, and two focus groups was applied.

Patients treated in accredited clinics had a greater perception of quality than those treated in non-accredited clinics. The association between being referred by health insurance and being in an accredited clinic was close, as was the relationship between not being referred by insurance company and attending a non-accredited clinic. All participants treated at certified clinics expressed satisfaction with the care they received, noting that the data collected on their medical record and follow-up care methods were like those in their own country. Sixty-two patients treated at a non-accredited clinic reported problems with information flow, despite their partial satisfaction with their medical care. They also stated that doctors' descriptions of the medical procedures to be conducted were insufficient, causing them to stay longer than they would have liked. An unbalanced application of the three variables was discovered to have a detrimental impact on quality perception.

2015, 2019, 2022

https://heinonline.org/HOL/LandingPage?handle=hein.journals/jnlolletl25&div=93&id=&page=

Ambulatory care, medical displacement, case study, quasi-experimental approach, Latin America

Positive

Al Shawan D.

Journal of Healthcare Leadership

2021

Hospital

Hospital (HAP)

Not applicable

Yes

To evaluate the impact of factors associated with the Joint Commission International accreditation process on quality and to assess health providers’ perceptions of this process.

Interrupted Time Series

Mixed methods approach. For the quantitative analysis, an interrupted time series was conducted to assess the changes on 12 quality outcomes pre- and post-accreditation. Thematic analysis was utilized to collect and analyze qualitative data from hospital employees and health providers.

Joint Commission International accreditation (JCIA) had a positive impact on 9 out of 12 outcomes. The improved quality outcomes included: the average length of stay, the percentage of hand hygiene compliance, the rate of nosocomial infections, the percentage of radiology reporting outliers, the rate of pressure ulcers, the percentage of the correct identification of patients prior to medication administration, the percentage of critical lab reporting within 30 minutes, and the bed occupancy rate. The outcomes that did not improve were the rate of patients leaving the Emergency Room without being seen, the percentage of Operating Room cancelations on the day of the or and the rate of patient falls. The JCIA process was perceived positively by all participants. Some of the perceived advantages of international accreditation included the transformation of the organizational culture to a culture that promotes continuous quality improvement, standardization, and the reduced paperwork in some departments. The participants’ responses also indicated that there were many factors that influence the success of the process. Examples of the factors identified in the study include the increased workload and the providers’ resistance to participate in the JCIA process.

2014-2015

https://pubmed.ncbi.nlm.nih.gov/33564271/

Joint Commission International, patient outcomes, staff perception

Positive

Kobayashi K, Ando K, Nakashima H, Machino M, Kanbara S, Ito S, Inoue T, Yamaguchi H, Ishiguro N, Imagama S.

Nagoya Journal of Medical Science. 2021 Feb;83(1):87.

2021

Hospital

Hospital (HAP)

Not applicable

Yes

To examine the activities of orthopedic surgeons in preparation for Joint Commission International (JCI) accreditation, including clear identification of patients, preoperative timeout and site marking to ensure correct surgery, timely approval of CT/MRI reports, care with pain management, prevention of infection, setting of quality indicators and daily monitoring, and teamwork.

Observational Study

The authors investigated changes in the timeout procedure and site marking rates in all surgeries performed by all departments before and after JCI accreditation.

The study illustrates gradual improvements in conducting timeout procedures and site marking leading up to and following JCI accreditation. Standardization of operating room procedures was especially helpful for promoting a clear understanding of individual responsibilities and enhancing communication among team members. Authors concluded that these actions have resulted in improved patient safety.

2017-2019

https://pubmed.ncbi.nlm.nih.gov/33727740/

continuous quality improvement, International Patient Safety Goals (IPSGs), medical safety, quality

Positive

Almallouhi E, Ajinkya S, Rahwan M, Holmstedt CA, Al Kasab S.

Telemed J E Health. 2021 Feb;27(2):167-171.

2021

Hospital

Not applicable

Disease-specific Care

No

To validate findings that have shown that primary stroke centers (PSCs) have shorter door to needle (DTN) time than non-PSCs hospitals in a high-volume telestroke network.

Observational Study

Prospectively maintained and reviewed data on all consecutive stroke patients who received intravenous alteplase (tissue plasminogen activator [tPA]) between July 2016 and November 2019 through a large telestroke program in Southeast United. Wilcoxon Rank-sum (Mann–Whitney) test was used to compare median times between different groups. Multivariate logistic regression model was used to assess the association between presenting to PSC and having DTN less or equal to 45 and less or equal to 60 minutes.

During the study period, 1,517 patients received tPA, 874 (57.6%) at PSC sites. There were more white patients in the PSC group (64.3%) compared to non-PSC group (58%) (p < 0.001). Other characteristics were similar in patients in both groups. Time metrics were as follows, Door to telestroke page: 16 min versus 13 min (p < 0.001), telestroke page to tPA recommendation: 23 min versus 22 min (p = 0.975), tPA recommendation to tPA bolus administration: 13 min versus 10 min (p < 0.001), and DTN 58 min versus 49 min (p < 0.001) at non-PSC and PSC sites, respectively. Multivariate analysis revealed, there were significantly higher odds for achieving a DTN less than or equal to 45 min (OR 2.8, 95% CI 1.8–4.4, p < 0.001) and DTN less than or equal to 60 min (OR 3, 95% CI 2.1– 4.3, p < 0.001) in the PSC group.

2016-2019

primary stroke certification, telestroke sites, thrombolysis time metrics

Positive

Batista SA, Miclos PV, Amendola F, Bernardes A, Mohallem AGDC.

ev Bras Enferm. 2021 May 28;74(2)

2021

Hospital

Hospital (HAP)

Not applicable

Yes

To identify the dominant dimensions of the authentic leadership of nurses in a private hospital network and to verify the association with job satisfaction and accreditation.

Cross-Sectional Study

A cross-sectional, analytical study carried out in 11 hospitals with 282 nurses, of which 94 were leaders and 188 were led. Four of the hospitals were accredited by Joint Commission International (JCI), three by the National Accreditation Organization (NAO) and four without accreditation. Participants answered the Authentic Leadership Questionnaire and the Job Satisfaction Survey.

The multiple comparison tests corrected by the Bonferroni method showed that the mean of the authentic leadership score in the Transparency dimension is higher in hospitals accredited by the JCI than in hospitals without accreditation (p=0.019). Tests of multiple comparisons between hospitals for the dimensions Transparency (p = 0.032) and Self-awareness (p = 0.007) showed that the there were smaller differences between leaders and subordinates on scores of authentic leadership in hospitals accredited by JCI versus those accredited by the NAO. Accreditation status had no influence on the Moral and Ethical Perspective dimension.

There was no evidence of differences in the mean scores of all dimensions of job satisfaction (JSS) between the groups of leaders who work in hospitals accredited by the JCI, the NAO and without accreditation. Among subordinates, however, job satisfaction scores were higher in hospitals accredited by the JCI than in hospitals accredited by the NAO (Pay (p=0.022), Rewards (p=0.040), Communication (p=0.030).

2017

https://pubmed.ncbi.nlm.nih.gov/34076214/

nursing, leadership, job satisfaction, hospital Accreditation, quality

Positive

Spivak S, Strain EC, Cullen B, Ruble AAE, Antoine DG, Mojtabai R.

Drug Alcohol Depend. 2021 Mar 1;220:108515.

2021

Behavioral Health Care (BHC)

Not applicable

No

To examine Electronic Health Record (EHR) utilization among US substance use disorder (SUD) versus mental health (MH) treatment facilities. Also to identify facility correlates that might explain such differences.

Descriptive Study

Data from the National Survey of Substance Abuse Treatment Services and the National Mental Health Services Survey were used to examine differences in clinical and administrative utilization of EHR between substance use disorder and mental health facilities.

Being an inpatient facility, having Joint Commission accreditation, being a private-for-profit, or a public facility were significantly positively associated with exclusive EHR use for core clinical activities; these associations were stronger among SUD facilities than MH facilities.

2017

https://pubmed.ncbi.nlm.nih.gov/33461154/

electronic health records, substance use disorder, mental health

Positive

Campra M, Riva P, Oricchio G, Brescia, V.

QUALITY MANAGEMENT Vol. 22, No. 181/ April 2021

2021

Hospital

Hospital (HAP)

Not applicable

Yes

The study investigated the possibility of obtaining better outcomes of the health structures accredited in Italy by the Joint Commission International compared to r other health organizations of the Italian system considering the mortality index as an indicator recognized by the literature as a summary indicator of outcome.

National Outcomes Program (PNE) Retrospective analysis of the performance of healthcare activities on the basis of the thirty-day mortality index for each health service observed in the past three years available and on the volume of activities provided at 8 facilities in Italy. The measure used to determine whether a structure is statistically better than the national average or the benchmarking average was the Relative Risk (RR).

The Relative Risk analysis conducted over three years found no significant differences (p <0.05) between Joint Commission accredited facilities and nonaccredited facilities despite the level of performance being almost always better among The Joint Commission accredited facilities than the national average.

2016-2018

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193202/

medical tourism; index of mortality; healthcare quality standard

Neutral

Al-Alawy K, Azaad Moonesar I, Ali Mubarak Obaid H, Gaafar R, Ismail Al-Abed Bawadi E.

Inquiry. 2021 Jan-Dec;58:46958020981463.

2021

Hospital

Hospital (HAP)

Not applicable

Yes

To explore the impact of hospital accreditation and inform policy decision-making.

Descriptive Study

Mixed-methods approach included an online survey and 3 focus groups involved 27 private hospitals. Survey questions included type of accreditation, reasons for accreditation, number of patients per annum, number of staff employed, whether resources to achieve accreditation were internal or through external support, reported areas of improvement, satisfaction and comments on accreditation. FGD participants were presented with the Donabedian Framework and asked to comment on 5 themes including how structure, process, and outcome were impacted by accreditation within their hospital.

Twenty-three hospitals were Joint Commission International (JCI) accredited, 3 accredited by Accreditation Canada International (ACI), 1 accredited by The Australian Council on Healthcare Standards (ACHS), and 1 was identified as a new hospital and in the process of accreditation. Key reasons for accreditation were to improve quality (n = 23), implement evidence-based practice (n = 17), continuity of accreditation (n = 15), and popularity (n = 11). Reported improvements include quality of care (27), patient care (26), organizational processes (21), and patient satisfaction (19) among others. Average stakeholder satisfaction rate was 74%. Participants from the 3 focus group discussions felt that staff hours and stress levels were high during the accreditation process, and some standards were useful while others were deemed non-essential.

Improvement related to accreditation was reported on quality of care (27), patient care (26), organizational processes (21), patient satisfaction (19), reduction in adverse or sentinel events (15), leadership (13), staff satisfaction (13), and organizational structure and governance (9). Satisfaction was measured on a scale of 1 to 10 (1 = very unsatisfied to 10 = very satisfied). 16 of 27 responses on satisfaction were above the average satisfaction score (74%), 4 reported a 60% satisfaction rate, and 3 responses were below the 40% (Figure 3). There was no significance in the cross tab analysis for cost and staff or patient numbers.

https://journals.sagepub.com/doi/10.1177/0046958020981463

hospital, accreditation, regulation, health policy, healthcare quality

Positive

Al Mansour A, Merry AF, Jowsey T, Weller JM

BMJ Open Quality 2022;11:e001652.

2021

Hospital

Hospital (HAP)

Not applicable

Yes

To explore perceptions of employees at the managerial level on the Joint Commission International (JCI) accreditation process and its impact on quality of patient care in Saudi Arabian JCI-accredited hospitals.

Descriptive Study

A qualitative study using semi-structured interviews to explore the perspectives of senior staff from three accredited public hospitals in Saudi Arabia. Interviews were transcribed prior to thematic analysis.

Twenty managers participated in the interviews. The following inter-related themes emerged concerning the JCI accreditation process and its impact on quality of patient care: drivers for the change; the plan for the change; the process of the change; maintaining changes post-accreditation and patients’ issues. Participants were positive in their accounts of: drivers for change; planning for the change needed to achieve accreditation and managing patients’ issues. Participants reported less favorably on: the process of the change; and maintaining changes post accreditation.

2016

https://bmjopenquality.bmj.com/content/11/1/e001652

international accreditation, management, staff experiences, accreditation process

Mixed

Stein LK, Mocco J, Fifi J, Jette N, Tuhrim S, Dhamoon MS

Correlations Between Physician and Hospital Stroke Thrombectomy Volumes and Outcomes: A Nationwide Analysis. Stroke. 2021 Aug;52(9):2858-2865.

2021

Hospital, Specialty hospital

Not applicable

Disease-specific Care

No

To determine whether a proceduralist or hospital volume threshold exists that is associated with better outcomes among Medicare beneficiaries.

Cohort Study

Retrospective cohort study using validated International Classification of Diseases, Tenth Revision, Clinical Modification codes to identify admissions with acute ischemic stroke and treatment with ST. They used de-identified, national 100% inpatient Medicare data sets from January 1, 2016, to December 31, 2017 for US individuals aged ≥65 years. Calculated total procedures by proceduralist and hospital. Performed adjusted logistic regression of total cases as a predictor of inpatient mortality, good outcome (defined by dichotomized discharge disposition of inpatient rehabilitation or better), and 30-day readmission. Adjusted for sex, age, Charlson Comorbidity Index, availability of neurocritical care, teaching hospital status, socioeconomic status, 2-year stroke volume, and urban versus rural hospital location. They dichotomized case numbers incrementally to determine a volume threshold for better outcomes.

Thirteen thousand three hundred thirty-five patients were treated with ST by 2754 proceduralists at 641 hospitals. For every 10 more proceduralist cases, patients had 4% lower adjusted odds of inpatient mortality (adjusted odds ratio, 0.96 [95% CI, 0.95–0.98], P<0.0001) and 3% greater adjusted odds of good outcome (adjusted odds ratio, 1.03 [95% CI, 1.02–1.04], P<0.0001). For every 10 more hospital cases, patients had 2% lower odds of inpatient mortality (adjusted odds ratio, 0.98 [95% CI, 0.98–0.99], P=0.0003) and 2% greater odds of good outcome (adjusted odds ratio, 1.02 [95% CI, 1.01–1.02], P<0.0001). With increasing volumes, there were higher odds of better outcomes

2016-2017

https://pubmed.ncbi.nlm.nih.gov/34092122/

certification, inpatients, mortality, stroke, thrombectomy

Positive

Novarro-Escudero N, Moon YJ, Olmedo A, Ferguson T, Caballero I, Onodera E, Effio E, Klein LM, Zink EK, Johnson B, Urrutia VC

Front Neurol. 2021 Aug 16;12:684775.

2021

Hospital

Not applicable

Disease-specific Care

Yes

To describe and compare demographics, performance, and clinical outcomes of the Pacífica Salud, Hospital Punta Pacífica (PSHPP) stroke center during its first 3 years 2017–2019.

Observational Study

Pacífica Salud, Hospital Punta Pacífica was organized to implement protocols of care based on the best practices by international guidelines and a quality improvement process. The methodology for implementation adapts a model for translating evidence into practice for implementation of evidence-based practices in medicine. This is a retrospective study of prospectively collected quality data between March of 2017 to December of 2019 for patients admitted to PSHPP with primary diagnosis stroke. Data collected include demographics, clinical data organized per the Joint Commission's STK Performance Measures, door to needle, door to groin puncture, 90 day modified Rankin Score, and hemorrhagic complications from IV thrombolysis and mechanical thrombectomy (MT). Primary outcome: year over year proficiency in documenting performance measures. Secondary outcome: year over year improvement.

A total of 143 patients were admitted for acute ischemic stroke, TIA, or hemorrhagic stroke. Of these, 36 were admitted in 2017, 50 in 2018, and 57 in 2019. Performance measure proficiency increased in the year-over-year analysis as did the total number of patients and the number of patients treated with IV thrombolysis and MT.

2017-2019

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415350/

stroke unit, acute stroke care, quality improvement, implementation, stroke centers

Positive

Kato, M., & Zikos, D.

J Hosp Manag Health Policy 2022;6:12 | https://dx.doi.org/10.21037/jhmhp-21-24

2021

Hospital

Hospital (HAP)

Not applicable

No

To examine how hospitals accredited by different independent agencies perform against one another in order to help hospital decision makers understand the role of accreditation selection in terms of quality.

Cross-Sectional Study

A cross-sectional analysis was completed to examine (I) differences in disease-specific 30-day mortality, and various Hospital Acquired Infection (HAI) rates across hospitals accredited by different agencies, and (II) whether one or more of the agencies are associated with any of these outcomes, after controlling for hospital structure characteristics. Results are anticipated to provide invaluable information to hospital decision makers about accreditation agency choices and quality of care. Hospital demographic data was consolidated from the 2018 American Hospital Association (AHA) database and Center for Medicare and Medicaid Services (CMS)’s Hospital Compare database for analysis.

According to post-hoc comparisons, the mean chronic obstructive pulmonary disease (COPD) and heart failure (HF) mortality differ in a statistically significant way between hospitals accredited by the Joint Commission and DNV, and Joint Commission and HFAP respectively. All other 30-day mortality and HAI outcomes were not found to be different across the three accrediting agencies. After controlling for several hospital structure variables, only the DNV-accreditation status was found to be associated with an increase to the 30-day COPD mortality (b=0.225, P<0.01). No agency was associated with the 30-day HF mortality or the central line-associated bloodstream infection (CLABSI) infection rates.

Hospitals accredited by Joint Commission are more likely to be large hospitals, annual admissions M=10,420, total beds M=224, and total surgical operations M=8,589. Joint Commission has the highest proportion of teaching hospitals at 10% of hospitals, a finding that is validated by another research (14). HFAP hospitals were on average the smallest hospitals, with total admissions M=5,029, total beds M=120, and total surgical operations M=5,053. DNV and CIHQ hospital sizes were in between the other agencies. DNV total admissions M=8,510, total beds M=188, and total surgical operations M=6,918. CIHQ total admissions=7,517, total beds M=137, and total surgical operations M=3,817. HFAP and DNV hospitals were also found to have the highest proportion of CAHs; (21% in HFAP and 23% in DNV-accredited hospitals). The observed differences may be explained by a multitude of factors. The total costs associated with accreditation is a main factor to consider when choosing an accreditation agency (10,19). Small rural hospitals have smaller margins compared to larger urban hospitals, which may keep small rural hospitals from utilizing the Joint Commission as their accreditation agency. This study did not seek to understand why hospitals chose a specific accreditation agency.

2015-2018

https://jhmhp.amegroups.com/article/view/6918/html

Hospital accreditation; Joint Commission; hospital outcomes; hospital acquired conditions

Neutral

Jensen, KL, Rivera, CG, Draper, EW, et al.

J Am Coll Clin Pharm. 2021; 4( 12): 1583- 1593.

2021

Ambulatory specialty clinic/service

Ambulatory Health Care (AMB)

Not applicable

No

To create a framework for addressing the task of developing an ambulatory ASP for a large health system by reviewing the regulatory requirements, examining relevant recent publications, and describing our institutional experience.

Other

The authors reviewed past reports, surveys, authors' own institutional experiences, reviews from the annual ASP summit, and other publications to determine the most accurate steps to creating an effective antimicrobial stewardship program (ASP).

In order to reduce unnecessary antimicrobial consumption in ambulatory settings, an ASP must be implemented. A framework for implementing ASP for a large health system includes: (1) leadership demonstrated through setting goals, accountability, hiring people with experience and patient safety; (2) Action taken to implement an active intervention; (3) Education must be prioritized for prescribers to implement the most up to date practices; (4) Peer comparison reporting is a key strategy; (5) Experience in ambulatory care and/or antimicrobial prescribing trends is important for an effective ASP.

2007-2021

https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/jac5.1528

antimicrobial, medication optimization, stewardship

Positive

Hempel EV, Duca N, Kipp R, van Harskamp J, Caputo G.

J Gen Intern Med. 2021 Mar;36(3):762-766.

2021

Ambulatory specialty clinic/service

Ambulatory Health Care (AMB)

Not applicable

No

To design an effective antibiotic stewardship program (ASP) that can address the rising rates of antibiotic resistance due to overuse and misuse of antibiotics. This design focuses on supporting the need for programs that specifically target improved primary care providers (PCP) prescribing practices.

Descriptive Study

Implemented a pilot program in a university internal medicine residency clinic. Based on their experiences and lessons, the authors created a model practice to guide the initiation of ambulatory antimicrobial stewardship programs (AAMP).

The authors provide tips to guide ambulatory clinics initiation and successful execution of the new elements of performance for the 2019 Joint Commission antibiotic stewardship programs for accredited outpatient practices. The findings are as follows: Think of the antimicrobial stewardship leader as a leadership team as opposed to one individual; Develop an inter-professional team to collaborate and develop a systems-based approach; Partner with informatics to use electronic medical record data to identify regionally prevalent infections; If available, review national prescribing patterns for comparison; Perform a needs assessment to identify deficiencies in local prescribing patterns; Review evidence for diagnosis and treatment of the selected condition; Develop local practice guidelines that incorporate current literature and any unique local factors, such as community resistance patterns, that may affect appropriate management in your clinical setting; Identify systems-level interventions that support providers in making appropriate treatment decisions; Consider the use of the entire inter-professional care team; Perform the EPs non-sequentially and in conjunction with one another as appropriate for your setting and resources; Utilize national data and trends to help inform your initial directions, but perform a local needs assessment and target interventions to practice-specific deficiencies.

2019

https://pubmed.ncbi.nlm.nih.gov/33420558/

Primary care providers, ambulatory antibiotic stewardship program, joint commission requirements

Positive

Xiao-Yan G, Yong-Gand W, Hong-Yi S, Peng L, Ru-Shuang Y, Kong-Han P, Jian-Cang Z.

Ann Transl Med. 2020,8(6):317.

2020

Hospital

Hospital (HAP)

Not applicable

Yes

To determine whether the implementation of an RRT in Chinese hospitals also improved outcomes.

Cohort Study

A Joint Commission International accredited hospital with 1,200 beds conducted a retrospective cohort study comparing 60 months after the implementation of the rapid response team (January 1, 2013, to December 31, 2017) and 36 months before implementation (January 1, 2009, to December 31, 2011). The rapid response team was instituted to meet the Joint Commission International standard. The outcomes included the overall hospital mortality and incidence of codes.

144,673 non-obstetric hospital admissions and 1,269,621 patient days in the control period and 348,687 non-obstetric hospital admissions and 2,361,913 patient days after the rapid response team (RRT) implementation were analyzed. The RRT was activated 834 times (2.39 calls per 1,000 patients and 0.35 call per 1,000 patient-days). There was no difference in the code rate (0.23 vs. 0.17 per 1,000 patient days, P=0.379) between the two periods. Although the hospital mortality had remained stable around 3.0 per 1,000 patients from 2009 to 2011, there was a significant 40% decrease of overall hospital mortality from 2.95 to 1.77 per 1,000 non-obstetric patients after the implementation of RRT (P=0.001), and the annual mortality showed a consistent decrease (P=0.037 for the trend). Moreover, the increase of RRT activations was significantly correlated with the decrease of hospital mortality (P=0.025).

2009-2017

https://pubmed.ncbi.nlm.nih.gov/32355761/

rapid response team, medical emergency team, hospital mortality, cardiac arrest

Positive

Despotou G, Her J, Arvanitis TN.

Journal of Nursing Regulation. 2020, 10(4):30-36.

2020

Hospital

Hospital (HAP)

Not applicable

Yes

To explore nurses’ attitudes toward Joint Commission International (JCI) accreditation and its perceived impact on patient safety. The study also sought to determine the perceived degree of implementation of the International Patient Safety Goals (IPSG).

Cross-Sectional Study

A cross-sectional observational study consisting of an online questionnaire (N= 76) and a semi-structured Skype interview (N= 5) of nurses working in South Korean tertiary hospitals. Descriptive statistics and descriptive correlation (Spearman’s ρ) analysis was used to interpret the viewpoints and highlight potential correlations.

The study found a positive attitude toward accreditation amongst nurses in South Korean tertiary care. There was positive association between experience and attitude toward certification (ρ= .345, p= .002) and perceived positive impact of safety (ρ= .338, p= .003). Majority of participants agreed that the IPSG had been implemented at their hospital.

2017

International Patient Safety Goals (IPSG), Joint Commission International (JCI), nursing, safety culture

Positive

Vaughn V, Greene M, Ratz D, Fowler K, Krein S, Flanders S, Dubberke E, Saint S, Patel P.

Infection Control & Hospital Epidemiology. 2019, 41(2), 143-148. doi:10.1017/ice.2019.313.

2020

Hospital

Hospital (HAP)

Not applicable

No

To determine: (1) the presence and composition of antibiotic stewardship programs; (2) current methods of CDI prevention, treatment, and testing; (3) diagnostic stewardship practices; and (4) whether antibiotic stewardship program composition, CDI prevention strategies, and diagnostic stewardship vary by hospital bed size.

Cross-Sectional Study

A random survey of 900 medical and surgical hospitals with an intensive care unit across the US. Survey topics included antibiotic stewardship programs; CDI prevention, treatment, and testing practices; and diagnostic stewardship strategies. Responses were compared by hospital bed size using weighted logistic regression.

Almost all (95%) responding hospitals had an antibiotic stewardship program and guideline-recommended CDI prevention practices were common. However only 41% of hospitals met The Joint Commission accreditation standards for multidisciplinary teams. Smaller hospitals were less likely to have stewardship team members with infectious diseases (ID) training and less likely to use high-tech disinfection devices, fecal microbiota transplantation, or diagnostic stewardship strategies.

