The impact of hospital accreditation on clinical documentation compliance: a life cycle explanation using interrupted time series analysis.
Bottom Line: 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.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).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.
Affiliation: Quality and Patient Safety, Al Noor Hospitals Group, Abu Dhabi, UAE.Show MeSH
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Mentions: The results of the confirmatory test, using a composite score (YC) of the 23 quality measures, provide proof of the Life Cycle Model (figure 2). The slope prior to accreditation (β1) is positive and highly significant, as hypothesised. The change in level following the accreditation survey (β2) signals a significant decline in compliance, as predicted; and, as postulated, the postaccreditation slope (β3) is also negative and statistically significant (table 3). Furthermore, the R2 indicates that over 87% of the variation in quality compliance outcomes is explained by the three variables in the Life Cycle Model (table 3). The best fit interrupted time series model not only contains three significant variables, but also the size of the coefficients indicates that the effects of these variables are substantial. The preintervention slope (β1) implies an increase in compliance by 2.19 percentage points per month prior to the accreditation survey. This Initiation Phase is characterised by a period of steep increases in compliance followed by sporadic declines. The β2 coefficient suggests that the mean level of compliance for the 23 quality measures decreased by 3.95 percentage points immediately following the accreditation survey. The β3 coefficient indicates a decrease in compliance of 2.16 percentage points per month postaccreditation. The postaccreditation slump is followed by a long period of stagnation characterised by an undulating plateau of compliance but, importantly, at a level of 20 percentage points higher than the preaccreditation survey levels (figure 2).
Affiliation: Quality and Patient Safety, Al Noor Hospitals Group, Abu Dhabi, UAE.