Comparison of US Accredited/Non-Accredited Rural Critical Access Hospitals
Comparison of US Accredited/Non-Accredited Rural Critical Access Hospitals
Background: US critical access hospitals play an integral role in rural healthcare. Accreditation may be helpful in assuring that these hospitals provide high-quality care.
Objective: To determine whether quality measures used in the US Centers for Medicare and Medicaid Services Hospital Compare database differed for critical access hospitals based on Joint Commission on Accreditation of Healthcare Organizations accreditation status.
Research Design: Cross-sectional with t-test statistics computed on weighted data to ascertain statistically significant differences (P ≤0.01).
Main Outcome Measure: Differences between accredited and non-accredited rural critical access hospitals on quality care indicators related to acute myocardial infarction, heart failure, pneumonia and surgical infection.
Subjects: US critical access hospitals.
Results: The differences between accredited and non-accredited rural critical access hospitals for 4 out of 16 hospital quality indicators were statistically significant (P ≤ 0.01) and favored accredited hospitals. Also, accredited hospitals were more likely to rank in the top half of hospitals for 6 of the 16 quality measures.
Conclusions: The results indicate that in the setting of critical access hospitals, external accreditation appears to result in modestly better performance.
The quality and access to healthcare varies widely in the USA. For the 20% of US residents living in rural settings, access to quality health care often depends on a critical access hospital. These small hospitals have less than 25 beds, often function as the primary source of health care for a region and may even be the sole provider for a community's Medicare and Medicaid beneficiaries and uninsured individuals.
Their integral role in rural healthcare delivery makes it important for these hospitals to provide quality care. External monitoring, which offers an unbiased assessment of internal mechanisms and provides benchmarks for an organization, is one way to help assure quality care. Accreditation is one important external measure, and among the hospital accrediting organizations in the USA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the most widely recognized. JCAHO is an independent, non-profit organization that conducts quality assessments in ~80% of hospitals in the USA. Its stated mission is to improve the safety and quality of care through evaluation and accreditation of healthcare organizations. In seeking JCAHO accreditation, a hospital agrees to be measured against a consistent and objective set of standards in areas such as patient assessment and care, patients' rights, human resources, organizational leadership, clinical ethics, management and information management.
Factors such as size, case mix, ownership and cost can influence a hospital's decision to seek JCAHO accreditation. Cost is perhaps the key factor for a critical access hospital. Given their limited resources, it is not surprising that there is a substantial difference in accreditation rates between urban and rural hospitals. More than 95% of urban hospitals are JCAHO accredited compared with ~35% of critical access hospitals.
Studies examining the link between accreditation status and quality reveal mixed results. One study concluded that while JCAHO accreditation correlated with a higher quality of care for acute myocardial infarction (AMI) and lower 30-day mortality rates, accreditation levels 'were of limited value in differentiating quality' among surveyed hospitals. Other studies fail to establish a correlation between accreditation scores and outcome measures such as mortality index, cost per case and length of stay or demonstrate only a weak correlation between JCAHO scores and inpatient quality indicators. In contrast, Longo et al. identified JCAHO accreditation as a key predictor for implementing patient safety initiatives. However, many studies are limited because they examined only a single disease state or focused on larger non-rural hospitals, providing little insight into the association of JCAHO accreditation with the quality of healthcare at rural hospitals.
This study sought to determine whether the process measures used in the US Centers for Medicare and Medicaid Services (CMS) Hospital Compare database differed for critical access hospitals based on accreditation status. The Hospital Compare website is a tool used by the Hospital Quality Alliance to convey information about quality to the public. The results should provide one objective assessment of whether there is a link between JCAHO accreditation and the quality of care provided by a critical access hospital and insight into how well the JCAHO process meets its mission to improve safety and quality of care in the setting of smaller rural hospitals.
Abstract and Introduction
Abstract
Background: US critical access hospitals play an integral role in rural healthcare. Accreditation may be helpful in assuring that these hospitals provide high-quality care.
Objective: To determine whether quality measures used in the US Centers for Medicare and Medicaid Services Hospital Compare database differed for critical access hospitals based on Joint Commission on Accreditation of Healthcare Organizations accreditation status.
Research Design: Cross-sectional with t-test statistics computed on weighted data to ascertain statistically significant differences (P ≤0.01).
Main Outcome Measure: Differences between accredited and non-accredited rural critical access hospitals on quality care indicators related to acute myocardial infarction, heart failure, pneumonia and surgical infection.
Subjects: US critical access hospitals.
Results: The differences between accredited and non-accredited rural critical access hospitals for 4 out of 16 hospital quality indicators were statistically significant (P ≤ 0.01) and favored accredited hospitals. Also, accredited hospitals were more likely to rank in the top half of hospitals for 6 of the 16 quality measures.
Conclusions: The results indicate that in the setting of critical access hospitals, external accreditation appears to result in modestly better performance.
Introduction
The quality and access to healthcare varies widely in the USA. For the 20% of US residents living in rural settings, access to quality health care often depends on a critical access hospital. These small hospitals have less than 25 beds, often function as the primary source of health care for a region and may even be the sole provider for a community's Medicare and Medicaid beneficiaries and uninsured individuals.
Their integral role in rural healthcare delivery makes it important for these hospitals to provide quality care. External monitoring, which offers an unbiased assessment of internal mechanisms and provides benchmarks for an organization, is one way to help assure quality care. Accreditation is one important external measure, and among the hospital accrediting organizations in the USA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the most widely recognized. JCAHO is an independent, non-profit organization that conducts quality assessments in ~80% of hospitals in the USA. Its stated mission is to improve the safety and quality of care through evaluation and accreditation of healthcare organizations. In seeking JCAHO accreditation, a hospital agrees to be measured against a consistent and objective set of standards in areas such as patient assessment and care, patients' rights, human resources, organizational leadership, clinical ethics, management and information management.
Factors such as size, case mix, ownership and cost can influence a hospital's decision to seek JCAHO accreditation. Cost is perhaps the key factor for a critical access hospital. Given their limited resources, it is not surprising that there is a substantial difference in accreditation rates between urban and rural hospitals. More than 95% of urban hospitals are JCAHO accredited compared with ~35% of critical access hospitals.
Studies examining the link between accreditation status and quality reveal mixed results. One study concluded that while JCAHO accreditation correlated with a higher quality of care for acute myocardial infarction (AMI) and lower 30-day mortality rates, accreditation levels 'were of limited value in differentiating quality' among surveyed hospitals. Other studies fail to establish a correlation between accreditation scores and outcome measures such as mortality index, cost per case and length of stay or demonstrate only a weak correlation between JCAHO scores and inpatient quality indicators. In contrast, Longo et al. identified JCAHO accreditation as a key predictor for implementing patient safety initiatives. However, many studies are limited because they examined only a single disease state or focused on larger non-rural hospitals, providing little insight into the association of JCAHO accreditation with the quality of healthcare at rural hospitals.
This study sought to determine whether the process measures used in the US Centers for Medicare and Medicaid Services (CMS) Hospital Compare database differed for critical access hospitals based on accreditation status. The Hospital Compare website is a tool used by the Hospital Quality Alliance to convey information about quality to the public. The results should provide one objective assessment of whether there is a link between JCAHO accreditation and the quality of care provided by a critical access hospital and insight into how well the JCAHO process meets its mission to improve safety and quality of care in the setting of smaller rural hospitals.