2017

https://pubmed.ncbi.nlm.nih.gov/31806059/

clostridioides difficile infection (CDI), antibiotic stewardship program, diagnostic stewardship, infection prevention practices

Positive

Araujo CA, Siqueira MM, Malik AM.

International Journal for Quality in Health Care. 2020 Sep;32(8):531-44.

2020

Hospital

Hospital (HAP)

Not applicable

Yes

To systematically review the impact of hospital accreditation on seven dimensions of health care quality: efficiency, safety, effectiveness, timeliness, patient-centeredness, access, and equity.

Systematic Review

An eight database search was conducted in June 2020: EBSCO, PubMed, Web of Science, Emerald, ProQuest, Science Direct, Scopus and Virtual Health Library. Search terms were conceptualized into three groups: hospitals, accreditation, and terms relating to healthcare quality. The eligibility criteria included academic articles that applied quantitative methods to examine the impact of hospital accreditation on healthcare quality indicators. After a critical appraisal of the 943 citations initially retrieved, 36 studies were included in this review.

Overall results suggest that accreditation may have a positive impact on efficiency, safety, effectiveness, timeliness and patient-centeredness. Only one of the included studies analyzed the impact on access, and no study has investigated the impact on equity dimension yet. The authors note that the positive impact of accreditation on healthcare dimensions should be interpreted with caution, due to limitations in the study designs of included articles (generally observational) and considerable variation in accrediting organizations and hospital types included.

2020

https://pubmed.ncbi.nlm.nih.gov/32780858/

accreditation, healthcare quality, healthcare quality dimensions, healthcare quality indicators, quality assessment

Positive

de la Puente Pacheco MA, De Oro Aguado CM, Arias EL, Pacheco BF.

The Journal of Health Care Organization, Provision, and Financing Volume. 2020; 57: 1 –10.

2020

Hospital

Hospital (HAP)

Not applicable

Yes

To analyze whether hospitals accredited by the Joint Commission International in outpatient medical care protocols located in Colombia achieve a higher quality perception from foreign patients compared to others treated in a non-accredited one.

Descriptive Study

A descriptive-analytical study was carried out through a quasi-experimental design based on a pre-test and post-test. A random stratified sampling design selected two groups of patients. A focus group with each group of patients aimed to find out the most shared opinions on the hospitals’ effectiveness in applying 3 variables: (1) duration of outpatient consultation, (2) follow-up care, and (3) an understandable explanation from physicians to patients about their medical situation. Focus Group Discussion findings were used to complement the statistical results with patients’ ideas that were not registered in the questionnaires. A t-test with Welch correction, chi-square test, correlation coefficient of Tau Kendall, pre-test, post-test, complementary questionnaire and a 2 focus groups were used in 178 foreign patients.

Patients treated in accredited hospitals had a higher quality perception than the non-accredited group.

2019

https://pubmed.ncbi.nlm.nih.gov/33243056/

medical tourism, Colombia, outpatients, focus groups, Chi-square distributions, surveys and questionnaires, accreditation

Positive

Holcombe A, Mohr N, Farooqui M, Dandapat S, Dai B, Zevallos CB, Quispe-Orozco D, Siddiqui F, Ortega-Gutierrez S.

Journal of Stroke and Cerebrovascular Diseases. 2020 Dec 1;29(12):105313.

2020

Hospital

Not applicable

Disease-specific Care

No

To explore the association between rurality, transfer patterns and level of care with clinical outcomes of Cerebral Venous Sinus Thrombosis (CVST) patients in a rural Midwestern state.

Cohort Study

A retrospective cohort observational study was conducted on all adults (18 years and older) with the diagnosis of Cerebral Venous Sinus Thrombosis (CVST) seen at the emergency departments of the hospitals in a Midwestern state between January 1, 2005 and December 31, 2014. These patients were identified by inpatient diagnosis codes from statewide administrative claims dataset. Records were linked across inter-hospital transfers using probabilistic linkage. Rurality was defined by Rural-Urban Commuting Areas using the 2-category approximation. Driving distances were estimated using GoogleMaps Application Programming Interface. Hospital stroke certification was defined by the Joint Commission. Severity of CVST was estimated by cost of care corrected for inflation and cost-to-charge ratios. Outcome was discharge disposition and total length of stay (LOS).

One hundred sixty-eight Cerebral Venous Sinus Thrombosis (CVST) patients were identified (79.8% female; median age = 32, IQR = 24.0-45.5). Median LOS was four days (IQR = 2-7) and patients traveled a median of 8.1 miles (IQR = 2.5-28.5) to the first hospital; 42% of patients were transferred to a second hospital, 5% to a third. More than half (58.3%) bypassed the nearest hospital. 86% visit a primary or comprehensive stroke center (CSC) during their acute care. Rurality was not significantly associated with LOS or discharge disposition after adjusting for age, sex and cost of care. Patients in CSC demonstrated greater likelihood of being discharged home compared to at a primary stroke center after adjusting for age and disease severity (p = 0.008).

2005-2014

https://pubmed.ncbi.nlm.nih.gov/32992183/

certification, Cerebral Venous Sinus Thrombosis (CVST), rural, systems of care, transfer patterns

Positive

DeVylder JE, Ryan TC, Cwik M, Jay SY, Wilson ME, Goldstein M, Wilcox HC.

Psychiatr Serv. 2020 Feb 1;71(2):205-208. doi: 10.1176/appi.ps.201900290.

2020

Hospital

Hospital (HAP)

Not applicable

No

To describe a quality improvement initiative that aimed to improve the detection of suicide risk in youths, to determine rates of positive screens among youths with a psychotic disorder in a pediatric emergency department (ED), to examine whether Ask Suicide-Screening Questions (ASQ) detects otherwise undetected suicide risk, and to explore whether the suicide risk of any particular demographic subgroups is under detected with treatment as usual.

Cohort Study

This was a retrospective cohort study of a consecutive case series of patients in the Johns Hopkins Hospital pediatric ED from March 2013 through December 2018. Patients under age 8 and over 18 years were excluded from the analysis. This report focuses on patients diagnosed as having a psychotic disorder, including schizophrenia, schizoaffective disorder, major depressive disorder with psychotic features, or bipolar disorder with psychotic features, as recorded in the electronic health record (EHR). Only the initial visit during the study period for each patient was used for the analyses. The ASQ is a four-item suicide-risk screening instrument that can be rapidly administered to patients and scored by nursing staff.

A total of 87 patients were diagnosed as having a psychotic disorder among our cohort of 15,007 patients (0.6%). Nearly half of the sample (N542, 48%) screened positive on the ASQ, with females more likely than males to screen positive (odds ratio [OR]527.1, 95% CI53.4–216.2), but no differences were found by race or age. Nearly all positive screens included the endorsement of at least one of the items assessing current suicidal ideation or behaviors; only three (7%) positive screens were due to positive responses to the item inquiring about lifetime suicide attempts alone. Youths with a suicide related chief complaint were more likely to screen positive (OR54.0, 95% CI51.6–10.1). Further, the ASQ missed only one youth with a suicide-related chief complaint.

2013-2018

https://pubmed.ncbi.nlm.nih.gov/31795855/

suicide screening, National Patient Safety Goal, emergency department, pediatrics

Positive

Holcombe A, Mohr N, Farooqui M, Dandapat S, Dai B, Zevallos CB, Quispe-Orozco D, Siddiqui F, Ortega-Gutierrez S.

J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105313

2020

Hospital

Not applicable

Disease-specific Care

No

To explore the association between rurality, transfer patterns and level of care with clinical outcomes of Cerebral Sinus Venous Thrombosis (CVST) patients in a rural Midwestern state.

Observational Study

CVST patients admitted to the hospital between 2005 and 2014 were identified by inpatient diagnosis codes from statewide administrative claims dataset. Records were linked across inter-hospital transfers using probabilistic linkage. Rurality was defined by Rural-Urban Commuting Areas using the 2-category approximation. Driving distances were estimated using Google Maps Application Programming Interface. Hospital stroke certification was defined by the Joint Commission. Severity of CVST was estimated by cost of care corrected for inflation and cost-to-charge ratios. Outcome was discharge disposition and total length of stay (LOS). Wilcoxon rank-sum, Chi-square, Fisher’s exact tests and linear and logistic regressions were used.

168 CVST patients were identified (79.8% female; median age = 32, IQR = 24.0 - 45.5). Median LOS was four days (IQR = 2-7) and patients traveled a median of 8.1 miles (IQR = 2.5-28.5) to the first hospital; 42% of patients were transferred to a second hospital, 5% to a third. More than half (58.3%) bypassed the nearest hospital. 86% visit a primary or comprehensive stroke center (CSC) during their acute care. Rurality was not significantly associated with LOS or discharge disposition after adjusting for age, sex and cost of care. Patients in CSC demonstrated greater likelihood of being discharged home compared to at a primary stroke center after adjusting for age and disease severity (p = 0.008).

2005 to 2014

https://pubmed.ncbi.nlm.nih.gov/32992183/

cerebral venous sinus thrombosis, systems of care, rurality, transfer patterns

Positive

Boyum JH, Rosier AS, Tibor LC, Turner MA, Hess AR, Kurup AN

Radiographics. 2020 Jul-Aug;40(4):1182-1187

2020

Hospital

Hospital (HAP)

Not applicable

No

To use the Universal Protocol as encouraged by The Joint Commission to identify sentinel events related to wrong-surgery events during 2016 and to implement a multidisciplinary team to prevent recurrences of similar incidents.

Uncontrolled Before-After Study

Formed multi-disciplinary team that conducted root cause analyses of patient safety events that occurred in 2016. The project team defined the current state of the problem, constructed a fishbone diagram of potential contributors to the problem, performed baseline observational audits, and consulted colleagues at another institution who had undertaken a similar project. The team applied standardized time out and other critical elements of the universal protocol as encouraged by The Joint Commission to identify sentinel events related to wrong-surgery events.

Testing of the standardized time-out in the initial procedural areas showed improved performance in completing the key elements of Universal Protocol. Verification of specimens to be collected increased from a baseline of 37% (32 of 87) to 84% (108 of 129) during the intervention. The sequence of steps in the time-out was performed in the correct order 73% (108 of 148) of the time. Results of the postintervention survey of the procedural members showed high satisfaction and willingness to implement the standardized time-out in daily practice. Notably, 88% (56 of 64) responded that the standardized timeout improved their ability to perform elements of Universal Protocol.

2016

https://pubmed.ncbi.nlm.nih.gov/32609592/

universal protocol, standardized time-out, adverse events

Positive

Latif F, Patel S, Badolato G, McKinley K, Chan-Salcedo C, Bannerman R, Schultz TR, Newton J, Schott MM, Tyson CM, Wavra T, Robb AS.

Hosp Pediatr. 2020 Oct;10(10):884-892.

2020

Hospital

Hospital (HAP)

Not applicable

No

To implement a TJC-compliant process of suicide risk screening and assessment in the pediatric emergency department (ED) and outpatient behavioral health clinic in a large tertiary care children’s hospital; to describe characteristics of this population related to suicide risk; and to report the impact of this new process on ED length of stay (LOS).

Uncontrolled Before-After Study

A workflow using the Columbia Suicide Severity Rating Scale was developed and implemented. Monthly reviews of compliance with screening and assessment were conducted. Descriptive statistics were used to define the study population, and multivariable regression was used to model factors associated with high suicide risk and discharge from the emergency department (ED). ED length of stay (LOS) of behavioral health patients was compared before and after implementation.

Average compliance rates for screening was 83% in the ED and 65% in the outpatient clinics. Compliance with standardized assessments in the ED went from 0% before implementation to 88% after implementation. The analysis revealed that 72% of behavioral health patients in the ED and 18% of patients in behavioral health outpatient clinics had a positive suicide risk. ED LOS did not increase. The majority of patients screening at risk was discharged from the hospital after assessment.

https://pubmed.ncbi.nlm.nih.gov/32928898/

suicidal behavior, suicide risk assessment, behavioral medicine, pediatric suicide prevention

Positive

Lockard KL, Dunn E, Kunz N, Pearsol A, Schaub RD Jr, Severyn DA, Lohmann D, McCall M, Morelli B, Teuteberg JJ, Kormos RL, Sciortino CM, Dew MA.

Prog Transplant. 2020 Dec;30(4):376-381.

2020

Hospital

Not applicable

Disease-specific Care

No

QI intervention to improve performance in 4 areas critical for the timely recovery and well-being of VAD patients. Specific aims: to (1) shorten LOS, (2) increase the perioperative PT consultation rate, (3) decrease the driveline infection rate, and (4) improve patients’ nutritional status, as indicated by prealbumin levels.

Uncontrolled Before-After Study

Preintervention baseline data collected in 2008. Iplemented performance improvement processes and intervention and collected data throughout the project’s duration 2008 through 2017. Plan-Do-Study-Ask methods were applied to identify performance improvement areas related to: (1) shorten LOS, (2) physical therapy (PT) consults, (3) driveline infections, and (4) prealbumin levels.

Across the performance improvement period, length of stay decreased from 40 to 23 days; physical therapy consults increased from 87% to 100% of patients; 1-year driveline infection incidence went from 38% to 23.5%; and the percentage of patients with prealbumin within the normal range increased from 84% to 90%.

2008-2017

https://pubmed.ncbi.nlm.nih.gov/32985349/

ventricular assist device, Joint Commission disease-specific care, performance measures, length of hospital stay, physical therapy, driveline infection, prealbumin

Positive

Poremski D, Lim ISH, Wei X, Fang T.

Jt Comm J Qual Patient Saf. 2020 Dec;46(12):699-705.

2020

Hospital

Behavioral Health Care (BHC)

Not applicable

Yes

To explore how accreditation provided by Joint Commission International, affects service quality at the Institute of Mental Health in Singapore and to advance understanding of its effects and the durability of improvements.

Other

Researchers conducted 21 qualitative semi-structured interviews with key informants to understand how obtaining reaccreditation was affecting the institute. The data were analyzed thematically to produce an understanding of the various ways in which accreditation improved care quality.

Accreditation contributed to the improvement of care via several mechanisms. Although participants universally endorsed the positive impact of accreditation on safety, it was harder to pinpoint specific outcomes that improved because of it. Accreditation, however, had unintended consequences: Unnecessary processes arising from over-interpretation of standards led to several staff behaviors that might ultimately compromise the sustainability of new processes.

2017

https://pubmed.ncbi.nlm.nih.gov/33127333/

reaccreditation, accreditation, mental health

Mixed

Cornistein W, Amalda G, Novau A , Rodriguez V, Freuler C, Staneloni MI.

Decennial 2020 abstracts 2020;41 Suppl 1

2020

Hospital

Hospital (HAP)

Not applicable

Yes

To compare the rates for device-associated infections in ICUs of institutions with advanced infection control programs ICPs versus national rates.

Observational Study

Included device associated infection rates in adult critical care units from 2014 to 2018. All ICUs reporting to VIHDA and 3 surgicalmedical teaching hospitals with an advanced ICP and Joint Commission International accreditation. The Argentina National Hospital Infection Surveillance System (VIHDA) definition was used to define central line-associated bloodstream infection (CLABSI), catheter-related urinary infection (CAUTI), and ventilator-associated pneumonia (VAP). The rates were compared as adjusted reasons for exposure time using openepi.com software provided by the CDC.

Compliance with infection control measures and bundles for device-associated infections in 3 hospitals with advanced ICPs (also accredited by JCI) was >80%. No data were available for the rest of hospitals included the national surveillance system. All 3 hospitals improved their rates over time. The differences in catheter-related bloodstream infection and VAP rates between these hospitals and the rest of the hospitals in the surveillance system was significant.

2014-2018

https://pubmed.ncbi.nlm.nih.gov/15061418/

infection control programs, healthcare-associated infections, CLABSI, CAUTI, VAP

Positive

Pacheco de la Puente MA, de Oro Aguado CM, Lugo Arias E, Fontecha Pacheco B

Inquiry. 2020 Jan-Dec;57:46958020976826

2020

Hospital

Hospital (HAP)

Not applicable

Yes

This study analyzes whether hospitals accredited by the Joint Commission International in outpatient medical care protocols located in Colombia achieve a higher quality perception from foreign patients compared to others treated in a nonaccredited one.

Descriptive Study

This study analyzed the perception of foreign patients in the application of the 3 variables that determine the quality of outpatient care (p. 3) on 6 procedures received in Colombia in 2 hospitals accredited in ambulatory care from the Joint Commission International and one not accredited. It also identifies application differences between hospitals and how patients responded. A descriptive-analytical study was carried out through a quasi-experimental design based on a pretest and post-test. A random stratified sampling design selected both groups. Also, a focus group was applied in each group of patients to find out the most shared opinions on the hospitals’ effectiveness in applying the 3 variables above, complementing the statistical results with patients’ ideas that were not registered in the questionnaires.

The findings reinforce the idea that accreditation in outpatient medical procedures is a tool that strengthens the expansion of Colombian medical tourism offer linked with foreign patients’ quality perception. The accreditation of the Joint Commission International in ambulatory medical care is an instrument that increases the confidence of foreign patients and insurers in the Colombian medical offer.

2020

https://pubmed.ncbi.nlm.nih.gov/33243056/

medical tourism, Colombia, outpatients, focus groups, Chi-square distributions, surveys and questionnaires, accreditation

Positive

Karamali M, Bahadori M, Ravangard R, Yaghoubi M.

Int J Health Care Qual Assur. 2020 Sep 8;ahead-of-print(ahead-of-print).

2020

Hospital

Hospital (HAP)

Not applicable

Yes

To review and map bibliographic data about “Hospital Accreditation” and assess the current quantitative trends.

Other

Scientometric methods and knowledge visualization using the coword analysis techniques conducted in three steps based on the data related to the field of hospital accreditation from 1975 to 2018 obtained from the MEDLINE database. Bibliographic data for titles, abstracts and keywords articles were saved in CSV format and MEDLINE templates by applying filters. Data extracted were exported into an Excel spreadsheet and were preprocessed. The authors applied the text mining and visualization using VOSviewer software.

Hospital accreditation studies have increased rapidly over the past 30 years. 6,661 documents in the field of hospital accreditation were published from 1975 to 2018. Hospitals or organizations active in the field of hospital accreditation were in the United States, Italy and Canada. The 10 most productive authors identified in the area of hospital accreditation with a higher influence were identified. “The United States”, “accreditation”, “Joint commission on accreditation” and “quality assurance, healthcare” had, respectively, the highest frequency. The cluster analysis identified and categorized them into four major clusters. Hospital accreditation field had a close relationship with quality improvement, patient safety, risk and standards.

1975-2018

https://pubmed.ncbi.nlm.nih.gov/32886458/

Hospital accreditation, Knowledge mapping, Coword analysis, MEDLINE

UTD

Devkaran S, O’Farrell PN, Ellahham S, Arcangel R.

BMJ Open. 2019 Feb 1;9(2):e024514.

2019

Hospital

Hospital (HAP)

Yes

To evaluate whether hospital re-accreditation improves quality, patient safety and reliability over three accreditation cycles by testing the accreditation life cycle model on quality measures.

Interrupted Time Series

Each month (over 96 months), a simple random sample of 10% of patient records was selected and audited resulting in a total of 388,800 observations from 14,500 records. The validity of the life cycle model was tested by calibrating interrupted time series (ITS) regression equations for 27 quality measures. The change in the variation of quality over the three accreditation cycles was evaluated using the Levene's test. The impact of hospital accreditation for the 27 quality measures was observed for 96 months, 1-year preaccreditation (2007) and 3 years postaccreditation for each of the three accreditation cycles (2008, 2011 and 2014). The life cycle model was evaluated by aggregating the data for 27 quality measures to produce a composite score and to fit an ITS regression equation to the unweighted monthly mean of the series.

The results provide some evidence for the validity of the four phases of the life cycle namely, the initiation phase, the presurvey phase, the postaccreditation slump and the stagnation phase. Furthermore, the life cycle model explains 87% of the variation in quality compliance measures (R squared= 0.87). The best-fit ITS model contains two significant variables. The Levene's test demonstrated a significant reduction in variation of the quality measures with subsequent accreditation cycles.

2007-2015

https://www.ncbi.nlm.nih.gov/pubmed/30772852

accreditation, patient safety, quality

Positive

Avia I, Hariyati TS.

Enfermeria clinica. 2019 Sep 1;29:315-20.

2019

Hospital

Hospital (HAP)

Not applicable

Yes

To review and analyze the impact of hospital accreditation on quality of care.

Not a Study

Articles were reviewed and focused on the hospital accreditation impact on quality of care which were published in English and Indonesian from 2008 to 2018. Comprehensive searches were conducted in the online databases of ProQuest, CINAHL and ScienceDirect.

A total of 11 articles were reviewed. The authors found that the hospital accreditation impacted the quality of care through improved quality of management (81.81%), improved employee participation (27.27%), and improved quality of results (54.54%). The articles also studied nurses and other health workers with consideration on their work experience, education, and age. Hospital accreditation has positive impact in improving the quality of services provided in the hospitals. The greatest impact was reflected by the hospitals that had been accredited by Joint Commission International. The perceptions on which the studies were based came from various health care personnel and were not limited to nurses.

2008-2018

https://pubmed.ncbi.nlm.nih.gov/31272880/

accreditation, hospital, quality of care

Positive

Awdishu L, Moore T, Turner C, Trzebinska D.

Pharmacy 2019, 7(3), 83.

2019

Hospital

Not applicable

Disease-specific Care

No

To describe the quality assurance and performance improvement in chronic kidney disease care.

Cohort Study

This is a single-center, retrospective study describing quality assurance and performance improvement in chronic kidney disease, Joint Commission certification and quality outcomes. A total of 440 patients were included in the analysis. Thirteen quality indicators consisting of clinical and process of care indicators were developed and measured for a period of two years from 2009–2017. Patient satisfaction was measured using The Consumer Assessment of Health Providers and Systems surveys administered by Press Ganey and collected for each certification and recertification cycle.

Significant improvements or at least persistently high performance were noted for key quality indicators: blood pressure control (85%), estimation of cardiovascular risk (100%), measurement of hemoglobin A1c (98%), vaccination (93%), referrals for vascular access and transplantation (100%), placement of permanent dialysis access (61%), discussion of advanced directives (94%), online patient education (71%) and completion of office visit documentation (100%). High patient satisfaction scores (94–96%) are consistent with excellent quality of care provided.

2009-2017

https://pubmed.ncbi.nlm.nih.gov/31277293/

chronic kidney disease, interprofessional care, performance improvement, quality assurance

Positive

Devkaran S, O'Farrell PN, Ellahham S, Arcangel R.

BMJ Open 2019;9:e024514. doi:10.1136/ bmjopen-2018-024514.

2019

Hospital

Hospital (HAP)

Not applicable

Yes

To evaluate whether hospital re-accreditation improves quality, patient safety and reliability over three accreditation cycles by testing the accreditation life cycle model on quality measures in one 650-bed tertiary academic hospital in Abu Dhabi, UAE.

Interrupted Time Series

This single site study applied interrupted time series (ITS) regression equations for 27 quality measures to test for validity of the life cycle model and impact of hospital accreditation on the 27 quality measures at a 650-bed tertiary academic hospital in Abu Dhabi, UAE. Change in the variation of quality over the three accreditation cycles was evaluated using the Levene’s test. Each month (over 96 months), a simple random sample of 10% of patient records was selected and audited resulting in a total of 388 800 observations from 14 500 records. The impact of hospital accreditation on the 27 quality measures was observed for 96 months, 1-year pre-accreditation (2007) and 3 years post accreditation for each of the three accreditation cycles (2008, 2011 and 2014). The life cycle model was evaluated by aggregating the data for 27 quality measures to produce a composite score (YC) and to fit an ITS regression equation to the unweighted monthly mean of the series.

The results provide some evidence for the validity of the four phases of the life cycle defined as: the initiation phase, the presurvey phase, the post-accreditation slump and the stagnation phase. The descriptive statistics of the dependent variables demonstrated that 88% of measures had a mean and median >90%. 78% of the β1 coefficients (the slope prior to the first accreditation) were positive, as predicted and half were statistically significant correlating with the presurvey ramp up phase in the life cycle mode. Conversely, 26% of the coefficients were negative, but only three were significant. The β2 coefficients—the change in level following the first accreditation—were negative and significant in five cases and positive and significant in six. In 60% of cases the first intervention effect was not significant. The β3 slope coefficient results were more mixed following the first accreditation: in five cases, coefficients were both negative and significant, and also five were positive and significant. Conversely, for 63% of cases there was no significant effect. In the case of the second intervention, β4, seven coefficients were both negative and significant, whereas only four positive coefficients were significant. For β5, the second post-accreditation slope, 59% of the coefficients were not significant but 8 of the 11 significant slopes were negative. Similarly, some 85% of the coefficients on (β6)—the third intervention—were not statistically significant; Finally, 86% of the post-accreditation slopes (β7) were not significant. The authors conclude that the findings demonstrate that subsequent accreditation surveys significantly reduces variation in quality performance which correlates with higher reliability.

2007-2014

https://pubmed.ncbi.nlm.nih.gov/30772852/

quality measures, life cycle model; accreditation

Positive

Okumura Y, Inomata T, Iwagami M, Eguchi A, Mizuno J, Shiang T, Kawasaki S, Shimada A, Inada E, Amano A, Murakami A.

BMJ Open 2019;9:e028656. doi:10.1136/ bmjopen-2018-028656.

2019

Hospital

Hospital (HAP)

Not applicable

Yes

To investigate the impact of standardization of the perioperative protocol based on the Joint Commission International (JCI) accreditation guidelines for operating time in cataract surgery.

Observational Study

A single site retrospective observational study including 2581 and 546 patients that underwent cataract surgery under topical anesthesia before and after JCI accreditation respectively between March 2014 and June 2016 at one hospital in Japan. The study compared three time periods, comprising the pre-procedure/surgery time (pre-PT), PT and post-PT, and total PT (TPT) of cataract surgery between patients before and after JCI accreditation, by regression analysis adjusted for age, sex and cataract surgery-associated confounders.

Pre-PT, PT, post-PT and TPT. Pre-PT (19.8±10.5 vs 13.9±8.5min, p<0.001) and post-PT (3.5±4.6 vs 2.6±2.1min, p<0.001) significantly decreased after JCI accreditation, while PT did not significantly change (16.8±6.7 vs 16.2±6.3min, p=0.065). TPT decreased on average by 7.3min per person after JCI accreditation (40.1±13.4 vs 32.8±10.9min, p<0.001). After adjusting for confounders, pre-PT (β=−5.82min, 95%CI −6.75 to −4.88), PT (β=−0.76min, 95%CI −1.34 to −1.71), post-PT (β=−0.85min, 95%CI −1.24 to −0.45) and TPT (β=−7.43min, 95%CI −8.61 to −6.24) were significantly shortened after JCI accreditation.

2014-2016

https://pubmed.ncbi.nlm.nih.gov/31203249/

cataract surgery, peri-operative protocol

Positive

Jahan R, Saver J, Schwamm L, Fonarow G, Liang L, Matsouaka R, Xian Y, Holmes D, Peterson E, Yavagal D, Smith E.

JAMA. 2019;322(3):252–263. doi:10.1001/jama.2019.8286.

2019

Hospital

Hospital (HAP)

Not applicable

No

To characterize the association of speed of treatment with outcome among patients with acute ischemic stroke (AIS) undergoing endovascular-reperfusion therapy.

Cohort Study

Retrospective cohort study used data from The Guidelines-Stroke nationwide US quality registry. Analysis was conducted using data regarding patients treated between January 1, 2015, and December31, 2016, with final follow-up through April 15, 2017. Participants were 6756 patients with anterior circulation large vessel occlusion AIS treated with endovascular-reperfusion therapy with onset-to-puncture time of 8 hours or less. Main outcomes and measures were: substantial reperfusion (modified Thrombolysis in Cerebral Infarction score 2b-3), ambulatory status, global disability (modified Rankin Scale [mRS]) and destination at discharge, symptomatic intracranial hemorrhage (sICH), and in-hospital mortality/hospice discharge.

Among 6756 patients, the mean (SD) age was 69.5 (14.8) years, 51.2%(3460/6756) were women, and median pretreatment score on the National Institutes of Health Stroke Scale was 17 (IQR, 12-22). Median onset-to-puncture time was 230 minutes (IQR, 170-305) and median door-to-puncture time was 87 minutes (IQR, 62-116), with substantial reperfusion in 85.9%(5433/6324) of patients. Adverse events were sICH in 6.7% (449/6693) of patients and in-hospital mortality/hospice discharge in 19.6%(1326/6756) of patients. At discharge, 36.9% (2132/5783) ambulated independently and 23.0%(1225/5334) had functional independence (mRS 0-2). In onset-to-puncture adjusted analysis, time-outcome relationships were nonlinear with steeper slopes between 30 to 270 minutes than 271 to 480 minutes. In the 30- to 270-minute time frame, faster onset to puncture in 15-minute increments was associated with higher likelihood of achieving independent ambulation at discharge (absolute increase, 1.14%[95%CI, 0.75%-1.53%]), lower in-hospital mortality/hospice discharge (absolute decrease, −0.77%[95%CI, −1.07%to −0.47%]), and lower risk of sICH (absolute decrease, −0.22%[95%CI, −0.40% to −0.03%]). Faster door-to-puncture times were similarly associated with improved outcomes, including in the 30- to 120-minute window, higher likelihood of achieving discharge to home (absolute increase, 2.13%[95%CI, 0.81%-3.44%]) and lower in-hospital mortality/hospice discharge (absolute decrease, −1.48%[95%CI, −2.60% to −0.36%]) for each 15-minute increment.

2015-2016

acute ischemic stroke (AIS), endovascular-reperfusion therapy

Positive

DeVylder JE, Ryan TC, Cwik M, Wilson ME, Jay S, Nestadt PS, Goldstein M, Wilcox HC.

JAMA network open. 2019 Oct 2;2(10):e1914070.

2019

Hospital

Hospital (HAP)

Not applicable

No

To examine the association between results of the Ask Suicide-Screening Questions (ASQ) instrument in a pediatric emergency department (ED), implemented through selective and universal screening approaches, and subsequent suicide-related outcomes.

Cohort Study

A retrospective cohort study was conducted at an urban pediatric emergency department in the United States, the Ask Suicide-Screening Questions Instrument was administered to youths aged 8 to 18 years with behavioral and psychiatric presenting problems from March 18, 2013, to December 31, 2016, and then to youths aged 10 to 18 years with medical presenting problems (in addition to those aged 8-18 years with behavioral and psychiatric presenting problems) from January 1, 2017, to December 31, 2018.

The main outcomes were subsequent emergency department (ED) visits with suicide related presenting problems (ie, ideation or attempts) based on electronic health records and death by suicide identified through state medical examiner records. Association with suicide-related outcomes was calculated over the entire study period using survival analyses and at 3-month follow-up for both conditions using relative risk.

The complete sample was 15003 youths (7044 [47.0%] male; 10 209 [68.0%] black; mean [SD] age, 14.5 [3.1] years at baseline). The follow-up for the selective condition was a mean (SD) of 1133.7 (433.3) days; for the universal condition, it was 366.2 (209.2) days. In the selective condition, there were 275 suicide-related ED visits and 3 deaths by suicide. In the universal condition, there were 118 suicide-related ED visits and no deaths during the follow-up period. Adjusting for demographic characteristics and baseline presenting problem, positive Ask Suicide-Screening Questions instrument screens were associated with greater risk of suicide-related outcomes among both the universal sample (hazard ratio, 6.8 [95% CI, 4.2-11.1]) and the selective sample (hazard ratio, 4.8 [95% CI, 3.5-6.5]).

2013-2018

https://pubmed.ncbi.nlm.nih.gov/31651971/

National Patient Safety Goal, accreditation, suicide screening

Positive

Pilliod RA, Dissanayake M, Cheng YW, Caughey AB

JAMA Pediatr. 2019 Dec 1;173(12):1180-1185

2019

Hospital

Hospital (HAP)

No

To determine if widespread adoption of a 39-week rule, limiting elective deliveries prior to 39 weeks gestation, is associated with an increase or decrease in overall mortality when considering both still births and infant deaths.

Cohort Study

This retrospective cohort study used birth certificate and infant death certificate data in the United States to compare years before and after the adoption of the39-weekrule. Births between2008 and 2009 were considered to be in the preadoption period (n = 7322234), and those between 2011 and 2012 were considered to be in the postadoption period (n = 6972626). Included births were singleton, nonanomalous births between 370/7weeks and 426/7weeks gestation. Statistical analysis was performed from July 19, 2016, through June 27, 2019. The primary outcomes of interest were still birth and infant death.

Overall mortality was not increased in the period after the wide spread adoption of limiting elective early-term deliveries despite an increase in stillbirth. A total of 7322234 births (49.0% girls and 51.0% boys) were included in the preadoption period and 6972626 births (49.1% girls and 50.9% boys) were included in the postadoption period. Compared with the preadoption period, there was a decrease in the proportion of deliveries at 37 weeks (−0.06%) and 38weeks (−2.5%) and an increase in the proportion of deliveries at 39 weeks (6.8%) and 40 weeks (0.2%) in the post adoption period (P < .001). The stillbirth rate increased in the postadoption cohort compared with preadoption (0.09%vs0.10%;P < .001). The infant death rate decreased in the postadoption period compared with preadoption (0.21% vs 0.20%; P < .001). An overall mortality rate of 0.31% was calculated for the preadoption period and 0.30% for the postadoption period (P = .06). Additional analysis in a counterfactual model suggests that up to 34.2% of the difference in mortality could be associated with the 39-week rule. Stable overall perinatal mortality rates were observed in the 2-year period immediately after adoption of the 39-week rule, despite an increase in stillbirth.

2008-2009

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820038/

infant deaths, 39-week rule, still births

Neutral

Um MH, Lyu ES, Lee SM, Park YK.

Asia Pacific Journal of Clinical Nutrition. 2018;27(1):158-166.

2018

Hospital

Hospital (HAP)

Not applicable

Yes

To identify differences in clinical nutrition service provisions between Joint Commission International-accredited acute care hospitals and non-accredited acute care hospitals.

Cross-Sectional Study

A survey questionnaire was sent to all 43 acute care hospitals in South Korea. A total of 35 sets of clinical nutrition service surveys, 234 sets of clinical dietitian job satisfaction surveys, and five-day daily work logs from 129 clinical dietitians were received.

Joint Commission International-accredited acute care hospitals (N=8) showed a higher, but not significantly higher, nutritional intervention rate of 12.7% among malnourished patients, compared with 7.0% in non-Joint Commission International-accredited acute care hospitals (N=27). Analysis of work hours of clinical dietitians indicated time spent on direct care was higher (p<0.05), while time spent on outpatient care was lower (p<0.05) among Joint Commission International-accredited acute care hospitals relative to non-Joint Commission International-accredited acute care hospitals. Joint Commission International-accredited acute care hospitals reported significantly higher satisfaction than did non-Joint Commission International-accredited acute care hospitals.

2013

https://www.ncbi.nlm.nih.gov/pubmed/29222894

accreditation, clinical dietitian, hospital, nutrition services

Positive

Mahmud A, Timbie JW, Malsberger R, Setodji CM, Kress A, Hiatt L…, Kahn KL.

The American Journal of Managed Care. 2018 Jul;24(7):334-40.

2018

Ambulatory Health Care (AMB)

Not applicable

No

To examine differences in patient outcomes associated with 3 patient-centered medical homes (PCMH) recognition programs—National Committee for Quality Assurance (NCQA) Level 3, The Joint Commission (TJC), and Accreditation Association for Ambulatory Health Care (AAAHC)—among Medicare beneficiaries receiving care at federally qualified health centers (FQHCs). 

Cross-Sectional Study

The study used data from Centers for Medicare & Medicaid Services' (CMS) federally qualified health centers (FQHCs) that received assistance to achieve National Committee for Quality Assurance (NCQA) Level 3 patient-centered medical home (PCMH) recognition. This study assessed the impact of 3 recognition programs on utilization, quality, and Medicare expenditures using a sample of 1108 demonstration and comparison FQHCs. Using propensity-weighted difference-indifferences analyses, the authors compared changes in outcomes over 3 years for beneficiaries attributed to FQHCs that achieved each type of recognition relative to beneficiaries attributed to FQHCs that did not achieve recognition. 

Recognized FQHCs compared with non-recognized FQHCs were associated with significant 3-year changes in FQHC visits, non-FQHC primary care visits, specialty visits, emergency department (ED) visits, hospitalizations, a composite diabetes process measure, and Medicare expenditures. Changes varied in direction and strength by recognition type. In year 3, compared with non-recognized sites, NCQA Level 3 sites were associated with greater increases in ambulatory visits and quality and greater reductions in hospitalizations and expenditures (P <.01). Joint Commission sites were associated with significant reductions in ED visits and hospitalizations (P <.01), and Accreditation Association for Ambulatory Health Care sites had increased ED visits. 

Unknown

https://www.ncbi.nlm.nih.gov/pubmed/30020753

ambulatory care, emergency room, hospital system, inpatient, accreditation

Positive

Lam MB, Figueroa JF, Feyman Y, Reimold KE, Orav EJ, Jha AK.

BMJ. 2018 Oct 18;363:k4011.

2018

Hospital

Hospital (HAP)

Not applicable

No

To determine whether patients admitted to US hospitals that are accredited have better outcomes than those admitted to hospitals reviewed through state surveys, and whether accreditation by The Joint Commission provides any additional benefits for patients compared with other independent accrediting organizations.

Observational Study

A list of US acute care hospitals, including critical access hospitals, was obtained from the Centers of Medicare and Medicaid Services (CMS), which included hospitals’ accreditation body or whether they were reviewed by the state and survey dates (ranging from 2014 to 2017). From the survey information available online at The Joint Commission website, hospital Medicare ID numbers were manually obtained and The Joint Commission list was used to cross reference the CMS list. If a hospital was also identified on The Joint Commission list, then it was included as a hospital accredited by The Joint Commission. Hospitals not on The Joint Commission list were categorized in the CMS list as being accredited by an alternative organization or reviewed by a state survey agency.

A total of 4,242,684 hospital admissions were recorded across 4400 hospitals (2847 hospitals accredited by The Joint Commission, 490 hospitals accredited by other independent accrediting organizations, and 1063 hospitals reviewed by a state survey agency). Of these admissions, 3 567 853 (84%) occurred at The Joint Commission hospitals, 492 937 (12%) at non-Joint Commission hospitals, and 181 894 (4%) at state survey hospitals. Compared with The Joint Commission or non-Joint Commission accredited hospitals, state survey hospitals were more often smaller, non-teaching, more likely to be located in rural settings, and lacking an intensive care unit. The Joint Commission hospitals were more likely to be larger, teaching institutions, located in urban locations, and in the northeast and south regions, compared with non-Joint Commission hospitals or state survey hospitals.

Patients treated at accredited hospitals had lower 30 day mortality rates for 15 selected medical conditions than those at hospitals that were reviewed by a state survey agency (10.2% v 10.6% (95% confidence interval 0.1% to 0.8%), P=0.03), but did not meet the prespecified Bonferroni P value threshold of P=0.0125 for statistical significance. Accredited and state survey hospitals had nearly identical rates of mortality for the six surgical conditions (2.4% v 2.4%, 0.0% (−0.3% to 0.3%), P=0.99). Readmissions for the 15 medical conditions at 30 days were significantly lower at accredited hospitals than at state survey hospitals (22.4% v 23.2%, 0.8% (0.4% to 1.3%), P<0.001) but did not differ for the surgical conditions (15.9% v 15.6%, 0.3% (−1.2% to 1.6%), P=0.75).

2014-2017

https://www.ncbi.nlm.nih.gov/pubmed/30337294

accreditation, patient outcomes, 30-day mortality, hospital readmission

Mixed

Chuang S, Howley PH, Gonzales SS.

International Journal for Quality in Health Care, 2018, 1–7.

2018

Hospital

Hospital (HAP)

Not applicable

Yes

To explore the implementation patterns of hospital accreditation through the lens of a systems-theory based model, and determine an international accreditation implementation typology.

Descriptive Study

A qualitative comparative study of five established international hospital accreditation systems in five countries (America, Canada, Australia, Taiwan and France) was undertaken based on a systems-theoretic holistic healthcare systems relationship model. A set of key attributes relevant to three systems-theoretic model relationships guided data collection, comparison and synthesis. This involved three stages: (1) literature review for identification of a set of attributes relevant to the relationships indicated in the holistic healthcare systems relationship (HHSR) model as a data collection guideline and comparative criteria; (2) a multi-method search strategy for collection of accreditation program data in the five countries based on the defined attributes; (3) analysis of differences and similarities between the five countries’ programs, followed by synthesis for typology development.

An accreditation implementation typology was developed based on the data synthesis of the similarities and differences among the relationships. A typology including five implementation types of hospital accreditation systems (TYPE I–V) was induced. TYPE I is a basic stand-alone accreditation system. The higher types represent stronger relationships among accreditation system, healthcare organizations and quality measurement systems. The five settings have shifted their accreditation approaches from the basic type (TYPE I). The Joint Commission was TYPE V; the accreditation system integrates with the clinical indicators - quality measurement systems (CI-QMS) and collaborates with patient-satisfaction QMSs during the accreditation process, and all reports are available on the same electronic platform, i.e. the Quality Check website.

https://www.ncbi.nlm.nih.gov/pubmed/30165637

hospital accreditation, quality measurement system, continuous quality improvement, systems-theory

Positive

Nair S, Chen J.

Journal for Healthcare Quality, 2018, 40(5), 301–309.

2018

Ambulatory clinic general

Ambulatory Health Care (AMB)

Not applicable

No

To examine the relationship between ambulatory care accreditation and quality of care and patient health outcomes in Health Resources and Services Administration (HRSA)–supported health centers.

Cross-Sectional Study

Cross-sectional study used secondary data to examine the relationship between accreditation and quality of care in health centers. The main data set was the 2013 Uniform Data System (UDS).

Adjusted analyses show that accredited health centers achieved higher performance on adult weight screening and follow-up (coef= 0.037, p= <.05), tobacco cessation intervention (coef= 0.042, p= <.05), and use of lipid-lowering therapy (coef= 0.028, p= <.05). Study results show that universal accreditation could result in additional 552,087 adult patients receiving weight screening and follow-up, 157,434 receiving tobacco cessation intervention and 25,289 receiving lipid-lowering therapy. Findings suggest that Health Resources and Services Administration (HRSA) support for accreditation has the potential to improve quality of care and as a result, reduce health disparities in underserved communities across the United States.

2013

https://www.ncbi.nlm.nih.gov/pubmed/29095745

federally qualified health center, accreditation, quality of care, quality improvement

Positive

Janevic T, Egorova NN, Zeitlin J, Balbierz A, Hebert PL, Howell EA.

Medical Care. 2018 Jun 1;56(6):470-6.

2018

Hospital

Hospital (HAP)

No

To estimate trends and differences in obstetric quality measures by race/ethnicity.

Cross-Sectional Study

The authors used 2008-2014 linked birth certificate-hospital discharge data from New York City to measure elective delivery (ED) before 39 gestational weeks (ED<39), low-risk cesarean, and episiotomy by race/ethnicity. Measures were following the Joint Commission and National Quality Forum specifications. Average annual percent change (AAPC) was estimated using Poisson regression for each measure by race/ethnicity. Risk differences (RD) for non-Hispanic black women, Hispanic women, and Asian women compared with non-Hispanic white women were calculated.

ED<39 decreased among whites [AAPC=-2.7; 95% confidence interval (CI), -3.7 to -1.7), while it increased among blacks (AAPC=1.3; 95% CI, 0.1-2.6) and Hispanics (AAPC=2.4; 95% CI, 1.4-3.4). Low-risk cesarean decreased among whites (AAPC=-2.8; 95% CI, -4.6 to -1.0), and episiotomy decreased among all groups. In 2008, white women had higher risk of most measures, but by 2014 incidence of ED<39 was increased among Hispanics (RD=2/100 deliveries; 95% CI, 2-4) and low-risk cesarean was increased among blacks (RD=3/100; 95% CI, 0.5-6), compared with whites. Incidence of episiotomy was lower among blacks and Hispanics than whites, and higher among Asian women throughout the study period.

Washington CW, Taylor LI, Dambrino RJ, Clark PR, Zipfel GJ.

Journal of Neurosurgery. 2018 Aug 1;129(2):471-9.

2018

Hospital

Not applicable

Disease-specific Care

No

To investigate the hypothesis that in the treatment of unruptured cerebral aneurysms (UCAs), Patient Safety Indicator (PSI) events, a surrogate for quality care, are less likely to occur in hospitals meeting the volume thresholds defined by the Joint Commission for Comprehensive Stroke Center (CSC) certification. The authors also sought to understand the relationship between treatment volumes and PSI events in the patient population.

Observational Study

Patients treated electively for an unruptured cerebral aneurysm were selected using the 2002-2011 National (nationwide) Inpatient Sample. The patients were evaluated for PSI events (e.g., pressure ulcers, retained surgical item, perioperative hemorrhage, pulmonary embolism, sepsis) defined by the Agency of Healthcare Research and Quality (AHRQ)-specified ICD-9 codes. Hospitals were categorized by treatment volume into CSC or non-CSC volume status based on the Joint Commission's annual volume thresholds of at least 20 patients with subarachnoid hemorrhage and performance of 15 or more endovascular coiling or surgical clipping procedures for aneurysms.

A total of 65,824 patients underwent treatment for an unruptured cerebral aneurysm. There were 4818 patients (7.3%) in whom at least 1 PSI event occurred. The overall inpatient mortality rate was 0.7%. In patients with a PSI event, this rate increased to 7% compared with 0.2% in patients without a PSI event (p<0.0001). The overall rate of poor outcome was 3.8%. In patients with a PSI event, this rate increased to 23.3% compared with 2.3% in patients without a PSI event (p<0.0001). There were significant differences in PSI event, poor outcome, and mortality rates between non-CSC and CSC volume-status hospitals (PSI event, 8.4% vs 7.2%; poor outcome, 5.1% vs 3.6%; and mortality, 1 % vs 0.6%). In multivariate analysis, all patients treated at a non-CSC volume-status hospital were more likely to suffer a PSI event with an OR of 1.2 (1.1-1.3). In patients who underwent surgery, this relationship was more substantial, with an OR OF 1.4 (1.2-1.6). The relationship was not significant in the endovascularly treated patients.

2002-2011

https://www.ncbi.nlm.nih.gov/pubmed/29053070

aneurysm, Comprehensive Stroke Center

Positive

Inomata T, Mizuno J, Iwagami M, Kawasaki S, Shimada A, Inada E…, Amano A.

PloS One. 2018 Sep 21;13(9):e0204301.

2018

Hospital

Hospital (HAP)

Yes

To examine the impact of Joint Commission International accreditation on operating room efficiency by comparing relevant time periods in the operating room for patients who received surgeries before and after Joint Commission International accreditation at Juntendo University Hospital.

Observational Study

Patients were considered for the study if they received elective and emergency surgeries under general anesthesia at Juntendo Hospital between December 2014 and June 2016. Patients were classified as before and after Joint Commission International accreditation on December 12, 2015. The primary outcome was total procedure/surgery time (TPT). Secondary outcomes include five time periods comprising the TPT: pre-anesthesia time (preAt), anesthesia induction time (AIT), procedure/surgery time (PT), anesthesia awareness time (AAT) and post-anesthesia time (postAT). The authors compared these time periods between patients before and after Joint Commission International accreditation and patients were matched for age, sex and the specific type of surgery. Chi-square tests, paired t-tests, and unpaired t-tests were used.

Of the 8,835 and 4,453 patients receiving surgery before and after Joint Commission International accreditation, 3,222 were matched for age, sex and specific surgery, resulting in groups for comparison. The TPT (197+/- 133.3 minutes vs. 195.2 +/- 131.9 minutes, before vs. after Joint Commission International, p= 0.494) was not significantly different between groups. The preAT was significantly increased after Joint Commission International accreditation (8.2 +/- 6.9 minutes vs. 8.5 +/- 6.9 minutes, before vs. after Joint Commission International, respectively, p=0.028), whereas the AIT was significantly reduced after Joint Commission International accreditation (34.4 +/- 16.1 minutes vs. 33.6 +/- 15.4 minutes, before vs. after Joint Commission International, respectively, p=0.037). However, PT (42.6 +/- 17.4 minutes, before vs. after Joint Commission International, p=0.318) and postPT (20.7 +/- 11.7 minutes vs. 20.6 +/- 10.8 minutes, before vs. after Joint Commission International, p=0.920) were not significantly different between groups.

2014-2016

https://www.ncbi.nlm.nih.gov/pubmed/30240416

operating room, surgery time

Positive

Barghouthi EA, Imam A.

Health Science Journal. 2018 Jan 1;12(1).

2018

Hospital

Hospital (HAP)

Not applicable

Yes

To assess the level of patient satisfation in Joint Commission International-accredited and non-accredited hospitals in Palestine.

Cross-Sectional Study

Quantitative descriptive cross-sectional design used to compare patient satisfaction in two Palestinian hospitals. The researcher measured the satisfaction between October and November 2016 using the SERVQUAL tool to assess five dimensions of quality (reliability, assurance, tangibility, empathy, and responsiveness). The sample size included was 332 inpatients, who were recruited by the researcher through convenient sampling method, and the data was analyzed using SPSS version 18.

The patients had a high level of satisfaction with a total mean of (4.34) out of (5) and a (0.70) standard deviation. The results indicated that there are statistically significant differences at the level (P<0.05) between the means of patient satisfaction relating to patient demographic characteristics (with the exception of gender), and also indicated that there are no statistically significant differences related to hospital characteristics. Moreover, for all satisfaction dimensions patients have more satisfaction in non-accredited hospitals than accredited ones.

2016

patient satisfaction

Mixed

AbuDagga A, Weech-Maldonado R, Tian F.

Health Care Management Review. 2018 Oct 1.

2018

Home Care (OME)

No

To examine the associations between six organizational characteristics and the provision of cultural competency training (CCT) in home health care and hospice agencies.

Cross-Sectional Study

The study used cross-sectional data from the agency component of the 2007 National Home and Hospice Care Survey. The CCT provision composite was composed of three items: whether the agency provides mandatory cultural training to understand cultural differences/beliefs that may affect delivery of services to (a) all administrators, clerical, and management staff; (b) all direct service providers; and © all volunteers. Organizational characteristics were volume, ownership status, chain membership, teaching status, Joint Commission accreditation status, and formal contracts.

The weighted sample (n= 14,469) had a mean CCT provision score of 1.75 (range- 0-3). Our ordinal logistic regression model showed that Joint Commission accreditation increased CCT provision odds in the home health (odds ratio [OR]= 2.07, 95% confidence interval [CI] [1.01, 4.24]) and hospice (OR= 4.40, 95% CI [2.07, 9.38]) settings. Teaching status increased CCT provision odds (OR= 2.71, 95% CI [1.19, 6.17]) in the home health setting. Formal contracts increased CCT provision odds (OR= 4.03, 95% CI [1.80, 9.00]), whereas not-for-profit ownership decreased CCT provision odds (OR= 0.19, 95% CI [0.07, 0.50]) in the hospice setting.

2007-2008

https://www.ncbi.nlm.nih.gov/pubmed/27984407

cultural competence, disparities, home health, hospice, training

Positive

Singleton JM, Sanchez LD, Masser BA, Reich B.

Internal and Emergency Medicine. 2018 Oct 1;13(7):1105-10.

2018

Hospital

Not applicable

No

To determine the efficiency of an eSignout platform at a community affiliate hospital by comparing emergency department length of stay (LOS) for a 5-month period before and after implementation and to compare the quality assurance (QA) events among admitted patients for the same time period.

Uncontrolled Before-After Study

A retrospective, interventional study was conducted with the main outcome measures including ED LOS with calculation of 95% CI, mean comparison (t test), and number of QA events before and after implementation of the eSignout model. The pre-intervention data collection period took place from April to August 2014, and the post-intervention data collection period occurred during the 5-month period after implementation (April to August 2015). The study was conducted at Beth Israel Deaconess-Needham (BID-Needham), a 58-bed community affiliate of Beth Israel Deaconess Medical Center (BIDMC) located in Needham, Massachusetts, with an annual ED volume of approximately 15,000 patient visits.

Prior to eSighnout implementation, 1045 patients were admitted [mean ED LOS 330.0 min (95% CI 318.6-341.4)]. Following implementation, 1106 patients were admitted [mean ED LOS 338.9 min (95% CI 327.4-350.4, p= 0.2853)]. Nine pre-implementation QA events and six-post implementation events were identified.

2014-2015

https://www.ncbi.nlm.nih.gov/pubmed/29516433

emergency care, quality improvement, information technology, electronic handoff, patient safety

Neutral

Barnett ML, Olenski AR, Jena AB.

JAMA Intern Med. 2017 May 1;177(5):693-700.

2017

Hospital

Hospital (HAP)

Not applicable

No

To assess whether heightened vigilance during survey weeks is associated with improved patient outcomes compared with nonsurvey weeks, particularly in major teaching hospitals.

Observational Study

Quasi-randomized analysis of Medicare admissions at 1984 surveyed hospitals from calendar year 2008 through 2012 in the period from 3 weeks before to 3 weeks after surveys. Outcomes between surveys and surrounding weeks were compared, adjusting for beneficiaries’ sociodemographic and clinical characteristics, with subanalyses for major teaching hospitals. Data analysis was conducted from January 1 to September 1, 2016.

The study sample included 244 787 and 1 462 339 admissions during survey and nonsurvey weeks with similar patient characteristics, reason for admission, and in-hospital procedures across both groups. There were 811 598 (55.5%) women in the nonsurvey weeks (mean [SD] age, 72.84 [14.5] years) and 135 857 (55.5%) in the survey weeks (age, 72.76 [14.5] years). Overall, there was a significant reversible decrease in 30-day mortality for admissions during survey (7.03%) vs nonsurvey weeks (7.21%) (adjusted difference, −0.12%; 95%CI, −0.22%to −0.01%). This observed decrease was larger than 99.5%of mortality changes among 1000 random permutations of hospital survey date combinations, suggesting that observed mortality changes were not attributable to chance alone. Observed mortality reductions were largest in major teaching hospitals, where mortality fell from 6.41% to 5.93% during survey weeks (adjusted difference, −0.38%; 95%CI, −0.74%to −0.03%), a 5.9% relative decrease. There were no significant differences in admission volume, length of stay, or secondary outcomes.

2008-2012

https://www.ncbi.nlm.nih.gov/pubmed/28319229

accreditation, best practices, patient mortality

Positive

Man S, Cox M, Patel P, Smith EE, Reeves MJ, Saver JL … , Fonarow GC.

Stroke, 2017 Feb 48(2), 412-419.

2017

Hospital

Not applicable

Disease-specific Care

No

To evaluate whether Primary Stroke Centers (PSCs) certified by different organizations have similar quality of care and in-hospital outcomes.

Observational Study

The study population consisted of acute ischemic stroke patients who were admitted to PSCs participating in Get With The Guidelines-Stroke program between January 1, 2010, and December 31, 2012. Measures of care quality and outcomes were compared among the 4 different PSC certifications.

A total of 477 297 acute ischemic stroke admissions were identified from 977 certified PSCs (73.8% Joint Commission, 3.7% Det Norske Veritas, 1.2% Healthcare Facilities Accreditation Program, and 21.3% State-based). Composite care quality was generally similar among the 4 groups of hospitals, although state-based PSCs under-performed Joint Commission PSCs in a few key measures, including intravenous tissue-type plasminogen activator use. The rates of tissue-type plasminogen activator use were higher in Joint Commission and Det Norske Veritas (9.0% and 9.8%) and lower in State and Healthcare Facilities Accreditation Program certified hospitals (7.1% and 5.9%) (P<0.0001). Door-to-needle times were significantly longer in Healthcare Facilities Accreditation Program hospitals. State PSCs had higher in-hospital risk-adjusted mortality (odds ratio 1.23, 95% confidence intervals 1.07–1.41) compared with Joint Commission PSCs.

2010-2012

https://www.ncbi.nlm.nih.gov/pubmed/28008094

certification, patient outcomes, primary stroke center, stroke

Positive

Williams SC, Morton DJ, Yendro S, Baker DW.

Home Health Care Management and Practice. 2018 Feb;30(1):23-9.

2017

Home Care (OME)

Not applicable

No

To compare Joint Commission-accredited and non-accredited home health agencies over a 3-year period using the Centers for Medicare and Medicaid Services (CMS) Home Health Compare data set.

Descriptive Study

Descriptive study used the CMS Home Health Compare data set to compare accredited and non-accredited performance on the CMS star ratings and 22 quality measures. A longitudinal model was used to determine differences between accredited and nonaccredited organizations on the quality measures. Categorical differences in star ratings and risk-adjusted outcome categories were analyzed using a chi-square test.

Joint Commission-accredited agencies had statistically higher star ratings than non-Joint Commission-accredited organizations (3.4 vs. 3.2, p < .001), and they were more likely to be categorized 4, 4.5, and 5 star organizations (p < .001). Absolute differences between accredited and non-accredited agencies on the OASIS quality measures were generally small but consistently favored accredited facilities over all 3 years studied (p < .05).

2013-2015

http://journals.sagepub.com/doi/full/10.1177/1084822317737249

Home Health Compare, accreditation, home health, quality measures, star ratings

Positive

Mekory TM, Bahat H, Bar-Oz B, Tal O, Berkovitch M, Kozer E.

International Journal for Quality in Health Care. 2017 Mar 10; 10:1-5.

2017

Hospital

Hospital (HAP)

Not applicable

Yes

To evaluate the rate of medication related errors in the pediatric ward and pediatric emergency department (PED), before and after implementing intervention strategies according to the Joint Commission International (JCI) accreditation program.

Cross-Sectional Study

The study was conducted at the PED in a university affiliated, 850 beds general hospital in Israel. All medical charts of pediatric patients admitted in February 2013 and February 2014 were reviewed. Data from patients charts was extracted into a database. To establish the accuracy of data collection, a senior investigator reviewed a random sample of 5% of the charts. The study data points were noted on each chart.

The study collected 937 valid prescription orders and 924 administration orders (1861 medical orders) from February 2013, and 961 valid prescription orders and 958 administration orders (1919 medical orders) from February 2014. After implementing intervention strategies according to the JCI accreditation program, there was a significant reduction in prescribing errors from 6.5 to 4.2% between years 2013 and 2014 (P = 0.03). There was no significant difference in administration error rates between the two periods (104 (11.3%) in the first period and 114 (11.9%) in the second; P = 0.61).

2013-2014

https://www.ncbi.nlm.nih.gov/pubmed/28340029

medical prescribing errors, patient safety, accreditation

Mixed

Fu KA, Razmara A, Cen S, Towfighi A, Mack WJ, Sanossian N.

Clinical Neurology and Neurosurgery. 2017 Jan 1; 164(2018): 39-43.

2017

Hospital

Hospital (HAP)

Not applicable

No

To determine nationwide availability and factors associated with inpatient neurological services.

Cross-Sectional Study

Using the 2011 American Hospital Association survey, this study determined the proportion of hospitals that provided inpatient neurological services. Demographic and household data from the 2010 national census and survey results were utilized to determine regional factors associated with the availability of inpatient neurological services. Using rate ratios, the association was estimated using Poisson regression. Hospitals lacking emergency departments or with a bed size of less than 25 beds were excluded to focus on acute care facilities with the potential to have sub-specialty services.

Of 3969 hospitals that completed the survey, 2017 (65%) provided inpatient neurological services. Hospitals with Joint Commission accreditation were 1.35 times more likely (95% CI: 1.16–1.57) to have inpatient neurological services. Compared to small hospitals (bed size 25–36), large hospitals (bed size 246–2264) were 4.53 times more likely (95% CI: 2.79–7.35) to provide inpatient neurological services. Hospitals that were the sole community provider or were non-federal governmental hospitals had a lower probability of providing inpatient neurological services with rate ratio of 0.65 (95% CI: 0.5–0.84) and 0.81 (95% CI: 0.7–0.94), respectively.

2010

https://www.ncbi.nlm.nih.gov/pubmed/29156330

hospitals, inpatient neurological services, quality improvement, accreditation

Positive

Ross A, Feider L, Nahm ES, Staggers N.

Military Medicine. 2017 May 1;182(5-6):e1688-95.

2017

Ambulatory clinic general

Ambulatory Health Care (AMB)

Not applicable

No

To assess pain reassessment compliance rates, associated documentation, and clinic work flow, and to identify opportunities for improvement.

Cross-Sectional Study

Pain reassessment compliance was evaluated using an Electronic Medical Record (EMR) query for patients treated between February 1 and May 30, 2013, who received Toradol at a large military outpatient clinic (n= 151). In addition, observations of clinic work flow were conducted using tracer methodology as recommended by The Joint Commission to track a convenience sample of 12 patients moving through clinic care processes. Pain reassessment documentation and work flow procedures were then evaluated using the Situation Awareness (SA) framework, which is an approach used to evaluate operational implications of factors affecting staff decisions and performance (e.g., stress and workload, interface design, automation, complexity of work flow, staff abilities and training, goals and expectations).

The Electronic Medical Record (EMR) review revealed compliance rates greater than 90% for all pain reassessment requirements with the exception of the maximum 30-minute interval between initial and follow-up pain assessment required by clinic policy, which had a compliance rate of 38%. Pain reassessments were documented to occur at a mean time of 48.25 minutes after initial assessment. Observations from the tracer methodology (recommended by The Joint Commission), revealed a lack of standardized procedures at the clinic. During the tracer, none of the 12 patient encounters were fully compliant with clinic policies. An analysis of clinic workflow using the SA framework revealed that the SA of clinic staff was impacted by a lack of standardized procedures and heavy reliance on staff memory.

2013

https://www.ncbi.nlm.nih.gov/pubmed/29087912

accreditation, pain assessment, military clinic

Neutral

Seabury S, Bognar K, Xu Y, Huber C, Commerford SR, Tayama D.

The American Journal of Emergency Medicine. 2017 Sep 1;35(9):1234-9.

2017

Hospital

Not applicable

Disease-specific Care

No

To document the quality gaps that exist in stroke care, particularly as measured by alteplase (rt-PA) administration, between metropolitan and non-metropolitan areas and to quantify the extent to which these gaps are associated with disparities in access to neurological services. The authors also sought to explore the impact of potential approaches to bridge the aforementioned gaps.

Cross-Sectional Study

Retrospective study used quality performance data from the 2015 Hospital Compare data-base linked to information on certification status from the Joint Commission and information on local access to neurological services from the Area Health Resources File. The authors used this data to compare stroke care quality according to geographic area, certification, and neurological access.

Non-metropolitan hospitals performed worse than metropolitan hospitals on all assessed stroke care quality measures. The most prevalent disparity occurred in the use of rt-PA (the standard of care for patients with an acute ischemic stroke) for eligible patients (52.2% versus 82.7%, respectively). Certified stroke centers in every geographic designation provided higher quality of care, whereas large variation was observed among non-certified hospitals. Regression analyses suggested that improvements in hospital certification or access to neurologists were associated with absolute improvements of 44.9% and 21.3%, respectively, in the percentage of patients receiving rt-PA.

2013-2014

https://www.ncbi.nlm.nih.gov/pubmed/28431874

stroke, quality of care, telemedicine, stroke certification

Positive

Slivinski A, Jones R, Whitehead H, Hooper V.

Journal of Emergency Nursing. 2017 Jan 1;43(1):24-32.

2017

Critical access hospital

Not applicable

Disease-specific Care

No

To describe one rural hospital's journey to The Joint Commission's Acute Stroke Ready Certification.

Descriptive Study

A multidisciplinary team of emergency department clinicians, hospital leadership, and community participants was formed to develop a structured care algorithm and intensive process improvement initiatives to guide the Acute Stroke Ready Hospital application process.

In the 7 months after implementation, door-to-laboratory results improved by an average of 12 minutes, door-to-computed tomography interpretation improved by 3 minutes, time to intravenous thrombolytics improved to less than 60 minutes, and patient transfer within 2 hours of arrival also improved. Emergency department average response time was reduced by 5 minutes, and time to neurology via telemedicine has been reduced by approximately 10 minutes.

2014-2015

https://www.ncbi.nlm.nih.gov/pubmed/28131346

stroke, Acute Stroke Ready Certification, stroke certification

Positive

Algahtani H, Aldarmahi A, Manlangit Jr J, Shirah B.

Annals of Saudi Medicine. Jul;37(4):326.

2017

Hospital

Hospital (HAP)

Not applicable

Yes

To assess the perceptions of health professionals on the impact of Joint Commission International (JCI) accreditation and implementation of change towards the delivery of quality patient care.

Cross-Sectional Study

Coss-sectional study conducted at King Abdulaziz Medical City. The hospital has 650 beds in different tertiary care specialties. Between June 2016 and September 2016, a validated questionnaire was distributed to physicians, nurses, medical technologists, dieticians, and other allied healthcare professionals. The questionnaire consisted of 19 items covering participation in accreditation, benefits of accreditation, and the quality of results of accreditation. Demographic data collected on the participants included age, gender, educational attainment, profession, length of service, and department. Data were analyzed using a one-way ANOVA test and a t-test.

Hospital accreditation was given a worthy response from the general view of 901 health professionals. The mean (standard deviation) of scores on a 5-point Likert scale were 3.79 (0.68) for participation in accreditation, 3.85 (0.84) for benefits, and 3.54 (1.01) for quality of results.

2016

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150592/

hospital accreditation, perception of accreditation, quality of care

Positive

Reddy LKV.

Health Science Journal. 2017 Mar 1;11(2).

2017

Hospital

Hospital (HAP)

Yes

To explore the potential ways of attracting medical tourists to Joint Commission International hospitals in Saudi Arabia and to measure the effectiveness of marketing mix on Saudi Arabian medical tourism.

Cross-Sectional Study

A cross-sectional quantitative survey was conducted using a structured questionnaire during the period from October 2016 to January 2017 to address the objectives. The non probability purposive sampling technique was used to collect the data to a target of 210 respondents. However, at the end of the data collection, 180 valid questionnaires were considered in the final analysis and the response rate was 85.71%. The respondents consisted of the doctors, nurses, and hospital administrators in three Joint Commission-accredited hospitals in Saudi Arabia, namely King Khaled Hospital, Hail; Aseer central Hospital, Abha and King Salman Hospital, Riyadh. The questionnaire consists of close ended responses such as (a) socio-demographic information, (b) ranking the potential ways in attracting medical tourists, © market mix questions- place, price, product, promotion and (d) open-ended question for suggestions improving medical tourism. Data analysis included using Cronbach's alpha, parametric multiple regression, and correlation analysis.

The probable approaches in attracting medical tourists were rated as first and second, respectively, for the characteristics measured in choosing a treatment of patients (11.74%) and prerequisites thought of the patients before coming to host countries for treatment (11.68%). The regression and correlation analysis were conducted to analyze correlations between the marketing mix variables for which the result is p<0.05 and there is a positive correlation between the variables except place-price, promotion-place, promotion-price. The study concluded that marketing mix plays an important role in attracting medical tourists to the Kingdom of Saudi Arabia. The question regarding the potentiality of the Kingdom of Saudi Arabia (KSA) to attract medical tourists indicated that 78.88% of respondents gave second rank to hospitals with accreditations (n=142).

2016-2017

medical tourism, marketing mix

Positive

Saut AM, Berssaneti FT, Moreno MC.

International Journal for Quality in Health Care, 2017, 29(5), 713–721

2017

Hospital

Hospital (HAP)

Not applicable

Yes

The aim of this study was to evaluate the impact of accreditation programs on Brazilian healthcare organizations.

Cross-Sectional Study

The study evaluated the impact of accreditation programs on healthcare organizations from the Federal District and from 18 Brazilian states. A web-based questionnaire survey was undertaken between February and May 2016. Quality managers of 141 Brazilian healthcare organizations were the main respondents of the study. The questionnaire was applied to not accredited and accredited organizations. The main outcome measures were patient safety activities, quality management activities, planning activities—policies and strategies, patient involvement, involvement of professionals in the quality programs, monitoring of patient safety goals, organizational impact and financial impacts.

The study identified 13 organizational impacts of accreditation. There was evidence of significant and moderate correlation between the status of accreditation and patient safety activities, quality management activities, planning activities—policies and strategies, and involvement of professionals in the quality programs. The correlation between accreditation status and patient involvement was significant but weak, suggesting that this issue should be treated with a specific policy. The impact of accreditation on the financial results was not confirmed as relevant; however, the need for investment in the planning stage was validated. The impact of accreditation is mainly related to internal processes, culture, training, institutional image and competitive differentiation.

2016

https://www.ncbi.nlm.nih.gov/pubmed/28992152

Quality improvement, accreditation, patient safety, surveys

Positive

Kagan I, Farkash-Fink N, Fish M.

J Nurs Care Qual. 2016 Oct-Dec;31(4):1-8.

2016

Hospital

Hospital (HAP)

Not applicable

Yes

To evaluate the nursing work climate at ward level, before and after accreditation by Joint Commission International at one tertiary medical center in Israel.

Uncontrolled Before-After Study

A before-and-after evaluation study using a questionnaire of nursing staff perceptions of accreditation effects. Three samples were used: (1) pre-Joint Commission, (2) post-Joint Commission, and (3) a paired pre-post sample.

Post-accreditation by Joint Commission International, physician-nurse relations improved; the involvement of social workers, dieticians, and physiotherapists increased; support services responded more quickly to requests; and management-line staff relations became closer. Nurses from all levels of the organizational hierarchy led the change process, and as a result, their status in the hospital was enhanced by recognition of their role as leader/coordinator and case manager of clinical care improvement. They, as a result, had the ability to make organizational and managerial decisions with greater independence. Nurses also reported that the efforts demanded by Joint Commission had generated a better across the-board working climate, improving interaction among professions, departments, and units. These outcomes satisfactorily met the key goal that Rabin Medical Center nursing managers had attached to the accreditation process, namely, to create a ward and organizational work climate that was improvement-oriented.

Not Identified

https://www.ncbi.nlm.nih.gov/pubmed/27096904

accreditation, hospitals

Positive

Chaudhry SA, Afzal MR, Chaudhry BZ, Zafar TT, Safdar A, Kassab MY…, Qureshi AI.

J Stroke Cerebrovasc Dis. 2016 Aug;25(8):1960-5.

2016

Hospital

Not applicable

Disease-specific Care

No

To identify the beneficial effects of primary stroke centers (PSCs) certification by the Joint Commission, this study compared the rates of in-hospital adverse events and discharge outcomes among ischemic stroke patients admitted to PSCs and those admitted to non-PSC hospitals in the United States.

Observational Study

Data was used from the Nationwide Inpatient Sample from 2010 and 2011. The analysis was limited to states that publicly reported hospital identity. The PSCs were identified by matching the Nationwide Inpatient Sample hospital files with the list provided by the Joint Commission. The analysis was limited to patients (age ≥18 years) discharged with a principal diagnosis of ischemic stroke (International Classification of Disease, 9th Revision, codes 433.x1, 434.x1).

The study identified 123,131 ischemic stroke patients from 28 states. A total of 72,982 (59.3%) patients were admitted to PSCs. After adjusting for age, gender, race or ethnicity, comorbidities, All Patients Refined Diagnosis Related Groups (APR-DRG)-based disease severity, and hospital teaching status, patients admitted to PSCs were at a lower risk of in-hospital adverse events complications: pneumonia (odds ratio [OR], .8; 95% confidence interval [CI], .7-.8) and sepsis (OR, .7; 95% CI, .6-.8). Patients admitted to PSCs were more likely to receive thrombolysis (OR, 1.6; 95% CI, 1.5-1.7). The mean cost of hospitalization (95% CI) of the patients was significantly higher in patients admitted at PSCs compared with those admitted at non-PSC hospitals $47621 (47099-48144) vs. $35229n (34803-35654), P < .0001). The patients admitted to PSCs had lower inpatient mortality (OR, .8; 95% CI, .8-.9) and were more likely to be discharged with none to minimal disability (OR, 1.1; 95% CI, 1.0-1.1).

Compared with non-PSC admissions, patients admitted to PSCs are less likely to experience hospital adverse events and more likely to experience better discharge outcomes.

2010-2011

http://www.ncbi.nlm.nih.gov/pubmed/27209089

certifed stroke center, in-hospital adverse events, ischemic stroke, outcomes, primary stroke centers, thrombolysis

Positive

Williams SC, Morton DJ, Braun BI, Longo BA, Baker DW.

J Am Med Dir Assoc. 2017 Jan;18(1):24-29.

2016

Nursing home

Nursing Care Center (NCC)

Not applicable

No

To compare quality ratings of accredited and non-accredited nursing homes using the publicly available Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare data set.

Cross-Sectional Study

This cross-sectional study compared the performance of 711 Joint Commission-accredited nursing homes (81 of which also had Post-Acute Care Certification) to 14,926 non-Joint Commission accredited facilities using the Nursing Home Compare data set (as downloaded on April 2015). Measures included the overall Five-Star Quality Rating and its four components (health inspection, quality measures, staffing, and RN staffing), the 18 Nursing Home Compare quality measures (5 short-stay measures, 13 long-stay measures), as well as inspection deficiencies, fines, and payment denials. T tests were used to assess differences in rates for Joint Commission-accredited nursing homes versus non-Joint Commission-accredited nursing homes for quality measures, ratings, and fine amounts. Analysis of variance models were used to determine differences in rates using Joint Commission accreditation status, nursing home size based on number of beds, and ownership type. An additional model with an interaction term using Joint Commission accreditation status and Joint Commission Post-Acute Care Certification status was used to determine differences in rates for Post-Acute Care Certified nursing homes. Binary variables (eg, deficiency type, fines, and payment denials) were evaluated using a logistic regression model with the same covariates.

After controlling for the influences of facility size and ownership type, Joint Commission-accredited nursing homes had significantly higher star ratings than non-Joint Commission-accredited nursing homes on each of the star rating component subscales (P < .05) (but not on the overall star rating), and Joint Commission-accredited nursing homes with Post-Acute Care Certification performed statistically better on the overall star rating, as well as 3 of the 4 subscales (P < .05). Joint Commission-accredited nursing homes had statistically fewer deficiencies than non-Joint Commission-accredited nursing homes (P < .001), were less likely to have immediate jeopardy or widespread deficiencies (P < .001), and had fewer payment denials (P < .001) and lower fines (P < .001).

2015

https://www.ncbi.nlm.nih.gov/pubmed/27600192

accreditation, nursing homes, quality ratings

Positive

Chen M, Zhou Q.

Clin Interv Aging. 2016; 11:1575-1577.

2016

Hospital

Hospital (HAP)

Not applicable

Yes

To provide their perspective in regards to pharmacotherapy in geriatric patients.

Case Study

N/A

The Second Affiliated Hospital, School of Medicine, Zhejiang University, People's Republic of China, successfully improved the appropriateness of physician orders for oral medication in geriatric VIP patients during the journey to Joint Commission International accreditation. A pharmacist-led multidisciplinary intervention program significantly reduced the proportion of drug-related problems from 13.0% (before Joint Commission International accreditation) to 3.5% (after Joint Commission International accreditation) (P<0.01).

Not Identified

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108496/

accreditation, geriatric patients, Joint Commission International, pharmacists, pharmacotherapy

Positive

Fiore MC, Adsit R.

Jt Comm J Qual Patient Saf. 2016 May;42(5):207-208.

2016

Hospital

Hospital (HAP)

Not applicable

No

To describe two policy developments that may help enhance tobacco cessation treatment for patients visiting healthcare settings including patients who are hospitalized: The Joint Commission's January 2012 Tobacco Cessation Performance Measure Set, and passage of the Affordable Care Act (ACA) with its mandate that insurers provide coverage for evidence-based prevention services, including smoking cessation, without barriers and without co-pays.

Not a Study

In January 2012, The Joint Commission released its Tobacco Cessation Performance Measure Set, which was predicated on some key findings, such as the fact that many patients’ hospitalizations are directly caused by smoking, making intervention during this time particularly salient. In addition, because all Joint Commission–accredited hospitals are required to be generally smoke free, admission to a hospital forces an individual who smokes to abstain during the hospitalization, so that he or she may be open during this time to making a quit attempt.

As of March 2016, 768 (approximately 20%) of 3,705 hospitals were reporting their performance on the tobacco cessation measure set.

In this issue of The Joint Commission Journal on Quality and Patient Safety, two articles provide additional information and guidance as hospitals move to implement the Joint Commission Tobacco Cessation Performance Measure Set and use the ACA insurance coverage mandate to help more of their patients quit tobacco. In “Two Years in the Life of a University Hospital Tobacco Cessation Service: Recommendations for Improving the Quality of Referrals,” Bjornson and colleagues describe two years of experience of the Oregon Health & Science University (OHSU) Tobacco Cessation Consult Service, a comprehensive program to help hospitalized OHSU smokers quit.

In a second article in this issue of The Joint Commission Journal on Quality and Patient Safety, “Improving Quality of Care for Hospitalized Smokers with HIV: Tobacco Dependence Treatment Referral and Utilization,” Fitzgerald and colleagues highlight a tragic paradox—although treatments for HIV disease have improved dramatically during the last decade, smoking rates among these patients remain high, and only a small proportion of such patients receive treatment for their tobacco dependence.

Not Identified

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4833016/

performance measures, smoking cessation

Positive

Kessler C, Tsipis NE, Seaberg D, Walker GN, Andolsek K.

J Healthc Manag. 2016 May-Jun;61(3):230-41.

2016

Hospital

Hospital (HAP)

Not applicable

No

To provide an overview of relevant policies that reflect best practices that could affect transition of care for all specialties, with recommendations most relevant for the emergency department. This review is meant to be a practical reference about transitions of care, tailored to emergency medicine physicians and the teams that make emergency departments run.

Not a Study

This review includes a comprehensive examination of various regulatory, accreditation, and policy-based elements with which EM physicians interact in their daily practice. The content is organized into five domains: Accreditation Council for Graduate Medical Education (ACGME), The Joint Commission, Affordable Care Act, National Quality Forum (NQF), and accountable care organizations.

The Joint Commission is influential with regard to the practice of emergency medicine, and The Joint Commission's Center for Transforming Healthcare has committed to improving transition of care. In August 2009, 10 of the center's collaborating hospitals and health systems began a project focused on hand-off communications. In 2012 the Joint Commission Center for Transforming Healthcare generated a customized hand-off communications tool for organizations to use to measure their organization's actual performance and identify barriers to excellent performance, as well as to direct them to proven solutions to address their unique barriers (Joint Commission Center for Transforming Healthcare, 2014). Developed by the hospitals that helped identify persistent problems, the hand-off communications tool is a targeted compilation of solutions linked to specific root causes of unsuccessful hand-offs. The Targeted Solutions Tool for Hand Off Communications uses the acronym SHARE-standardize critical content, hardwired within your system, allow opportunity to ask questions, reinforce quality and measurement, and educate and coach.

The Joint Commission observed that the pilot organizations that implemented solutions based on SHARE principles demonstrated the following: a greater than 50% reduction in defective hand-offs and an increase in patient and family satisfaction; staff satisfaction; and successful transfers of patients. Through the Center for Transforming Healthcare and other initiatives, The Joint Commission provides additional evidence of the need to prioritize improvements in transitions of care.

Not Identified

https://www.ncbi.nlm.nih.gov/pubmed/27356450

United States

Positive

Lee MY.

J Behav Health Serv Res. 2016 Dec 05.

2016

Hospital, Behavioral health hospital, Behavioral health outpatient

Hospital (HAP), Behavioral Health Care (BHC)

Not applicable

No

To explore national accreditation rates and the relationship between accreditation status and organizational characteristics and quality indicators in children's mental health. The study also provides the first national perspective on the three largest accreditors of mental health care-The Joint Commission, the Commission on Accreditation of Rehabilitation Facilities, and the Council on Accreditation.

Cross-Sectional Study

Data from the Substance Abuse and Mental Health Services Administration's (SAMHSA's) National Survey of Mental Health Treatment Facilities (NSMHTF) were used from 8,247 facilities that serve children and/or adolescents. Nearly 60% (n=4,925) of the facilities were accredited by the Council on Accreditation (COA), the Commission on Accreditation of Rehabilitation Facilities (CARF), or The Joint Commission (TJC).

Variables examined as quality indicators from the NSMHTF included the following: facilities’ implementation of QA practices (regularly scheduled case reviews with supervisor and a quality review committee, client outcome follow-up after discharge, periodic utilization review, periodic client satisfaction surveys, and monitoring continuing education requirements for professional staff), provision of evidence supported treatments (ESTs) most relevant to children’s mental health (cognitive behavioral therapy [CBT], therapeutic foster care [TFC], multi-systemic therapy (MST), and functional family therapy [FFT]), and practices to increase client safety (facility’s report of adopting initiatives toward reduction of seclusion and restraints).

Data analyses were conducted using SAS 9.3. Descriptive statistics revealed the proportion of the accredited facilities. Chi-square analyses examined if accreditation status was associated with each of the facility characteristics and with the facilities’ reporting of each of the quality indicators.

Of the 8247 child and/or adolescent serving mental health facilities, 60% (n = 4925) were accredited by at least one of the three accreditors — Council on Accreditation, Commission on Accreditation of Rehabilitation Facilities, or The Joint Commission. Among those accredited facilities, The Joint Commission was the sole accreditor for 44% (n = 2171), Commission on Accreditation of Rehabilitation Facilities was for 27%, and Council on Accreditation was for 25%, and 5% (n = 221) of the facilities were accredited by more than one accreditor. The Joint Commission and Commission on Accreditation of Rehabilitation Facilities was the most popular combination (n = 153), followed by The Joint Commission and Council on Accreditation (n = 46), Council on Accreditation and CARF (n = 10), and all three accreditors (The Joint Commission, Commission on Accreditation of Rehabilitation Facilities, and Council on Accreditation; n = 12).

Compared to non-accredited facilities, more accredited facilities reported greater number of admissions, acceptance of government funding and client funds, and implementation of several quality indicators. More accredited facilities reported implementation of each QA practice—regularly scheduled case reviews with a supervisor and a quality review committee, client outcome follow-up after discharge, periodic utilization review, periodic client satisfaction surveys, and monitoring continuing education requirements for professional staff. Accreditation status was not significantly associated with facilities providing CBT, MST, or FFT. There was a significant association between accreditation status and facilities providing TFC; more facilities that provided TFC were accredited than not accredited, but among accredited facilities, more did not provide TFC (n = 4190, 85.08%). In addition, accreditation status and safety were significantly associated; compared to non-accredited facilities, more accredited facilities reported adopting initiatives to reduce seclusion and restraint practices.

2008-2009

https://www.ncbi.nlm.nih.gov/pubmed/27921199

accreditation, children, quality

Positive

Weeks W, Kotzbauer GR, Weinstein JN.

Milbank Q. 2016 Jun;94(2):314-33.

2016

Hospital

Hospital (HAP)

Not applicable

No

To construct a hospital-level measure of value from a numerator composed of quality of care measures (satisfaction, use of timely and effective care, and avoidance of harms) and a denominator composed of risk-adjusted 30-day episode-of care expenditures for four specific procedures including myocardial infarction, coronary artery bypass grafting, colectomy, and hip replacement surgery.

Cross-Sectional Study

Using Hospital Compare and Medicare expenditure data, the authors constructed a hospital-level measure of value from a numerator composed of quality-of-care measures (satisfaction, use of timely and effective care, and avoidance of harms) and a denominator composed of risk-adjusted 30-day episode-of-care expenditures for acute myocardial infarction (1,900 hospitals), coronary artery bypass grafting (884 hospitals), colectomy (1,252 hospitals), and hip replacement surgery (1,243 hospitals).

The study found substantial variation in aggregate measures of quality, cost, and value at the hospital level. Value calculation provided additional richness when compared to assessment based on quality or cost alone: about 50% of hospitals in an extreme quality- (and about 65% more in an extreme cost-) quintile were in the same extreme value quintile.

With the exception of coronary artery bypass grafting, higher-value hospitals were larger and had a higher average daily census than lower-value hospitals, but were no more likely to be accredited by the Joint Commission or to have a residency program accredited by the American Council of Graduate Medical Education.

2012

https://www.ncbi.nlm.nih.gov/pubmed/27265559

expenditures, quality, value

Neutral

Fang X, Zhu LL, Pan SD, Xia P, Chen M, Zhou Q.

Therapeutics and Clinical Risk Management. 2016;12:535-544.

2016

Hospital

Hospital (HAP)

Not applicable

Yes

To summarize relevant experiences in narcotics-related risk management toward safe drug administration and to provide some reference for international counterparts.

Longitudinal Studies

Longitudinal follow-up study evaluated risk management experiences by summarizing the organizational, educational, motivational, and information technological measures in storage, prescribing, preparing, dispensing, administration, and monitoring of medication in a large-scale Joint Commission International-accredited academic medical center hospital in the People's Republic of China from 2011-2015.

The intensity of use of meperidine in hospitalized patients in 2015 was one-fourth that in 2011. A 100% implementation rate of standard storage of narcotics has been achieved in the hospital since December 2012. A "Plan, Do, Check, Act" cycle was efficient because the ratio of number of inappropriate narcotics prescriptions to total number of narcotics prescriptions for inpatients decreased from August 2014 to December 2014 (28.22% versus 2.96%, P=0.0000), and it was controlled below 6% from then on. During the journey to good pain management ward accreditation by the Ministry of Health, People's Republic of China, (April 2012-October 2012), the medical oncology ward successfully demonstrated an increase in the pain screening rate at admission from 43.5% to 100%, cancer pain control rate from 85% to 96%, and degree of satisfaction toward pain nursing from 95.4% to 100% (all P-values <0.05). Oral morphine equivalent dosage in the good pain management ward increased from 2.3 mg/patient before June 2012 to 54.74 mg/patient in 2014. From 2011 to 2015, the oral morphine equivalent dose per discharged patient increased from 8.52 mg/person to 20.36 mg/person. A 100% implementation rate of independent double-check prior to narcotic dosing has been achieved since January 2013. From 2014 to 2015, the ratio of number of narcotics-related medication errors to number of discharged patients significantly decreased (6.95% versus 0.99%, P=0.0000).

2011-2015

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827882/

medication errors, medication management, meperidine, narcotics, prescribing, quality improvements, pain management, accreditation, morphine

Positive

Nomura AT, Silva MB, Almeida MD.

Revista Latino-Americana de Efermagem. 2016;24.

2016

Hospital

Hospital (HAP)

Yes

To analyze the quality of nursing documentation by comparing the periods before and after the preparation for the hosptial accreditation and using the Quality of Nursing Diagnoses, Interventions and Outcomes- Brazilian version (Q-DIO- Brazilion version).

Observational Study

Observational study of interventions in a public university hospital, which serves 60 specialties and has approximately 850 beds shared among 10 Nursing Services. The study sample consisted of nursing documentation of 112 medical records for patients hospitalized in the clinical and surgical inpatient units in the period before hospital accreditation and 112 medical records for patients hospitalized after accreditation. The records from each period were compared using the Q-DIO instrument-Brazilian version. Data were also analyzed using chi-square tests and Fisher's exact test.

There was a significant improvement in the quality of nursing documentation. When the total score of the instrument was evaluated, a significant improvement was observed in 24 out of the 29 items (82.8%).

2013-2014

https://www.ncbi.nlm.nih.gov/pubmed/27878216

nursing records, nursing audit, hospital accreditation, education department, hospital

Positive

Halasa YA, Zeng W, Chappy E, Shepard DS.

East Mediterr Health J. 2015 Apr 2;21(2):90-9.

2015

Hospital

Hospital (HAP)

Not applicable

Yes

To quantify the impact of implementing Joint Commission International hospital accreditation standards on 5 selected structural and outcome hospital performance measures, and the monetary value associated with the expected improvement.

Observational Study

The four-year retrospective study compared 2 matched groups of general acute hospitals in Jordan. Difference-in-differences and adjusted covariance analyses were used to test the impact of accreditation on the selected hospital performance measures.

Of the five selected measures, three showed statistically significant effects (all improvements) associated with accreditation: reduction in return to intensive care unit (ICU) within 24 hours of ICU discharge; reduction in staff turnover; and completeness of medical records. The net impact of accreditation was a 1.2 percentage point reduction in patients who returned to the ICU, 12.8% reduction in annual staff turnover and 20.0% improvement in the completeness of medical records. Pooling over three years, these improvements translated into total savings of US$ 593,000 in Jordan’s health-care system. Also, accreditation status was associated with a 119.3% improvement in the quality index compared to 2006.

2006-2009

http://www.ncbi.nlm.nih.gov/pubmed/25876820

accreditation, hospitals

Positive

Bogh SB, Falstie-Jensen AM, Bartels P, Hollnagel E, Johnsen SP.

Int J Qual Health Care. 2015 Oct;27(5):336-43.

2015

Hospital

Hospital (HAP)

Not applicable

Yes

To examine if performance measures improve more in accredited hospitals than in non-accredited hospitals.

Cohort Study

Study participants included all patients admitted for acute stroke, heart failure or ulcer at Danish hospitals. The study intervention was hospital accreditation by either the Joint Commission International or the Health Quality Service. Hospitals were divided into two groups based on accreditation status through the study period. A historical follow-up study was performed using process of care data from all public hospitals in Denmark to examine the development over time in performance measures according to participation in accreditation programs.

Participating in accreditation was not associated with significant improvements in performance measures for acute stroke, heart failure, or ulcer. A total of 27,273 patients were included in the study. 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]).

2004-2008

http://www.ncbi.nlm.nih.gov/pubmed/26239473

accreditation, hospitals, quality indicators, quality of care

Neutral

Rajaram R, Chung JW, Kinnier CV, Barnard C, Mohanty S, Pavey ES…, Bilimoria KY.

JAMA. 2015 Jul 28;314(4):375-83.

2015

Hospital

Hospital (HAP)

Not applicable

No

To examine the characteristics of hospitals penalized by the Hospital-Acquired Condition (HAC) Reduction Program, and to evaluate the association of a summary score of hospital characteristics related to quality with penalization in the HAC program.

Cross-Sectional Study

Data for hospitals participating in the FY2015 Hospital-Acquired Condition (HAC) Reduction Program were obtained from Centers for Medicare and Medicaid Services' (CMS) Hospital Compare and merged with the 2014 American Hospital Association Annual Survey and FY2015 Medicare Impact File. Logistic regression models were developed to examine the association between hospital characteristics and HAC program penalization. An eight-point hospital quality summary score was created using hospital characteristics related to volume, accreditation, and offering of advanced care services. The relationship between the hospital quality summary score and HAC program penalization was examined. Publicly reported process-of-care and outcome measures were examined from four clinical areas (surgery, acute myocardial infarction, heart failure, pneumonia), and their association with the hospital quality summary score was evaluated.

Of the 3284 hospitals participating in the Hospital-Acquired Condition (HAC) program, 721 (22.0%) were penalized. Hospitals were more likely to be penalized if they were: major teaching hospitals (42.3%; OR, 1.58; 95% CI, 1.09-2.29) or very major teaching hospitals (62.2%; OR, 2.61; 95% CI, 1.55-4.39; vs non-teaching hospitals, 17.0%); they cared for more complex patient populations based on case mix index (quartile four vs quartile one: 32.8% vs 12.1%; OR, 1.98; 95% CI, 1.44-2.71); they were accredited by the Joint Commission (24.0% accredited, 14.4% not accredited; odds ratio [OR], 1.33; 95% CI, 1.04-1.70); or they were safety-net hospitals vs non-safety-net hospitals (28.3% vs 19.9%; OR, 1.36; 95% CI, 1.11-1.68). Hospitals with higher hospital quality summary scores had significantly better performance on 9 of 10 publicly reported process and outcomes measures compared with hospitals that had lower quality scores (all P ≤ .01 for trend). However, hospitals with the highest quality score of 8 were penalized significantly more frequently than hospitals with the lowest quality score of 0 (67.3% [37/55] vs 12.6% [53/422]; P < .001 for trend). Among hospitals participating in the HAC Reduction Program, hospitals that were penalized more frequently had more quality accreditation's, offered advanced services, were major teaching institutions, and had better performance on other process and outcome measures. These paradoxical findings suggest that the approach for assessing hospital penalties in the HAC Reduction Program merits reconsideration to ensure it is achieving the intended goals.

2014

http://www.ncbi.nlm.nih.gov/pubmed/26219055

HAC reduction program, accreditation, hospital penalties, hospitals

Negative

Wang HF, Jin JF, Feng XQ, Huang X, Zhu LL, Zhao XY, Zhou Q.

Ther Clin Risk Manag. 2015 Mar 5;11:393-406.

2015

Hospital

Hospital (HAP)

Not applicable

Yes

To assess experience in reducing Medication Administration Errors (MAEs) during the period before and after Joint Commission International accreditation.

Descriptive Study

A 3-and-half-year intervention program focusing on MAEs in inpatient nursing care was performed in a 3,200-bed hospital in Zhejiang Province, People’s Republic of China. Data mining was performed on MAEs derived from a compulsory electronic reporting system. Medication Administration Errors (MAEs) in hospitalized patients during the hospital's journey to Joint Commission International accreditation was compared to the post-Joint Commission International accreditation era (first half-year of 2011 to first half-year of 2014). Comprehensive interventions included organizational, information technology, educational, and process optimization-based measures.

During the journey to Joint Commission International accreditation and in the post-Joint Commission International accreditation era (first half-year of 2011 to first half-year of 2014)the number of (Medication Administration Errors) MAEs continuously decreased from 143 (first half-year of 2012) to 64 (first half-year of 2014), with a decrease in occurrence rate by 60.9% (0.338% versus 0.132%, P<0.05). The number of MAEs related to high-alert medications decreased from 32 (the second half-year of 2011) to 16 (the first half-year of 2014), with a decrease in occurrence rate by 57.9% (0.0787% versus 0.0331%, P<0.05). Omission was the top type of MAE during the first half-year of 2011 to the first half-year of 2014, with a decrease by 50% (40 cases versus 20 cases). Intravenous administration error was the top type of error regarding administration route, but it continuously decreased from 64 (first half-year of 2012) to 27 (first half-year of 2014). More experienced registered nurses made fewer medication errors. The number of MAEs in surgical wards was twice that in medicinal wards. Compared with non-intensive care units, the intensive care units exhibited higher occurrence rates of MAEs (1.81% versus 0.24%, P<0.001).

2011-2014

http://www.ncbi.nlm.nih.gov/pubmed/25767393

medical errors, quality improvement, medication administration

Positive

Aparicio HJ, Carr BG, Kasner SE, Kallan MJ, Albright KC, Kleindorfer DO, Mullen MT.

J Am Heart Assoc. 2015 Oct 14;4(10):e001877.

2015

Hospital

Not applicable

Disease-specific Care

No

To examine the impact of primary stroke centers (PSCs) on racial disparities in rt-PA.

Observational Study

Data was from the Nationwide Inpatient Sample from 2004 to 2010, limited to states that publicly reported hospital identity and race. Hospitals certified as primary stroke centers (PSCs) by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed.

Discharges (304 152 patients) from 26 states met eligibility criteria, and of these 71.5% were white, 15.0% black, 7.9% Hispanic, and 5.6% other. Overall, 24.7% of white, 27.4% of black, 16.2% of Hispanic, and 29.8% of other patients presented to primary stroke centers (PSCs). A higher proportion received rt-PA at primary stroke centers (PSCs) than non-PSCs in all race/ethnic groups (white 7.6% versus 2.6%, black 4.8% versus 2.0%, Hispanic 7.1% versus 2.4%, other 7.2% versus 2.5%, all P<0.001). In a multivariable model adjusting for year, age, sex, insurance, medical comorbidities, a diagnosis-related group–based mortality risk indicator, ZIP code median income, and hospital characteristics, blacks were less likely to receive rt-PA than whites at non-PSCs (odds ratio=0.58, 95% CI 0.50 to 0.67) and PSCs (odds ratio=0.63, 95% CI 0.54 to 0.74) and Hispanics were less likely than whites to receive rt-PA at PSCs (odds ratio=0.77, 95% CI: 0.63 to 0.95). In the fully adjusted model, interaction between race and presentation to a PSC for likelihood of receiving rt-PA did not reach significance (P=0.98). Racial disparities in intravenous rt-PA use were not reduced by presentation to PSCs. Black patients were less likely to receive thrombolytic treatment than white patients at both non-PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt-PA in the fully adjusted model.

2004-2010

https://www.ncbi.nlm.nih.gov/pubmed/26467999

health disparities, health policy, stroke, stroke care, thrombolysis

Neutral

Hornik A, Morgan C, Platakis J, Morales-Vidal S.

Top Stroke Rehabil. 2013 Mar-Apr;20(2):124-30.

2015

Hospital

Not applicable

Disease-specific Care

No

To provide a practical summary of recommendations to develop a primary stroke center, including some pearls that result from the experience of the institution in the field.

Not a Study

This review discusses the brief history of organized stroke care in the United States, evidence to support the value that primary and comprehensive stroke centers may bring, and the criteria and certification process to become a primary or comprehensive stroke center.

The article provided a practical summary of the recommendations to develop a primary stroke center (PSC). The article also commented on the most important aspects of comprehensive stroke centers. There are over 800 primary stroke centers certified by The Joint Commission. Analysis of primary stroke center performance has indicated that establishment of PSCs with concomitant development of formal protocols for stroke care and measurement of adherence to the metrics has been associated with improvement in stroke care. One important step in the pathway to becoming a PSC, is the development of an acute stroke team (AST); written protocols for the use of intravenous thrombolytics in acute stroke have also been shown to enhance administration and reduce complications.

The article also commented on the experience of Loyola University Medical Center and their continued successful primary stroke center certification since 1995. In addition to following mandatory measures and key recommendations, it is optimal for hospitals attempting to obtain certification as a PSC to strive for the best care of stroke patients, providing evidence-based care, improving long-term outcomes, decreasing complications, improving patient satisfaction, improving public confidence in the institution's ability to provide stroke care, attracting and retaining qualified staff, decreasing cost of service delivery, and gaining recognition by various insurance companies and third party payees.

Not Identified

http://www.ncbi.nlm.nih.gov/pubmed/23611853

Positive

Devkaran S, O'Farrell PN.

BMC Health Serv Res. 2015 Apr 3;15:137.

2015

Hospital

Hospital (HAP)

Not applicable

Yes

Interrupted Time Series

The study was conducted in a 150-bed multispecialty hospital in Abu Dhabi, United Arab Emirates. The quality performance outcomes were observed over a 48 month period. The quality performance differences were compared across monthly intervals between two time segments, 1 year pre- accreditation (2009) and 3 years post-accreditation (2010, 2011 and 2012) for the twenty-seven quality measures. The principal data source was a random sample of 12,000 patient records drawn from a population of 50,000 during the study period (January 2009 to December 2012). Each month (during the study period), a simple random sample of 24 percent of patient records was selected and audited, resulting in 324,000 observations. The measures (structure, process, and outcome) are related to important dimensions of quality and patient safety.

The study findings showed that preparation for the accreditation survey results in significant improvement as 74% of the measures had a significant positive pre-accreditation slope. Accreditation had a larger significant negative effect (48% of measures) than a positive effect (4%) on the post accreditation slope of performance. Similarly, accreditation had a larger significant negative change in level (26%) than a positive change in level (7%) after the accreditation survey. Moreover, accreditation had no significant impact on 11 out of the 27 measures. However, there is residual benefit from accreditation three years later with performance maintained at approximately 90%, which is 20 percentage points higher than the baseline level in 2009. The authors concluded that although there is a transient drop in performance immediately after the survey, this study showed that the improvement achieved from accreditation is maintained during the three year accreditation cycle.

2009-2012

https://www.ncbi.nlm.nih.gov/pubmed/25889013

Joint Commission International

Positive

Sutter ME, Wintemute GJ, Clarke SO, Roche BM, Chenoweth JA, Gutierrez R, Albertson TE.

West J Emerg Med. 2015 Dec;16(7):1079-83.

2015

Hospital

Hospital (HAP)

Not applicable

No

To determine if opioid use patterns in one emergency department changed from 2011, before The Joint Commission's 2012 sentinel event program "Safe Use of Opioids in Hospitals" began, to 2013, after the start of the program.

Observational Study

This was a retrospective observational study of all adult emergency department patients who received an intravenous opioid and had a serum creatinine measured. Opioids used, dose prescribed, and serum creatinine were recorded. As an index of the safety of opioids, uses of naloxone after administration of an opioid was recorded.

Morphine was the most commonly used opioid by doses given, but its percentage of opioids used decreased from 68.9% in 2011 to 52.8% in 2013. During the same period, use of hydromorphone increased from 27.5% to 42.9%, while the use of fentanyl changed little (3.6% to 4.3%). The authors concluded that The Joint Commission program was at least indirectly responsible for the changes in relative dosing of opioids. Naloxone administration was rare after an opioid had been given. Opioids were not dosed in an equipotent manner.

2011-2013

https://www.ncbi.nlm.nih.gov/pubmed/26759658

medication safety, opioids

Positive

Zaman MU, Fatima N.

J Coll Physicians Surg Pak. 2015 Oct;25(10):711-2.

2015

Hospital

Hospital (HAP)

Not applicable

No

To provide a prospective on the incentives and disincentives to seek accreditation.

Not a Study

Editorial review on the accreditation of healthcare organizations. Provides a brief description of incentives and challenges related to the healthcare organizations' pursuit of accreditation.

The incentives for a healthcare facility to get accredited are: better chances of funding, better business opportunities and reputation as a certified healthcare facility geared towards patients' safety and care. In United States, an accredited healthcare facility gets eligibility for medicare and other governmental healthcare programs. Joint Commission on Accreditation of Healthcare Organization (JCAHO) gives accredited facility a deemed status for meeting health and safety standards for medicare and medicaid.

Disincentives for seeking accreditation include stringent standards and performance criteria which discourages many healthcare facilities to proceed for accreditation. Another important factor is the cost incurred in the process of obtaining accreditation. In general, amount to be paid to the accreditation body makes only 10% of total cost with the remaining 90% related to site preparation, up-gradation of infrastructure and staff training prior to the survey. Another possible disincentive for accreditation is possible negative impact on the rate of service delivery due to too many checks. These checks, in attempting to maintain the accreditation as de-certification by the accrediting body, would have a serious and negative impact and would put the reputation of the organization at stake.

Not Identified

https://www.ncbi.nlm.nih.gov/pubmed/26454383

cost, incentives, accreditation

Positive

Towers TJ, Clark J.

J Healthc Manag. 2014 Sep-Oct;59(5):323-35.

2014

Hospital

Hospital (HAP)

Not applicable

No

To assess (1) the extent to which mortality rates change with the inspection cycle; (2) the extent to which organizational characteristics provide a "buffering capacity," or a shield against the ebbs and flows of the inspection cycle; and (3) the extent to which fluctuation in mortality rates is ameliorated when site visits are unannounced.

Observational Study

Data source was 10 years' hospital discharge data (1999-2008) for 58 New Jersey hospitals from HCUP State Inpatient Database. Employed ordinary least squares regression models with dependent variable of monthly risk-adjusted mortality rate and independent variables including time to site visit, system affiliation and technological status, teaching status, admission rates, unannounced visit (y/n).

Lower mortality rates were found among low technology hospitals one month post visit. No effect of whether visit was unannounced. While hospitals with low technological status experience temporarily lower mortality rates immediately following an inspection (j3 = -0.0964, p < .01), hospitals with high technological status do not.The authors concluded that in low technology hospitals: (1) accreditation site visits trigger changes in patient care processes—changes that presumably bring these processes into closer alignment with Joint Commission standards; (2) these changes in processes result in improved rates of mortality; and (3) the process changes tend to evaporate in the weeks immediately following the site visit.

1999-2008

http://www.ncbi.nlm.nih.gov/pubmed/25647951

hospitals, mortality

Mixed

Song P, Li W, Zhou Q.

BMC Pharmacol Toxicol. 2014 Feb 26;15:8.

2014

Hospital

Hospital (HAP)

Not applicable

Yes

To examine the effectiveness of stewardship intervention in the outpatient setting and provide some reference for international counterparts.

Uncontrolled Before-After Study

A before-after intervention study, aiming at antibacterial use in outpatients, was performed in a university-affiliated hospital with 2.8 million outpatient visits annually during the journey to Joint Commission International (JCI) accreditation (March of 2012 - March of 2013). Comprehensive intervention measures included formulary adjustment, classification management, motivational, information technological, educational and organizational measures. A defined daily dose (DDD) methodology was applied. Pharmacoeconomic data and drug-related problems (DRPs) were statistically compared between the two phases.

The one-year intervention program on outpatient antibacterial use during the journey to Joint Commission International accreditation reduced the expenditure on antibacterials, improved the appropriateness of antibacterial prescriptions.

The variety of antibacterials available in outpatient pharmacy decreased from 38 to 16. The proportion of antibacterial prescriptions significantly decreased (12.7% versus 9.9%, P < 0.01). The proportion of prescriptions containing the restricted antibacterials was 30.4% in the second phase, significantly lower than the value of 44.7% in the first phase (P < 0.01). The overall proportion of oral versus all antibacterial prescriptions increased (94.0% to 100%, P < 0.01) when measured as defined daily doses. Statistically significant increases in relative percentage of DDDs of oral antibacterials (i.e., DDDs of individual oral antibacterial divided by the sum of DDDs of all antibacterials) were observed with moxifloxacin, levofloxacin, cefuroxime axetil, ornidazole, clindamycin palmitate, cefaclor, amoxicillin, and clarithromycin. Occurrence rate of DRPs decreased from 13.6% to 4.0% (P < 0.01), with a larger decrease seen in surgical clinics (surgical: 19.5% versus 5.6%; internal medicine: 8.4% versus 2.8%, P < 0.01). The total expenditure on antibacterials for outpatients decreased by 34.7% and the intervention program saved about 6 million Chinese Yuan Renminbi (CNY) annually.

2012-2013

http://www.ncbi.nlm.nih.gov/pubmed/24568120

accreditation, antibacterial prescriptions, antibacterial stewardship, outpatient

Positive

Johnson AM, Goldstein LB, Bennett P, O'Brien EC, Rosamond WD; investigators of the Registry of the North Carolina Stroke Care Collaborative.

J Am Heart Assoc. 2014 Apr 10;3(2):e000423.

2014

Hospital

Not applicable

Disease-specific Care

No

To examine differences in changes in the quality of acute stroke care at Joint Commission-certified Primary Stroke Centers (PSCs) versus non-PSCs over time.

Observational Study

This study compared compliance with the Joint Commission's 10 acute stroke care performance measures and defect-free care in Primary Stroke Centers (PSCs) and non-PSCs participating in the Registry of the North Carolina Stroke Care Collaborative from January 2005 through February 2010. It included 29,654 cases presenting at 47 hospitals-10 PSCs, eight preparing for certification, and 29 non-PSCs-representing 43% of North Carolina's non-Veterans Affairs, acute care hospitals

Performance measure compliance increased for all measures for all 3 groups in 2005-2010, with the exception of discharge on antithrombotics, which remained consistently high. Primary Stroke Centers (PSCs) and hospitals preparing for certification had better compliance with all but 2 performance measures compared with non-PSCs (each P<0.01). Defect-free care was delivered most consistently at hospitals preparing for certification (52.8%), followed by PSCs (45.0%) and non-PSCs (21.9%). Between 2005 and 2010, PSCs and hospitals preparing for certification had a higher average annual percent increase in the provision of defect-free care (P=0.01 and 0.04, respectively) compared with non-PSCs.

While room for improvement remains, Primary Stroke Center (PSC) certification is associated with an overall improvement in the quality of stroke care in North Carolina.

2005-2010

http://www.ncbi.nlm.nih.gov/pubmed/24721795

hospitals, stroke certification

Positive

D'Aunno T, Pollack HA, Frimpong JA, Wuchiett D.

J Subst Abuse Treat. 2014 Oct;47(4):245-50.

2014

Behavioral health outpatient

Behavioral Health Care (BHC)

Not applicable

No

To examine the extent in which US methadone maintenance treatment (MMT) programs made changes in the 23 years preceding the study to provide adequate methadone doses; also to identify factors associated with variation in program performance.

Observational Study

Program directors and clinical supervisors of nationally-representative methadone treatment programs were surveyed in 1988 (n=172), 1990 (n=140), 1995 (n=116), 2000 (n=150), 2005 (n=146), and 2011 (n=140).

Efforts to improve methadone treatment practices have made substantial progress, but 23% of patients across the nation are still receiving doses that are too low to be effective. Results show that the proportion of patients who received doses below 60 mg/day-the minimum recommended-declined from 79.5 to 22.8% in a 23-year span.

Results from random effects models show that programs that serve a higher proportion of African-American or Hispanic patients were more likely to report low-dose care. Programs with Joint Commission accreditation were more likely to provide higher doses, as were programs that serve a higher proportion of unemployed and older patients.

The findings show that Joint Commission accredited programs were more motivated to improve quality of care and were relatively resource-rich (funds, staffing, training). In addition, Joint Commission accredited programs were shown to be technology leaders that responded earlier to research documenting the benefits of high methadone doses.

1988, 1990, 2011

https://www.ncbi.nlm.nih.gov/pubmed/25012549

dose levels, methadone, opioid, opioid disorders, organizational correlates

Positive

McDonald CM, Cen S, Ramirez L, Song S, Saver JL, Mack WJ, Sanossian N.

Stroke. 2014 Dec;45(12):3717-9.

2014

Hospital

Not applicable

Disease-specific Care

No

To determine hospital-based factors associated with achievement of Primary Stroke Centers (PSC) certification.

Cross-Sectional Study

The 2011 American Hospital Association survey and the 2010 national census for population and household data were used to identify hospital and demographic factors influencing certification as a Primary Stroke Centers (PSC) by the Joint Commission, Healthcare Facilities Accreditation Program, and DNV Healthcare.

Of the 3,696 hospitals to complete the survey, the 3,069 fulfilling study criteria included 908 Primary Stroke Centers (PSC) (31%) and 2161 non-PSC. Less than one in every three hospitals achieve PSC certification. Independent hospital characteristics associated with PSC certification were Joint Commission accreditation (odds ratio [OR], 3.5; 95% confidence interval [CI], 2.4–5.0), increasing size (per quartile in number of beds; OR, 2.5; 95% CI, 2.1–3.1) and inpatient neurological services (OR, 3.2; 95% CI, 2.4–4.6), number of households per zip code (per 1000 households; OR, 1.1; 95% CI, 1.0–1.2), increasing Hispanic population (by 10% increase; OR, 1.1; 95% CI, 1.0–1.2), and income per household (per $10 000; OR, 1.2; 95% CI, 1.1–1.3). Designation as a sole community provider (OR, 0.22; 0.10–0.47) or governmental hospital control (0.61; 0.44–0.84) was associated with noncertification.

2011-2013

https://www.ncbi.nlm.nih.gov/pubmed/25388418

hospitals, stroke certification

Positive

Liu A, Lawrence N.

J Am Acad Dermatol. 2014 Jun;70(6):1088-91.

2014

Hospital

Hospital (HAP)

Not applicable

No

To determine whether recently established guidelines for the sterilization of surgical instruments have had any clinical impact on post-surgical infection rates.

Uncontrolled Before-After Study

Infections rates after excisional and Mohs micrographic surgery before and after implementation of new Joint Commission sterilization guidelines were examined retrospectively. All surgeries were performed at an academic outpatient office.

The review of infections rates after excisional and Mohs micrographic surgery before and after implementation of new Joint Commission sterilization guidelines revealed no impact on post-surgical infection rates. In all, 1415 patients underwent a total of 1688 surgeries. No significant differences were observed in mean patient age (P = .113), mean number of Mohs micrographic surgical levels (P = .067), final defect size (P = .305), patient gender (P = .072), repair type (P = .691), or infection rate (P = .453). No major differences in predisposing factors were identified in patients who developed post-surgical infections. Changes in surgical instrument sterilization protocols had no impact on post-surgical infection rates. The authors conclude that the implementation of such guidelines places an additional burden on the health care system without providing any improvement in patient outcomes.

2010-2012

http://www.ncbi.nlm.nih.gov/pubmed/24680104

hospital, infection rates

Neutral

Jaber HM.

Diss. Walden University, 2014.

2014

Hospital

Hospital (HAP)

Not applicable

Yes

To assess nurses’ perceptions of the impact of Joint Commission International accreditation on health care quality and to explore the perceived contributing factors that might affect the quality of care.

Cross-Sectional Study

Participants from one accredited and another non-accredited hospital in Saudi Arabia formed the purposive non-probability sample that included 353 nurses. The Wilcoxon rank sum test was used to compare nurses’ assessments of quality at the accredited and non-accredited hospitals. Correlation analysis was carried out to assess the relationship between the accreditation and quality results scales for nurses from the accredited hospital. Spearman correlation analysis was used to examine association between quality improvement activities (leadership, commitment and support, strategic quality planning, human resources utilization, quality management, and use of data) and quality of care ratings by nurses.

The results indicated that Joint Commission International accreditation has a significant impact on quality of care ratings by nurses. Correlation analysis showed a significantly positive correlation between the nurses’ perception of accreditation and the perception of quality of care (r = .54, p <.0001), with an R2 value of .25. Multiple regression analysis showed that leadership commitment was the best predictor of quality of care as perceived by nurses. The authors conclude that this study may foster social change by encouraging hospital administrators and policy makers, particularly in developing countries, to implement quality improvement programs that will eventually improve the health care system in their countries.

Not Identified

Positive

Devkaran S, O'Farrell PN.

BMJ Open. 2014 Aug 5;4(8):e005240.

2014

Hospital

Hospital (HAP)

Not applicable

Yes

To evaluate whether accredited hospitals maintain quality and patient safety standards over the accreditation cycle by testing a life cycle explanation of accreditation on quality measures. Four distinct phases of the accreditation life cycle were defined based on the Joint Commission International process. Predictions concerning the time series trend of compliance during each phase were specified and tested.

Interrupted Time Series

An interrupted time series (ITS) regression analysis of 23 quality and accreditation compliance measures. The setting was a 150-bed multispecialty hospital in Abu Dhabi, UAE. For each month (over 48 months) a simple random sample of 24% of patient records was audited, resulting in 276,000 observations collected from 12,000 patient records, drawn from a population of 50,000.

The four phases of the life cycle are as follows: the initiation phase, the presurvey phase, the post-accreditation slump phase and the stagnation phase. The Life Cycle Model explains 87% of the variation in quality compliance measures (R(2)=0.87). The ITS model not only contains three significant variables (β1, β2 and β3) (p≤0.001), but also the size of the coefficients indicates that the effects of these variables are substantial (β1=2.19, β2=-3.95 (95% CI -6.39 to -1.51) and β3=-2.16 (95% CI -2.52 to -1.80).

There is a post accreditation slump in compliance, however this follows a plateau in compliance at a level of 20 percentage points higher than the pre-accreditation survey levels of compliance. The authors conclude that although there was a reduction in compliance immediately after the accreditation survey, the lack of subsequent fading in quality performance should be a reassurance to researchers, managers, clinicians and accreditors. Also, at a microlevel, the findings of this research demonstrate that a private hospital can use accreditation to improve quality.

2009, 2010 - 2012

https://www.ncbi.nlm.nih.gov/pubmed/25095876

accreditation, hospitals

Positive

Clark SL, Meyers JA, Milton CG, Frye DR, Horner S, Baker A, Perlin JB.

Obstet Gynecol. 2014 Jan;123(1):29-33.

2014

Hospital

Hospital (HAP)

Not applicable

No

To evaluate whether current Joint Commission exclusion criteria for perinatal care measure PC-01, "Elective Delivery" before 39 weeks of gestation, accurately identify valid, codeable indications for planned early-term delivery.

Descriptive Study

This study utilized a review and critical analysis of all cases recorded as non-compliant for the measure - perinatal care measure PC-01, "Elective Delivery" before 39 weeks of gestation, in a large health care system during the second half of 2012.

During the study period, of 107,145 total deliveries, 205 cases were reported as non-compliant with PC-01. Ten percent of compliance fallouts (ie, cases coded as non-compliant) resulted from valid indications for delivery identifiable by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding not included on the Joint Commission exclusion list; these were primarily unusual or extreme variations of these conditions. Twenty-five percent of fallouts represented valid indications not represented by an ICD-9-CM code. Eight percent of cases were reported as fallouts as a result of imprecise physician charting; only 2% represented chart abstraction errors. Fifty-five percent of cases involved stated indications for early-term delivery not generally recognized as such by the medical community. Compliance rates of 98% are achievable across a large population using the current ICD-9-CM-based metric for compliance assessment used by the Joint Commission (PC-01). The current exclusion list does not appear to be amenable to further improvement by inclusion of more or different ICD-9-CM codes. However, given the low volumes generated using the current PC-01 denominator definition, approximately 60% of facilities would have compliance rates below a 95% benchmark with even a single justified outlier if analyzed on a quarterly basis. Thus, the current Joint Commission exclusion criteria for this measure identify the vast majority of valid indications for early-term delivery used by obstetrician-gynecologists and identifiable with ICD-9-CM codes.

2012

http://www.ncbi.nlm.nih.gov/pubmed/24463660

hospitals

Positive

Beadles CA, Lich KH, Viera AJ, Greene SB, Brookhart MA, Weinberger M.

BMJ Open. 2014 Feb 12;4(2):e003960.

2014

Hospital

Hospital (HAP)

Not applicable

No

To examine the effect of including oral anticoagulation therapy (OAT) in The Joint Commission's National Patient Safety Goals (NPSGs) on historically low rates of OAT initiation for individuals with incident atrial fibrillation (AF).

Cohort Study

Data from 944,500 individuals enrolled between January 2006 and December 2010, supplemented with data from the Area Resource File and Online Survey, Certification and Reporting data network. Evaluated oral anticoagulation therapy (OAT) initiation before and after the 2008 NPSGs revisions in a retrospective cohort new user design with an atrial fibrillation intervention group and two control groups: a positive control—patients estimated to be at very high risk of thromboembolism (mechanical heart valve and pulmonary embolism); and a negative control —patients with very low perceived risk of thromboembolism ( paroxysmal AF). Developed multivariable models using a difference-in-difference parameterization. Effects were estimated with generalized estimating equations.

Oral anticoagulation therapy (OAT) initiation was low (26.8%) for eligible individuals with incident AF in 2006–2008 but increased after NPSGs implementation (31.7%, p=0.022). OAT initiation was high but decreased in the positive control group (67.5% vs 62.0%, p=0.003). Multivariate analysis resulted in a relative 11% (95% CI) (4% to 18%), p<0.01) increase in OAT initiation for incident atrial fibrillation (AF) patients.

2006-2010

https://www.ncbi.nlm.nih.gov/pubmed/24525389

national patient safety goals, oral anticoagulation therapy

Positive

Howell EA, Zeitlin J, Hebert PL, Balbierz A, Egorova N.

JAMA. 2014 Oct 15;312(15):1531-41.

2014

Hospital

Hospital (HAP)

Not applicable

No

To examine whether two Joint Commission obstetric quality indicators are associated with maternal and neonatal morbidity.

Observational Study

Population-based observational study using linked New York City discharge and birth certificate data sets from 2010. All delivery hospitalizations were identified and two perinatal quality measures were calculated (elective, non-medically indicated deliveries at 37 or more weeks of gestation and before 39 weeks of gestation; cesarean delivery performed in low-risk mothers). Published algorithms were used to identify severe maternal morbidity (delivery associated with a life-threatening complication or performance of a lifesaving procedure) and morbidity in term newborns without anomalies (births associated with complications such as birth trauma, hypoxia, and prolonged length of stay). Mixed-effects logistic regression models were used to examine the association between maternal morbidity, neonatal morbidity, and hospital-level quality measures while risk-adjusting for patient socio-demographic and clinical characteristics.

Severe maternal morbidity occurred among 2372 of 115,742 deliveries (2.4%), and neonatal morbidity occurred among 8057 of 103,416 term newborns without anomalies (7.8%). Rates for elective deliveries performed before 39 weeks of gestation ranged from 15.5 to 41.9 per 100 deliveries among 41 hospitals. There were 11.7 to 39.3 cesarean deliveries per 100 deliveries performed in low-risk mothers. Maternal morbidity ranged from 0.9 to 5.7 mothers with complications per 100 deliveries and neonatal morbidity from 3.1 to 21.3 neonates with complications per 100 births. The maternal quality indicators elective delivery before 39 weeks of gestation and cesarean delivery performed in low-risk mothers were not associated with severe maternal complications (risk ratio [RR], 1.00 [95% CI, 0.98-1.02] and RR, 0.99 [95% CI, 0.96-1.01], respectively) or neonatal morbidity (RR, 0.99 [95% CI, 0.97-1.01] and RR, 1.01 [95% CI, 0.99-1.03], respectively).

Rates for the quality indicators elective delivery before 39 weeks of gestation and cesarean delivery performed in low-risk mothers varied widely in New York City hospitals, as did rates of maternal and neonatal complications. However, there were no correlations between the quality indicator rates and maternal and neonatal morbidity. Current quality indicators may not be sufficiently comprehensive for guiding quality improvement in obstetric care.

2010

http://www.ncbi.nlm.nih.gov/pubmed/25321908

neonatal morbidity, perinatal quality measure, quality indicators maternal mobidity

Neutral

Chung JW, Ju MH, Kinnier CV, Haut ER, Baker DW, Bilimoria KY.

BMJ Qual Saf. 2014 Nov;23(11):947-56.

2014

Hospital

Hospital (HAP)

Not applicable

No

To examine hospital and market characteristics that were associated with hospital-level rates of postoperative venous thromboembolism (VTE) imaging, focusing on hospitals with particularly high rates.

Observational Study

For Medicare beneficiaries undergoing 11 major operations (2009-2010) at 2820 hospitals, hospital-level postoperative VTE imaging use rates were calculated. Hospital characteristics associated with hospital VTE imaging use rates were examined including case severity, size, ownership, VTE process measure adherence, accreditations, staffing, malpractice environment, and county market factors. Associations between explanatory variables and VTE imaging rates were assessed using quantile regressions at the 25th, median, 75th and 90th quantiles.

Mean postoperative VTE imaging rates ranged from 85.26 (SD=67.38) per 1000 discharges in the lowest quartile of hospitals ranked by VTE imaging rates to 168.86 (SD=76.70) in the highest quartile. Drivers of high imaging rates at the 90th quantile were high resident-to-bed ratio (coefficient=51.35, p<0.01), Joint Commission accreditation (coefficient=19.05, p<0.01), presence of other hospitals in the same market with high imaging rates (coefficient=15.29, p<0.01), average case severity (coefficient=11.97, p<0.01), local malpractice costs (coefficient=11.29, p<0.01), and market competition (coefficient=11.03, p<0.01).

The authors concluded that hospital teaching status, resident-to-bed ratio, malpractice environment and local market factors drive hospital postoperative VTE imaging use, suggesting that non-clinical forces predominantly drive hospital VTE imaging practices.

2009-2010

https://www.ncbi.nlm.nih.gov/pubmed/25136140

Venous Thromboembolism, Imaging

Positive

Nayar P, Yu F, Apenteng B.

Health Care Management Review. 2014 Jan 1;39(1):66-74.

2014

Behavioral health hospital

Behavioral Health Care (BHC)

Not applicable

No

To examine the influence of the use of innovative organizational practices, both science based (psychosocial interventions) and practice based, on the organizational performance of substance abuse treatment facilities (SATFs).

Cross-Sectional Study

Cross-sectional data on 13,513 substance abuse treatment facilities (SATFs)in the United States, obtained from the National Survey of Substance Abuse Treatment Services 2009 database were used to assess performance.

Multinomial logistic regression models found a positive association between the use of science-based innovations and practice-based innovations and organizational performance, that is, the provision of comprehensive (core and wraparound) services. Substance abuse treatment facilities (SATFs) that were located in metropolitan areas, those accredited by the Commission on Accreditation of Rehabilitation Facilities and Joint Commission, that had a mixed (Substance Abuse and Mental Health) focus or were recipients of earmark funds also had higher organizational performance. The results signify that substance abuse facilities that are high innovators in terms of implementing science based and practice-based innovative practices have higher organizational performance. Organizations that have institutionalized these practices have invested considerable resources in innovation. The shown higher organizational performance provides justification for the organizational investment in innovation.

2009

substance abuse, organizational performance, accreditation

Positive

Mullen MT, Kasner SE, Kallan MJ, Kleindorfer DO, Albright KC, Carr BG.

J Am Heart Assoc. 2013 Mar 26;2(2):e000071.

2013

Hospital

Not applicable

Disease-specific Care

No

To compare utilization of rt-PA at primary stroke centers (PSCs) and non-certified hospitals in a nationwide all-payer, age ≥18 cohort. The authors hypothesized that PSCs would administer rt-PA to a significantly higher proportion of patients than would non-PSCs.

Observational Study

Data from the Nationwide Inpatient Sample from 2004 to 2009 was utilized and analysis was limited to states that publicly reported hospital identity. All patients ≥18 years with a primary diagnosis of acute ischemic stroke were included. Subjects were excluded if the treating hospital was not identified, if it was not possible to determine the temporal relationship between certification and admission, and/or if admitted as a transfer. Rt-PA was defined by ICD9 procedure code 99.10. All eligibility criteria were met by 323 228 discharges from 26 states. Multivariate model adjusted for year, age, sex, race , insurance, income, comorbidities, severity, hospital characteristics

Overall 323,228 discharges from 26 states, 19.5% from certified PSCs. IV rt-PA use 3.1% overall (2.2% no PSCs vs 6.7% at PSCs). Between 2004 and 2009 rt-PA administration increased from 1.4 to 3.3% in non PSCs and from 6.0 to 7.6% at PSCs. Subjects evaluated at PSCs were significantly more likely to receive rt-PA after risk adjustment. Systems of care are necessary to ensure stroke patients have timely access to PSCs.

2004-2009

http://www.ncbi.nlm.nih.gov/pubmed/23537806

acute stroke, stroke certification

Positive

McHugh M, Neimeyer J, Powell E, Khare RK, Adams JG.

Ann Emerg Med. 2013 Jun;61(6):616-623.e2.

2013

Hospital

Hospital (HAP)

Not applicable

No

To describe hospital reporting on the four emergency department (ED)-related program measures, variation in performance on the ED measures across hospital characteristics, and the characteristics of hospitals that were more likely to receive performance scores based on improvement versus achievement.

Descriptive Study

An exploratory, descriptive analysis merged 2008 to 2010 performance data from Hospital Compare with the 2009 American Hospital Association Annual Survey and calculated a composite score for the four ED measures and used Kruskal-Wallis tests to examine differences in performance across hospital characteristics. The study also examined differences in the percentage of scores that were awarded according to improvement versus achievement.

There were 2,927 hospitals that qualified for the value-based purchasing program and were included in the analysis. For-profit hospitals received the highest scores; public hospitals and hospitals lacking The Joint Commission accreditation received the lowest scores. Public hospitals had the largest share of scores awarded according to improvement (39.8%); for-profit hospitals had the lowest (27.8%). This study found variation in performance by hospital characteristics on the ED-related program measures. Although public and non-Joint Commission-accredited hospitals trailed in performance, they showed strong signs of improvement, signaling that performance gaps by ownership and accreditation may decrease. The authors concluded that considering the increasing scope of the value-based purchasing program, ED leaders should monitor both achievement and improvement on the four ED-related program measures. The lowest performing hospitals were those that were not accredited by the Joint Commission.

2008-2010

http://www.ncbi.nlm.nih.gov/pubmed/23489652

emergency care measures, hospitals, value based purchasing

Positive

Bhattacharya P, Mada F, Salowich-Palm L, Hinton S, Millis S, Watson SR…, Rajamani K.

J Stroke Cerebrovasc Dis. 2013 May;22(4):383-8.

2013

Hospital

Not applicable

Disease-specific Care

No

To explore racial differences in the delivery of care to patients with acute stroke between Joint Commission-certified hospitals and non-certified hospitals.

Observational Study

A retrospective chart review was conducted in patients sustaining ischemic stroke admitted to five Joint Commission-certified centers and five non-certified hospitals. Racial disparities were investigated in the entire group as well as for Joint Commission-certified and non-certified hospitals separately. Demographic data, risk factors, utilization of acute stroke therapies, and compliance with core measures were collected. A total of 574 patients (25.1% African Americans) were included.

Joint Commission certification reduced disparity in certain variables, including tPA and deep venous thrombosis prophylaxis administration. Important racial disparities exist in the delivery of several acute stroke care variables. African American subjects fared better in all core measures at a Joint Commission-certified center than at a non-certified center.

Not Identified

https://www.ncbi.nlm.nih.gov/pubmed/22078781

certification, hospital, primary stroke center, racial differences

Positive

Fricke, KL, Gastanaduy MM, Klos R, Begue´ RE.

Infect Control Hos Epidemiol. 2013 Jul;34(7)723-9.

2013

Hospital

Hospital (HAP)

Not applicable

No

To describe practices for influenza vaccination of healthcare personnel (HCP) with emphasis on correlates of increased vaccination rates.

Cross-Sectional Study

A survey method was utilized with all hospitals in Louisiana invited to participate. A 17-item questionnaire inquired about the hospital type, patients served, characteristics of the vaccination campaign, and the resulting vaccination rate.

Of 254 hospitals, 153 (60%) participated and were included and 124 responses received. Most programs (64%) required that Healthcare Personnel (HCP) either receive the vaccine or sign a declination form, and the rest were exclusively voluntary (36%); no program made vaccination a condition of employment. The median vaccination rate was 67%, and the vaccination rate was higher among hospitals that were accredited by the Joint Commission; provided acute care; served children, pregnant women, oncology patients, or intensive care unit patients; required a signed declination form; or imposed consequences for unvaccinated HCP (the most common of which was to require that a mask be worn on patient contact). Hospitals that provided free vaccine, made vaccine widely available, advertised the program extensively, required a declination form, and imposed consequences had the highest vaccination rates (median, 86%; range, 81%–91%).

2012

https://www.ncbi.nlm.nih.gov/pubmed/23739077

accreditation, hospitals, vaccinations

Positive

Vachhani JA, Klopfenstein JD.

Neurosurgery. 2013 Apr;72(4):590-5.

2013

Hospital

Hospital (HAP)

Not applicable

No

To assess the effect of implementation of the Universal Protocol (UP) on the incidence of neurosurgical wrong-site surgery at the University of Illinois College of Medicine at Peoria/Illinois Neurological Institute.

Uncontrolled Before-After Study

The Morbidity and Mortality Database in the Department of Neurosurgery was reviewed to identify all recorded cases of WSS since 1999. This was compared with the total operative load (excluding endovascular procedures) of all attending neurosurgeons to determine the incidence of overall WSS. A comparison was then made between the incidences before and after UP implementation.

Fifteen WSS events were found with an overall incidence of 0.07% and Poisson 95% confidence interval of 8.4 to 25. All but one of these were wrong-level spine surgeries (14/15). There was only 1 recorded case of wrong-side surgery and this occurred after implementation of the UP. A statistically greater number of WSS events occurred before (n = 12) in comparison with after (n = 3) UP implementation (P < .001). A statistically significant reduction in overall WSS was seen after implementation of the UP. This reduction can be attributed to less frequent wrong-level spine surgery. There was no case of wrong procedure or patient surgery and the 1 case of wrong-side surgery occurred after UP implementation.

1999-2011

http://www.ncbi.nlm.nih.gov/pubmed/23262565

universal protocol, wrong-site surgery

Positive

Rajamani K, Millis S, Watson S, Mada F, Salowich-Palm L, Hinton S, Chaturvedi S.

J Stroke Cerebrovasc Dis. 2013 Jan;22(1):49-54.

2013

Hospital

Not applicable

Disease-specific Care

No

To examine the delivery of care for patients with acute ischemic stroke and to compare differences in Joint Commission-certified and -non-certified centers in Michigan.

Observational Study

A systematic chart review of patients with acute ischemic stroke from 10 Michigan hospitals was performed, half of whom were Joint Commission-certified primary stroke certification centers (PSCs). Sixty charts were randomly chosen from 1 calendar year from each hospital. An experienced nurse performed the data abstraction, and data analysis was performed with the Fisher exact test.

A total of 602 charts--of which 302 were from Joint Commission-certified primary stroke centers (PSCs)--were chosen for the study. The 2 groups were similar with regard to stroke risk factors except that there were significantly more patients with atrial fibrillation in non-certified centers and there were more African American patients in Joint Commission-certified PSCs. Significantly more patients were considered for thrombolytic therapy in Joint Commission-certified PSCs compared to non-certified centers (90.4% v 66%; P = .0001). Overall, 3.8% of patients had received thrombolytic therapy without any significant difference between Joint Commission-certified PSCs and non-certified centers (4.6% v 3%; adjusted odds ratio 1.64; 95% confidence interval 0.64-4.19; P = .87). However, thrombolysis rates among eligible patients was significantly higher in the Joint Commission-certified PSCs (48.2% v 8.8%; P = .0001). The most common reason documented for not giving thrombolytic therapy was late arrival outside the therapeutic window, which was more common in Joint Commission-certified PSCs (72.8% v 55.6%; P = .0001) compared to non-certified centers. Seventy-four percent of patients from Joint Commission-certified PSCs were discharged home or to inpatient rehabilitation facility compared to 71% (P = .38) from non-certified hospitals. The mean length of stay was marginally shorter in Joint Commission-certified PSCs compared to non-certified centers (5.53 v 6.25 days; P = .08). Rates of thrombolysis administration for acute stroke patients across Michigan were low in both Joint Commission-certified and non-certified hospitals, although better processes were in place in Joint Commission-certified PSCs. While there was no overall difference in the administration of thrombolytic treatment, a greater number of the eligible patients received thrombolysis in the certified centers. There was a tendency to shorter lengths of stay at Joint Commission-certified PSCs, but there was no significant difference in discharge to home, inpatient rehabilitation, or inpatient mortality in this study.

2006

http://www.ncbi.nlm.nih.gov/pubmed/21852156

acute stroke, primary stroke centers, stroke certification, thrombolysis

Neutral

Coll KM, Sass M, Freeman BJ, Thobro P, Hauser N.

Residential Treatment For Children & Youth 30.3 (2013): 227-237.

2013

Behavioral health outpatient

Behavioral Health Care (BHC)

Not applicable

No

To investigate the treatment outcome differences between youth offenders from The Joint Commission accredited residential treatment center (RTC) and youth from a non-accredited center.

Case Control Study

Two adolescent residential treatment sites were used in this study. Clinicians at both adolescent treatment facilities where the Youth Comprehensive Risk Assessment (YCRA) tool is utilized systematically gather information from these assessments and develop treatment goals and interventions related to six areas. At 6-month intervals, residents undergo a re-evaluation, which is designed to make adjustments in treatment planning and decisions about discharge. The risk factor for youth in both groups was noted and compared at admissions and after 5 months of treatment.

Post t-test analysis showed that youth from the accredited center reported significantly more progress in total risk of 4 of the 6 risk areas including risk to self, social/ adaptive functioning, substance abuse risk, and family resources.

Not Identified

accrediation, treatment center, treatment outcomes

Positive

Gorelick PB.

J Stroke. 2013 May; 15(2): 78-89.

2013

Hospital

Not applicable

Disease-specific Care

Yes

To discuss the history of organized stroke care in the United States, evidence to support the value of primary and comprehensive stroke centers, and the certification criteria and process to become a primary or comprehensive stroke center.

Not a Study

Stroke center designation has been associated with a number of quality improvements including but not limited to access to timely thrombolytic therapy and utilization of stroke unit care. Primary stroke centers may be established successfully as a metropolitan-wide matrix in large population areas to facilitate diagnosis and treatment of acute stroke patients. Organization of acute stroke in this way may be advantageous especially when there is high annual hospital volume or high physician patient volume in relation to stroke care which heightens preferable outcomes or cost savings. An organized stroke care system such as an inpatient stroke unit has been associated with reduced length of care and case fatality, cost-effectiveness when followed by early supportive discharge, and as a model for stroke care, generalizeability if implemented in non-principal referral hospitals. It should be noted that there is evidence to suggest that primary stroke center designated hospitals had better outcomes than non-certified hospitals before The Joint Commission program for primary stroke center designation was implemented. Possibly, the certified hospitals had organizational programs already in place prior to achieving certification status.

Not Identified

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779669/

comprehensive stroke center, organization of health care, primary stroke center

UTD

The Lewin Group, INC.

N/A

2012

Hospital, Critical access hospital

Hospital (HAP), Critical Access Hospital (CAH)

Not applicable

No

To provide The Joint Commission and the market, including the hospital community, payers, employers and others an empirical estimate quantifying the value proposition of Joint Commission accreditation for the nation's acute care and critical access hospitals.

Longitudinal Studies

Panel study design of more than 5,000 U.S. acute care and critical access hospitals over a 6 year period starting in FY2005 and ending in FY2010 to study the impact of Joint Commission accreditation status on public measures of financial health, operating efficiency and quality of care. Financial data were obtained for FY2005 through FY2010 for hospitals in each category using public sources (CMS Medicare Cost Report Data). Quality outcome information was obtained from the CMS Hospital Compare Data for FY2005 through FY2008.

Used regression analyses to examine the relationship between Joint Commission accreditation and select performance measures. Both descriptive and multiple regression analysis found accreditation was related to improved financial position in terms of total financial margins, operating margins, average net income and occupancy rate. Joint Commission accreditation was also related to improved performance on composite quality measures.

During the 2008 height of the economic downturn, there were no differences in total margins observed between Joint Commission accredited and non-accredited hospitals. However, for every year over the study period (2005 - 2010), Joint Commission accredited hospitals total margins were consistently higher than their non-accredited counterparts. Between 2008 and 2010, average total margins for accredited hospitals increased from 0.75 percent to 4.2 percent compared to 0.74 percent to 1.8 percent for non-accredited hospitals during the same time period.

Joint Commission accreditation was also associated with improved performance across all six composite evidence-based quality measures examined ranging from 14.96 percent (Heart Failure) to 2.45 percent (Surgical Care Improvement).

2005-2010

accreditation, hospitals

Positive

Wagner LM, McDonald SM, Castle NG.

Policy Polit Nurs Pract. 2012 Feb;13(1):8-16.

2012

Nursing home

Nursing Care Center (NCC)

Not applicable

No

To examine the association between accreditation and select measures of quality in U.S. nursing homes, both cross-sectionally and over time.

Observational Study

A list of currently accredited nursing homes was identified through a web search of The Joint Commission quality check web site (http://www.qualitycheck.org/) in July 2011. Accreditation status during the period of interest (2002-2010) was compiled and coded separately by year. Identifying information for all facilities was checked against a complete list of U.S. nursing homes and all entries that corresponded to other types of facilities (e.g. Veteran’s Affairs medical centers, children’s convalescent centers) were removed. A total of 874 Joint Commission-accredited nursing homes were identified. Additional primary data used in this investigation included state Medicaid reimbursement levels. These data were previously collected by the authors.

Results indicated that better quality nursing homes become Joint Commission accredited and that these accredited nursing homes continue to improve their quality after accreditation. However, The Joint Commission accredited nursing homes continue to improve their quality most during the 1st year of full accreditation; over a longer time period, the impact on quality appears to diminish as fewer significant findings were identified for accredited nursing homes with the greater length of time they are accredited.

2002-2010

http://www.ncbi.nlm.nih.gov/pubmed/22527332

long term care, nursing home, quality of care

Positive

Wagner LM, McDonald SM, Castle NG.

Jt Comm J Qual Patient Saf. 2012 May;38(5):207-15.

2012

Nursing home

Nursing Care Center (NCC)

Not applicable

No

To explore the impact of Joint Commission accreditation on resident safety culture (RSC) perceptions among leadership in nursing homes in the US.

Cohort Study

Safety culture ratings were compared between respondents from Joint Commission-accredited nursing homes and those that were non-accredited from the sample, as well as the characteristics of senior managers between accredited and non-accredited nursing homes. The "Quality Check" website by the Joint Commission was used to identify 874 nursing homes that were accredited between 2002 and 2010. The Nursing Home Survey on Resident Safety Culture (NHSRSC) was used to collect information on RSC from administrators and directors of nursing homes. From a random sample of 6,000 nursing homes, only those participating in Medicare and/or Medicaid certification was included.

4,008 questionnaires were received from nursing home administrators, giving a response rate of 67%. Findings revealed that leadership from Joint Commission-accredited nursing homes had a more positive resident safety culture (RSC) than from those in non-accredited facilities. NHSRSC survey scores were around 43–67 range for non-accredited nursing homes, compared to scores within the 53–76 range for Joint Commission–accredited nursing homes. This may reflect the Joint Commission's shift in focus towards health care worker fatigue and patient safety. Respondents in accredited nursing homes also scored more favorably on feedback and communication regarding incidents, which may be related to the fact that the Joint Commission has standards on the reporting of adverse events.

2002-2010

http://www.ncbi.nlm.nih.gov/pubmed/22649860

accreditation, nursing homes, safety culture

Positive

Wagner LM, McDonald SM, Castle NG.

Gerontologist. 2012 Aug;52(4):561-70.

2012

Nursing home

Nursing Care Center (NCC)

Not applicable

No

To examine the association between nursing home accreditation and deficiency citations, also to determine if there are any changes with receiving citations over time.

Longitudinal Studies

Data for accredited nursing homes originated from the "Quality Check" website from The Joint Commission. The On-line Survey Certification of Automated Records (OSCAR) was used to identify deficiency citations of these respective nursing homes. Four categories of these deficiency citations were analyzed: resident behavior and facility practices, quality of life, quality of care, and the most severe citations.

Findings showed that nursing homes that were Joint Commission-accredited demonstrated an improvement in quality and maintained this standard during their accreditation. Joint Commission-accredited facilities were also less likely to be for-profit facilities than non-accredited ones. In addition, there was no difference found in overall staffing levels between accredited and non-accredited facilities. Accredited nursing homes continue to improve quality the longer they have been accredited.

2002-2010

http://www.ncbi.nlm.nih.gov/pubmed/22391872

accreditation, long term care, nursing homes, quality improvement

Positive

Prabhakaran S, McNulty M, O'Neill K, Ouyang B.

Stroke. 2012 Mar;43(3):875-7.

2012

Hospital

Not applicable

Disease-specific Care

No

To determine whether utilization of intravenous tissue-type plasminogen activator (tPA) increases with duration of time as a certified primary care stroke center (PSC).

Observational Study

A retrospective analysis of the Illinois Hospital Association patient level COMPdata was performed identifying those patients with primary discharge diagnosis of acute ischemic stroke based on International Classification of Disease version 9 codes and defined intravenous thrombolysis by International Classification of Diseases version 9 procedure code (99.10). Patients were categorized as cared for at non-primary stroke centers (PSC), PSC>1 year before, < 1 year after, and > than 1 year after certification. Generalized estimating equations were used to calculate adjusted odd ratios for tissue plasminogen activator (tPA) utilization by PSC category.

Stroke thrombolysis is strongly impacted by the primary stroke center (PSC) certification process. Adjusting for age, insurance status, admission source, year study, region of Illinois, and hospital bed size, the odds of tissue plasminogen activator (tPA) utilization increased with advancing stage of PSC certification. In addition, PSC increase tPA usage in the earliest stages.

2003-2009

http://www.ncbi.nlm.nih.gov/pubmed/22135073

certification, stroke, tPA

Positive

Nagaraja N, Bhattacharya P, Mada F, Salowich-Palm L, Hinton S, Millis S…, Rajamani K.

J Neurol Sci. 2012 Mar 15;314(1-2):88-91.

2012

Hospital

Not applicable

Disease-specific Care

No

To examine whether gender-based differences in acute stroke care occur in both Joint Commission certified and non-certified hospitals.

Cross-Sectional Study

602 charts of patients with ischemic stroke were reviewed from five Joint Commission certified and five non-certified hospitals for gender differences in the pre-hospital factors, emergency department evaluation, in-hospital stroke care, discharge outcome and use of secondary prevention measures.

More women arrived via ambulance (63.1% women vs. 53.9% men, p=0.025) while more men came by self-transportation (42.6% vs. 30%, p=0.0016). There was no difference by gender for evaluation for thrombolytics (89.4% men vs. 85.9% women) or intravenous t-PA administered (3.5% men vs. 2.5% women, p=0.82). More patients in Joint Commission certified centers were evaluated for thrombolysis than in non-certified centers. Delay in arrival was the commonest reason for not getting thrombolysis in both groups. More men than women had mild/resolving symptoms, had more interventional procedures, and better discharge outcome. More men were discharged on antithrombotics. Even after adjusting for age, gender differences were significant for arrival by ambulance, self transportation, mild/resolving symptoms, interventional procedures performed and marginally for good discharge outcome. There were significant gender differences in delivery of acute stroke care in Michigan hospitals even after adjustment for age differences. In spite of milder symptoms and less usage of emergency services, men received more aggressive stroke care with a tendency towards better discharge outcome. Going to a Joint Commission certified center was a better predictor of consideration for thrombolytics than gender.

2006

https://www.ncbi.nlm.nih.gov/pubmed/22154189

stroke certification

Positive

Alkhenizan A, Shaw C.

J Family Community Med. 2012 May;19(2):74-80.

2012

Hospital

Hospital (HAP)

Not applicable

Yes

To review the literature on the attitude of health care professionals towards accreditation.

Systematic Review

A systematic qualitative review of literature using four databases including Medline, Embase, Healthstar, and CINAHL presented seventeen studies that had evaluated the attitudes of health care professionals towards accreditation.

Owners of hospitals indicated that accreditation had the potential of being used as a marketing tool. Health care professionals viewed accreditation programs as bureaucratic and demanding. There was consistent concern, especially in developing countries, about the cost of accreditation programs and impact on the quality of health care services. In general, the attitude of the health care professionals in the seventeen studies that had evaluated attitudes of health care professionals towards accreditation was supportive. In a few studies, the attitude to accreditation was negative because the participants did not believe that accreditation had a significant impact on the quality of health care services and also because of the significant additional cost involved.

1980-2011

https://www.ncbi.nlm.nih.gov/pubmed/22870409

accreditation, health professionals, hospitals

Mixed

Nguyen NT, Nguyen B, Nguyen VQ, Ziogas A, Hohmann S, Stamos MJ.

J Am Coll Surg. 2012 Oct;215(4):467-74.

2012

Hospital

Hospital (HAP)

Not applicable

No

To analyze the perioperative outcomes of bariatric surgery performed at accredited vs non-accredited centers. In an effort to improve the quality of care in bariatric surgery, two accreditation programs based on volume were initiated.

Descriptive Study

Patient-level data obtained from the University HealthSystem Consortium for patients who underwent bariatric surgery for the treatment of morbid obesity between 2007 and 2009 were reviewed. Perioperative outcomes were analyzed according to accreditation status. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, 30-day readmission, overall complications, and cost. Comparisons of length of stay and cost were performed at the hospital-level data.

Of the 35,284 bariatric operations performed during the study period, 89.2% of cases were performed at 71 accredited centers; 10.8% of cases were performed at 43 non-accredited centers. The rate of in-hospital mortality was significantly lower in accredited centers (0.06% vs 0.21%). Compared with non-accredited centers, bariatric surgery performed at accredited centers was also associated with shorter length of stay (mean difference 0.3 days; 95% CI 0.16 to 0.44) and lower cost (mean difference, $3,758; 95% CI, $2,965 to $3,952). Post-hoc analyses based on procedural type and severity of illness suggested possible associations between center accreditation and improved in-hospital mortality in patients who underwent gastric bypass and patients with higher severity of illness; similarly, patients requiring prolonged ICU or hospital stay (≥7 days) had significantly lower in-hospital mortality within accredited centers.

2007-2009

https://www.ncbi.nlm.nih.gov/pubmed/22727608/

Positive

Vélez-González H, Pradhan R, Weech-Maldonado R.

J Health Care Finance. 2011 Winter;38(2):12-23.

2011

Hospital

Hospital (HAP)

Not applicable

No

To understand the influence of non-financial measures (efficiency, productivity, and quality) on the financial performance of for-profit system hospitals.

Descriptive Study

Based on data provided through The Joint Commission and Bazzoli; The sample of 499 for-profit system hospitals in the US from the years 1999 to 2002. Data analyzed include American Hospital Association Annual Survey, Medicare Cost Reports, Joint Commission accreditation survey performance scores, and CMS Hospital Case Mix Index dataset. Dependent variables consist of financial measures (operating and total margins), while independent variables consist of variables measuring efficiency, productivity and quality.

Results suggest the influence of non-financial performance measures on financial performance; occupancy rate positively influences financial performance while greater labor intensity may have negative implications for financial performance. In addition, this study shows that quality positively influences financial performance thereby offering a potential business case for quality. Despite higher cost, increasing nursing staff in hospitals and using clinical protocols for treatment care will result in substantial cost saving in the long run.

1999-2002

http://www.ncbi.nlm.nih.gov/pubmed/22372029

financial performance, hospital, quality

Positive

Schmaltz SP, Williams SC, Chassin MR, Loeb JM, Wachter RM.

J Hosp Med. 2011 Oct;6(8):454-61.

2011

Hospital

Hospital (HAP)

Not applicable

No

To examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases.

Cohort Study

The relationship between publically reported hospital quality measures and Joint Commission accreditations status was examined using data from hospital discharges from 2004 – 2008 on 16 measures compared to hospital characteristics.

Accredited hospitals (n=2,917) improved their performance significantly more than non-accredited hospitals (n=762) for 13 out of the 16 individual performance measures from 2004-2008. Furthermore, after adjusting for hospital characteristics (including baseline performance), accredited hospitals were more likely to exceed 90% performance in 2008 than non-accredited hospitals (84% versus 69%).

2004-2008

http://www.ncbi.nlm.nih.gov/pubmed/21990175

accreditation, hospitals, national quality measures, public reporting

Positive

Lichtman J, Jones S, Leifheit-Limson E, Wang Y, Goldstein L.

Stroke. 2011 December; 42(12): 3387–3391.

2011

Hospital

Not applicable

Disease-specific Care

No

To determine if there was a difference in patient outcomes (30-day mortality and readmission) between Joint Commission Primary Stroke Centers (PSC) and non-PSC hospitals.

Observational Study

Data from the Medicare Provider Analysis and Review files of all fee-for-service (FFS) Medicare beneficiaries ages 65+ with a primary diagnosis of subarachnoid hemorrhage stroke (SAH) (n=2,305) or intracerebral hemorrhage (ICH) (n=31,272) from 2006 were analyzed.

A risk-adjusted analysis found that the relative risk of death (within 30 days of admission) was lower for patients discharged from Joint Commission certified Primary Stroke Center hospitals (subarachnoid hemorrhage stroke (SAH) 34% lower, intracerebral hemorrhage (ICH) 14% lower) compared to non-certified hospitals. However, there was no difference in risk-adjusted readmission rates (within 30 days) between Joint Commission-certified Primary Stroke Center hospitals versus non-certified hospitals for either SAH or ICH. It was not clear whether the difference in outcomes was due to better care at the Joint Commission-PSC hospitals or due to selection bias in which better hospitals were more likely to pursue certification in the first place.

2006

http://www.ncbi.nlm.nih.gov/pubmed/22033986

certification, mortality, readmission, stroke

Mixed

Morse RB, Hall M, Fieldston ES, McGwire G, Anspacher M, Sills MR…, Shah SS.

JAMA. 2011 Oct 5;306(13):1454-60.

2011

Hospital

Hospital (HAP)

Not applicable

No

To evaluate longitudinal trends in Children's Asthma Care (CAC) measure compliance and to determine if an association exists between compliance and outcomes.

Cross-Sectional Study

This study used administrative data and Children's Asthma Care (CAC) compliance data for 30 US children’s hospitals. A total of 37,267 children admitted with asthma between 1/1/08 & 9/30/10, with follow-up through 12/31/10 (45,499 admissions). Hospital-level CAC measure compliance data obtained from National Association of Children's Hospitals and Related Institutions (NACHRI) Readmission and post-discharge emergency department (ED) utilization data were obtained from the Pediatric Health Information System.

Children's Asthma Care (CAC) measure: CAC-1 (admitted with an asthma exacerbation received relievers) and CDC-2 (systemic corticosteroids during the admission) compliance levels were uniformly high with little variation. CAC-3 measured whether they were discharged with a complete home management plan of care (HMPC) (CAC-3). Aggregate CAC-3 compliance was initially modest but improved during the study period, with substantial variation in compliance and improvement among the hospitals. There was no significant association between CAC-3 compliance, overall or independently, for any of the sub-components and either of the outcome measures at any of the 3 time intervals. Authors concluded CAC-3 measure may not meet the criteria outlined by the Joint Commission for accountability measures and the Joint Commission should reconsider whether the CAC-3 component of the measure set is appropriately classified as an “accountability measure” suitable for public reporting, accreditation, or pay for performance. Comment: this study does not directly address the impact of accreditation but relates to unique Joint Commission measurement requirements for a specialty hospital population.

2008-2010

http://www.ncbi.nlm.nih.gov/pubmed/21972307

asthma care, compliance, hospitals, quality measures

Neutral

Xian Y, Holloway R, Chan P, Noyes K, Shah M, Ting H…, Friedman B.

JAMA. 2011 Jan 26;305(4):373-80.

2011

Hospital

Not applicable

Disease-specific Care

No

To examine the association between admission to stroke centers for acute ischemic stroke and mortality.

Observational Study

Observational study using patient-level (n=30,947) data from the New York Statewide Planning and Research Cooperative System (SPARCS) to study the correlation between mortality rates due to acute ischemic stroke in treatment at Designated Stroke Centers (DSCs) vs. non DSCs.

By calculating standardized difference in baseline characteristics, and using an instrumental variable analysis, results determined that DSC was associated with a lower 30-day all-cause mortality when compared to non-DSC (10.1% vs. 12.5%) and greater use of thrombolytic therapy (4.8% vs. 1.7%).

2005-2007

http://www.ncbi.nlm.nih.gov/pubmed/21266684

certification, mortality, stroke

Positive

Lichtman JH, Jones SB, Wang Y, Watanabe E, Leifheit-Limson E, Goldstein LB.

Neurology. 2011 Jun 7;76(23):1976–1982.

2011

Hospital

Not applicable

Disease-specific Care

No

To assess whether 30-day risk-standardized mortality (RSMR) and readmission (RSRR) rates differed between hospitals with and without Joint Commission-certified primary stroke centers (PSCs) in 2006.

Observational Study

The study cohort included all fee-for-service Medicare beneficiaries ≥65 years old discharged with a primary diagnosis of ischemic stroke in 2006. Hierarchical linear regression models calculated hospital-level RSMRs and RSRRs, adjusting for patient demographics, comorbid conditions, and hospital referral region

Although the absolute differences were small, a higher proportion of hospitals with a Joint Commission-certified primary stroke centers (PSC) had 30-day risk standardized mortality rate (RSMRs) that were lower than the national average as compared with hospitals without a Joint Commission-certified PSC, but 30-day risk standardized readmission rate (RSRRs) were similar regardless of Joint Commission-certified PSC status. There was heterogeneity in the distribution of risk-standardized outcomes for hospitals, with considerable overlap between these groups. The data suggest that Joint Commission PSC certification identifies a large number of high-performing hospitals for mortality outcomes, but does not necessarily guarantee better performance than may be found in hospitals without a Joint Commission-certified PSC. The lack of certification does not necessarily indicate poorer hospital performance.

2006

http://www.ncbi.nlm.nih.gov/pubmed/21543736

certification, stroke

Neutral

Al-Awa B, De Wever A, Melot C, Devreux I.

Res J Med Sci. 2011;5:200-3.

2011

Hospital

Hospital (HAP)

Not applicable

Yes

To identify valuable information regarding the impact and limitations of the accreditation process found by other researchers as well as the experience of King Abdulaziz University Hospital in Saudi Arabia.

Observational Study, Systematic Review

Literature review and survey data were included in the analysis to understand the link between accreditation and patient safety.

The 28 out of 81 (34.57%) patient safety indicators significantly improved during the accreditation process at King Abdulaziz University Hospital. Survey results show that the overall average of relative improvement percent is 34.43%. Both results are similar to other findings. The accreditation process as experienced by King Abdulaziz University Hospital has significantly improved 1/3 of patient safety indicators and perception of nursing staffs is correlated with statistical findings. Those findings are supported by international literature. Overall, it is recommended that accreditation in both emerging and industrialized countries be provided especially if there is a strong commitment from the leadership and that process is voluntary rather than obligatory. Authors conclude that more in-depth studies regarding accreditation should be made to establish its conclusive results.

Not Identified

accreditation, hospitals, patient safety

Positive

Tormoehlen LM, Mowry JB, Bodle JD, Rusyniak DE.

Clin Toxicol (Phila). 2011 Jul;49(6):492-8.

2011

Hospital

Behavioral Health Care (BHC)

Not applicable

No

To compare the number of adolescent opioid cases and their outcome severity before and after the 2000 Joint Commission pain initiative.

Uncontrolled Before-After Study

Retrospective case series of opioid exposures involving persons 12-18 years of age reported to a US poison center from 1994 to 2007. The main outcome measure was the number of adolescent opioid cases reported for 1994-2000 compared to 2001-2007. Secondary outcomes included outcome severity, number of cases involving specific opioids, and correlation between the number of cases and the amount of opioids distributed to the state.

There were 1634 adolescent opioid-related cases with 187 cases developing medical complications. Compared with 1994-2000, the rate ratio of cases involving adolescents and opioid analgesics for the years 2001-2007 was 1.69 (95% CI: 1.53, 1.86), and these cases were 2.84 (95% CI: 2.06, 3.91) times more likely to have had medical complications. Medical complications involving methadone (p =0.001) increased after the Joint Commission initiative, while complications related to codeine (p =0.001) and propoxyphene (p =0.030) decreased. There were 15 deaths in 2001-2007 and none in 1994-2000 (p =0.012). Lastly, there was a correlation between the rate of adolescent opioid cases and the amount of opioids distributed to the state (r(2) =0.90; p < 0.001). In the seven years following the Joint Commission pain standards, there was an increase in the number and severity of adolescent opioid-related poison center cases. The increase correlates with statewide availability of opioids. These data may prove useful in drug education and prevention programs targeting adolescents.

1994-2007

http://www.ncbi.nlm.nih.gov/pubmed/21824060

adolescent opioid use, pain initiative

Negative

Starling III J, Coldiron BM.

J Am Acad Dermatol. 2011 Oct;65(4):807-10.

2011

Hospital

Ambulatory Health Care (AMB)

Not applicable

No

To determine the incidence of wrong site surgery after implementation of a preoperative protocol in patients presenting for treatment of skin cancer at a high-volume, Joint Commission accredited, tertiary referral center for dermatologic surgery.

Descriptive Study

A retrospective chart review was performed of 7,983 cases performed on patients presenting for treatment of skin cancer in the office setting.

There were no cases of wrong site surgery. There were, however, 18 cases of failure to identify the original biopsy site (cancer site). The intergration of a correct surgery site protocol into a daily patient care model is a useful step in preventing occurrences of wrong site dermatologic surgery.

Not Identified

https://www.ncbi.nlm.nih.gov/pubmed/21764169

accreditation, adverse event reporting, hospitals, wrong site surgery

Positive

Hafner JM, Williams SC, Koss RG, Tschurtz BA, Schmaltz SP, Loeb JM.

Int J Qual Health Care. 2011 Dec;23(6):697-704.

2011

Hospital

Hospital (HAP)

Not applicable

No

To assess perceptions about the value and impact of publicly reporting hospital performance measure data.

Descriptive Study

Structured focus-group interviews were conducted to gather hospital staff perceptions of the perceived impact of publicly reporting performance measure data.

Interviews revealed six common themes. Publicly reporting data: (i) led to increased involvement of leadership in performance improvement; (ii) created a sense of accountability to both internal and external customers; (iii) contributed to a heightened awareness of performance measure data throughout the hospital; (iv) influenced or re-focused organizational priorities; (v) raised concerns about data quality and (vi) led to questions about consumer understanding of performance reports. Few differences were noted in responses based on hospitals' performance on the measures. Public reporting of performance measure data appears to motivate and energize organizations to improve or maintain high levels of performance. Despite commonly cited concerns over the limitations, validity and interpretability of publicly reported data, the heightened awareness of the data intensified the focus on performance improvement activities. This study reveals that as the healthcare industry has moved towards greater transparency and accountability, healthcare professionals have responded by re-prioritizing hospital quality improvement efforts to address newly exposed gaps in care.

Not Identified

https://www.ncbi.nlm.nih.gov/pubmed/21840943

hospitals, performance improvement, performancemeasurement, public reporting, quality improvement, quality measurement

Positive

Ferris CG.

Diss. Univeristy of Texas, 2011.

2011

Hospital

Hospital (HAP)

Not applicable

No

To evaluate the effectiveness of an Intranet intervention in increasing the proportion of health care workers (HCWs) who received influenza vaccination and to assess other interventions employed by hospitals, health systems, and nursing homes to determine which policies have been the most effective in boosting vaccination rates among American health care workers.

Cross-Sectional Study

The Intranet-based intervention designed to encourage influenza vaccination among health care workers was conducted at St. Luke’s Episcopal Hospital during the 2008-09 flu season. A Microsoft Structured Query Language (SQL) database linked to a human resource database was used to calculate how many employees participated in the online survey.

There was a statistically significant difference in the percentage of employees who received the flu vaccine – 48.5% in the 2008-09 season when the intranet-based intervention was implemented as compared to 36.3% in the previous year (P < .001).

2008-2009

http://digitalcommons.library.tmc.edu/dissertations/AAI3464851/

healthcare worker vaccinations, hospitals, influenza vaccination

Positive

Rizzi F, Pizzuto M, Lodetti L, Corli O, Da Col D, Damiani ME…, Bonaldi A.

BMJ Qual Saf.2011 Jul; 20(7):592-8.

2011

Not applicable

Disease-specific Care

Yes

To describe the key results of a certification process based on the Joint Commission International criteria for the home hospitalization model implemented by the palliative care units of seven Milan hospitals for terminally ill patients with cancer.

Descriptive Study

In 2006, the inter-hospital working team implemented a certification project based on the Joint Commission International Disease or Condition-Specific Care (DSCS) program. Thirty standards subdivided into five functional areas with 150 measurable elements were the starting-point for periodic improvement plans within and across participating hospitals. Program compliance was analyzed in terms of annual performance improvement and consistency across the seven Palliative Care Units (PCUs) involved in achieving set goals. The Joint Commission International standards were applied on 3,316 terminally ill patients with cancer treated at home from 2005 to 2009.

As a result of the work carried out, the Joint Commission International survey conducted three years after project implementation demonstrated full compliance with the established standards, leading to the Joint Commission International certification award (for the first time in this clinical setting internationally).

The work carried out with a view to certification confirmed the possibility that facilities spread across different hospitals can actually share common processes and standardize the activities for the care of end-of-life patients with cancer at home as if they were one single service provider.

2006

http://www.ncbi.nlm.nih.gov/pubmed/21292692

cancer, certification, home care, palliative care units

Positive

Alkhenzian A, Shaw C.

Ann Saudi Med. 2011 Jul-Aug;31(4): 407-416.

2011

Hospital

Hospital (HAP)

Not applicable

Yes

The aim of this study was to evaluate the impact of accreditation programs on the quality of healthcare services.

Systematic Review

A systematic review of the literature was performed to evaluate the impact of accreditation programs on the quality of healthcare services. Several databases were systematically searched, including Medline, Embase, Healthstar, and CINAHL.

Twenty-six studies evaluating the impact of accreditation were identified. The majority of the studies showed general accreditation for acute myocardial infarction (AMI), trauma, ambulatory surgical care, infection control and pain management; and subspecialty accreditation programs to significantly improve the process of care provided by healthcare services by improving the structure and organization of healthcare facilities. Several studies showed that general accreditation programs significantly improve clinical outcomes and the quality of care of these clinical conditions and showed a significant positive impact of sub-specialty accreditation programs in improving clinical outcomes in different sub-specialties, including sleep medicine, chest pain management and trauma management. In an analysis of data from 742 hospitals using 7 performance measures against Joint Commission accreditation scores, Joint Commission measures were found to be not correlated with outcome measures. In another large analysis of Joint Commission accreditation scores and the Agency for Healthcare Research (AHRQ), Inpatient Quality Indicators (IQI) and Patient Safety Indicators (PSI) (n=2116 institutions), worse performance on the PSI factor was associated with worse performance on Joint Commission scores (P=.02). In a large data analysis of 216 state psychiatric hospitals, there was a weak relationship between accreditation and indicators of quality of care. In a large analysis of data from Centers for Medicare and Medicaid Services (CMS) in US (n=134 579 patients from 4221 hospitals), patients treated at accredited hospitals were more likely to receive higher quality of care for the management of acute myocardial infarction (AMI) than those treated at non-accredited hospitals. In this study, the mortality rate was lower post AMI in accredited hospitals than in non-accredited hospitals. In a cross-sectional survey conducted in the US in 1988 (n=5172), 1990 (n=5140), 1995 (n=5116), 2000 (n=5150) and 2005 (n=5146), methadone maintenance facilities accredited by The Joint Commission were more likely to adhere to the recommended dosage guideline of methadone, compared to non-accredited hospitals. In a large cross-sectional survey of outpatient substance abuse treatment programs conducted in the US (n=1137), Joint Commission accreditation was positively associated with two elements of treatment comprehensiveness: the percentages of clients receiving physical examinations and mental health care. In an American prospective study (n=36 institutions), medication error rates were similar between accredited and non-accredited hospitals. In this study, five non-accredited hospitals achieved accreditation during the study. In a retrospective chart review (n=1082), Joint Commission pain initiatives on opioids use significantly improved perioperative pain management without a visible increase in adverse effects.

1980-2009

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156520/

The Joint Commission

Positive

Tabrizi JS, Gharibi F, Wilson AJ.

Health Promotion Perspectives. 2011;1(1):1.

2011

Hospital

Hospital (HAP)

Not applicable

Yes

To define the general advantages and disadvantages of accreditation programs to assist in choosing the most appropriate approach.

Systematic Review

Systematic search of Scientific Information Database, Ovid Medline & PubMed databases was conducted by the keywords of accreditation, hospital, medical practice, clinic, accreditation models, health care and Persian meanings. From 2379 initial articles, 83 articles met the full inclusion criteria. From initial analysis, 23 attributes were identified which appeared to define advantages and disadvantages of different accreditation approaches and the available systems were compared on these.

Six systems were identified in the international literature including the Joint Commission from USA, the Canadian program The Canadian Council on Health Services Accreditation (CCHSA), and the accreditation programs of UK, Australia, New Zealand and France. The main distinguishing attributes among them were: quality improvement, patient and staff safety, improving health services integration, public’s confidence, effectiveness and efficiency of health services, innovation, influence global standards, information management, breadth of activity, history, effective relationship with stakeholders, agreement with AGIL attributes and independence from government. Based on 23 attributes of comprehensive accreditation systems, the study defined from a systematic review, the Joint Commission accreditation program of USA and then CCHSA of Canada offered the most comprehensive systems with the least disadvantages. Other accreditation programs such as those in Australia, France, New Zealand and UK were fairly comparable according to these criteria. However the decision for any country or health system should be based on an assessment weighing up their specific objectives and needs.

2011

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963612/

accreditation, healthcare, hospital, quality

Positive

Fonarow GC, Gregory T, Driskill M, Stewart MD, Beam C, Butler J…, Sacco RL.

Circulation. 2010 Dec 7;122(23):2459-69.

2010

Hospital

Hospital (HAP)

Disease-specific Care

No

To present an overview on hospital accreditation, recognition, and certification programs and the potential for such programs to facilitate improved quality of care and outcomes for patients with cardiovascular disease and stroke.

Not a Study

This AHA advisory reviewed current accreditation and certification programs related to cardiovascular disease and stroke and discusses potential opportunities to develop and enhance hospital certification programs for cardiovascular disease and stroke.

This AHA presidential advisory states that “current evidence suggests mixed results for correlation of certification programs to hospital performance, including quality of care and outcomes”. The authors recommend a need for: “standardized, objective, unbiased assessments of hospital structural process, and outcome performance, while allowing flexibility as technology and methodology advances.”

Not Identified

http://www.ncbi.nlm.nih.gov/pubmed/21098429

cardiovascular disease, hospital accreditation, stroke certification

Positive

Revere L, Robinson L.

J Healthc Manag. 2010 Jan-Feb;55(1):39-49.

2010

Hospital

Hospital (HAP)

Not applicable

No

To investigate how hospitals use the Internet as a tool to market the quality of their services.

Descriptive Study

Data from the American Hospital Association’s database, The Joint Commission’s website, and hospital’s websites were collected from a random sample of 45 hospitals in the U.S., including accreditations status, Joint Commission quality awards, and the number of competitor hospitals within 25 miles. A rating system (0-3) was applied to quality information. Data analysis included frequency distribution.

The study found that larger hospitals were more likely to earn more Joint Commision awards than smaller hospitals (Pearson correlation analysis, p=.001). Also, hospitals that have more Joint Commission awards are more likely to promote their quality information on their website, than those with fewer awards.

Not Identified

http://www.ncbi.nlm.nih.gov/pubmed/20210072

accreditation, hospital, market quality achievements

Positive

Chassin MR, Loeb JM, Schmaltz SP, Wachter RM.

N Engl J Med. 2010 Aug 12;363(7):683-8.

2010

Hospital

Hospital (HAP)

Not applicable

No

To review the origins of contemporary standardized quality measurement, with a focus on hospitals, where such programs have reached their most highly developed state; and, discuss some lessons learned from recent experience and propose a conceptual framework to guide future developments in this fast-moving field.

Not a Study

The authors of this sounding board article review the origins of contemporary standardized quality measurement, with a focus on hospitals. The article further discusses some lessons learned from recent experience and proposes a conceptual framework to guide future developments in this fast-moving field.

Hospitals made improvements in the clinical processes of care from a performance rate of 81.8% in 2002 to a rate of 95.4% in 2009. By 2009, among all 3,123 reporting hospitals, the 22 accountability measures that were in use at that time assessed about 12.5 million opportunities to provide specific elements of evidence-based care. The percentage of hospitals whose performance across all their accountability measures exceeded 90% increased substantially — from 20.4% in 2002 to 85.9% in 2009

Not Identified

http://www.nejm.org/doi/full/10.1056/NEJMsb1002320#t=article

accreditation

Positive

Mansi IA, Shi R, Khan M, Huang J, Carden D.

J Natl Med Assoc. 2010 Oct;102(10):898-905.

2010

Hospital

Hospital (HAP)

Not applicable

No

To determine the effects of compliance with The Joint Commission core quality measures for heart failure on patient outcomes at a university hospital caring for high-risk patients.

Other

Reviewed data collected for The Joint Commission on patients admitted with heart failure at a university hospital serving an indigent population in Louisiana. Patients were divided based on compliance with The Joint Commission measures into quality-compliant or quality-deficient groups. Of 646 reviewed records, 542, representing 357 patients, were included in the analysis. There were 193 patients in the quality-compliant and 164 in the quality-deficient group. Outcome measures included rate of heart failure admission/year and readmission within 90 days. Multivariate logistic and linear regression analyses were performed to identify independent associations between patient characteristics and heart failure admission.

Multiple linear regression analysis demonstrated higher rates of heart failure admission/year, and multiple logistic regression revealed higher readmissions at 90 days in the quality-compliant group (parameter estimate, 0.203; p = .02; odds ratio, 2.82; 95% confidence interval, 1.46-5.44, respectively). Compliance with TJC quality measures for heart failure at a university hospital in Louisiana was associated with higher readmission rates for heart failure. Several factors may explain this trend, including patient characteristics and focus on national reporting benchmarks rather than patient-centered health care.

2003-2004

http://www.ncbi.nlm.nih.gov/pubmed/21053704

heart failure, hospitals

Negative

Wahl WL, Arbabi S, Zalewski C, Wang SC, Hemmila MR.

J Burn Care Res. 2010 Jan-Feb;31(1):190-5.

2010

Hospital

Hospital (HAP)

Not applicable

No

To assess the effects of The Joint Commission intensive care unit (ICU) core measures for outcomes in the burn population.

Uncontrolled Before-After Study

The prospective outcomes measured for this study were hospital length of stay, ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (BSI) rates, and mortality for all burn patients admitted to the ICU. Protocols for the ICU core measures of deep venous thrombosis prophylaxis, stress ulcer prophylaxis, and daily weaning parameters, were in place before the start of the study period in 2005. Head-of-bed up at 30 degrees and glucose control, although variably practiced, were formally instituted in 2005. Enforcement of daily weaning parameters and sedation holidays were also implemented after 2005. The time period before institution of the core measures was 2003 to 2004 (pre-group), which was compared with the study time period of 2006 to 2008 (post-group).

There were no differences in the mean burn size, percent of inhalation injuries, or age between the two time periods. The VAP rate fell from 42/1000 to 13/1000 ventilator days, P = .0001. The BSI rate also declined from 12/1000 to 4/1000 line days, P = .05. Hospital and ICU lengths of stay and ventilator days did not change significantly between the periods. Risk-adjusted mortality for ICU patients improved from 13 to 7% (P = 0.01, odds ratio = 0.5 [0.29-0.85]). Although not specifically designed for the burn population, implementation of the proposed Joint Commission on the Accreditation of Healthcare Organizations ICU core measures for burn patients was associated with improvements in VAP and BSI rates, as well as a lower mortality

2003-2008

http://www.ncbi.nlm.nih.gov/pubmed/20061855

Positive

Das S.

Diss. University of Illinois at Urbana Champaign, 2010.

2010

Hospital

Hospital (HAP)

Not applicable

No

To evaluate a novel method of instituting quality improvement among hospitals in the area of smoking cessation through publicizing poor performance.

Cluster Randomized Trial

All hospitals in California were randmoized to treatment and control regions. Treatment hospitals were then informed of their current Joint Commission smoking cessation advice rates and researcher intention to publicize these rates in local media; offer smoking cessation training at cost to treatment (then control) hospitals. A reassessment of smoking cessation rates to determine if the intervention had an effect was followed by a complete post analysis to determine predictors of greater improvement.

Over one year the control sites had a significantly higher increase in smoking cessation advice rates. The end adherence rate was 94% overall (compared to an initial rate of 88%). This study demonstrates a secular trend of improvement and the impact collection of Joint Commission data has on hospital performance in all areas of care, likely via financial incentives.

accrediation, public reporting, smoking cessation

Positive

Maeda JL.

Diss. University of Illinois at Chicago, 2010.

2010

Hospital

Hospital (HAP)

Not applicable

No

To evaluate the relationship between the quarterly performance for left ventricular systolic dysfunction (LVSD) heart failure on the key evidence-based performance measures.

Other

The study design was a retrospective, observational cohort with quarterly repeated measures using primary data from The Joint Commission's ORYX initiative. A total of 3,011 non-Federal, short-stay, Joint Commission-accredited acute care hospitals that participated in the ORYX program were aggregated to 306 hospital referral regions across the United States from Quarter One of 2003 through Quarter 4 of 2006 (n=4,896).

The average hospital referrel region (HRR) adherence to the heart failure performance measures substantially increased over time with larger improvements made for the behavioral measures of smoking cessation counseling and discharge indicators and smaller gains for the clinical measures of angiontensin converting enzyme (ACEI) or inhibitor/angiotensin receptor blocker (ARB) prescribed at discharge and LV function assessment. ACEI or ARB prescribed at discharge is associated with only a marginally lower risk of mortality at one-year post-discharge. A higher HRR performance for left ventricular (LV) function assessment in the 80th percentile of mortality is associated with a 1.8% decrease in 30-day mortality. Market intensity results in only small differences in mortality and inpatient heart failure care based on the current Joint Commission performance measures.

2003-2006

heart failure, hospitals, performance measurement

Neutral

Cress D, Pelton J, Thayer SC, Bukrey C.

Orthop Nurs. 2010 May-Jun;29(3):150-68.

2010

Hospital

Hospital (HAP)

Not applicable

No

To describe the journey one midwestern healthcare system took to establish a consolidated, specialized joint replacement center, which received The Joint Commission's Disease-Specific Care Certification for hip and knee replacement.

Descriptive Study