D. S. Shepard - International Society for Quality in Health Care

D. S. Shepard - International Society for Quality in Health Care

Value and Impact of International Hospital
Accreditation in Spain
International Society for Quality in Health Care - ISQua
October 22nd, 2012
Geneva, Switzerland.
Objectives & Significance
• Objectives:
 Quantify the impact of international hospital accreditation by the Joint
Commission International (JCI) on value (quality) and economic costs
 Location: Asturias and Andalusia regions, Spain
• Significance:
– First controlled evaluation of hospital accreditation
– Recent systematic reviews of health sector accreditation:
Donald S. Shepard,1* Eduardo A. Undurraga,1
José M.
Gutierrez,2
and Pedro J.
Saturno3
• Greenfield & Braithwaite, Int J Qual Health C (2008)
– 66 empirical studies (>3,000 abstracts)
– Conclusion: indicators of effectiveness showed mixed results
1 Heller
School, Brandeis University Waltham, MA, USA
2 University of Cantabria, Santander, Spain
3 Universidad de Murcia, Murcia, Spain
• Greenfield et al., BMC Health Services Research (2012)
– 140 empirical studies (>9,000 abstracts)
– Conclusion: lack of robust empirical evidence of impact
• Hinchcliff et al., BMJ Quality and Safety (2012)
*email: [email protected]
– 122 empirical studies
– Conclusion: more empirical research is needed to draw conclusions about effectiveness
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Results for Asturias
Study Design
• Retrospective controlled design
• Compare JCI-accredited hospitals against control hospitals
• Quantitative indicators:
•
2008 JCI accreditation (compared to 4 control hospitals in same
region and cluster)
•
Positive indicators: 3 clinical
– Managerial quality (1)
– Clinical (4)
– Medical complications (6)
• Estimation of effects:
– Difference in difference
– 2-way ANOVAs
• Compare 2 periods:
– Total savings (where significant): €2,752,000/yr
– pre-accreditation (2-4 yr)
– post-accreditation (3-4 yr)
– Cumulative over 4 years of accreditation: €11,008,000
• Calculate savings
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Results for Andalusia
•
One hospital, 1999 JCI accreditation (compared to 6 control hospitals,
only 2 indicators available):
•
Non-significant indicators: 2 (clinical and managerial)
•
Negative indicators: 3 med complications (total: €242,000/yr)
•
Not available: 3 med complications
Conclusions
•
First controlled evaluation of hospital JCI accreditation
– Asturias: (2008) improved 3 clinical indicators (worsened 3 med. complications)
– Andalusia: (1999) improved performance on available indicators (2 clinical)
– Positive indicators: 2 clinical
– Average annual savings (considering only clinical indicators): € 1.6m
– Findings consistent with previous study in Jordan with same methods
•
Focus on clinical indicators instead of medical complications:
– Avoid artifacts from increasing documentation of secondary diagnoses per discharge
(mean increase 47% in Andalusia, 24% in Asturias, both p<0.05 compared to
control hospitals)
– Total savings: €522,000/yr
– Negative and non-significant indicators: 0
•
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•
Andalusia (2009) re-accreditation: mostly negative results
•
Future refinements: adjust for favorable baseline levels
•
Study shows the value of a comprehensive and nation-wide database
– Improvements probably depend on baseline values (already favorable).
2009 re-accreditation (compared to 6 control hospitals)
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–
–
–
–
Hospital re-accredited on 2002, 2006, and 2009
Positive indicator: 1 med complication
Non-significant indicator: 2 (clinical and med complication)
Negative indicator: 5 (3 clinical, 1 managerial, 1 med complication)
Not available: 3 (med complication)
– Collects annual indicators
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– Study relatively inexpensive
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Acknowledgments
•
Joint Commission International (sponsor)
•
Ministerio de Sanidad, Politica Social e Igualdad: Instituto de Informacion Sanitaria
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–
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•
Maria Angeles Gogorcena, Jefe de Area de Información y Estadísticas Asistenciales
Maria Alvarez
Antonio Torres Olivera, Director Gerente
Victor Reyes Alcázar, Area de Gestión del Conocimiento
[email protected]
Servicio de Salud, Principado de Asturias
–
–
–
Jose Ramon Riera Velasco, Director General de Calidad
Ana Roces
Mar Martinez Suárez
•
Centro de Investigaciones Científicas (CISC), Universidad de Cantabria
•
Fundación para la Formación e Investigación Sanitarias de la Región de Murcia
(FFIS) y Universidad de Murcia
•
Brandeis University, Waltham, MA, USA
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Thank you
Agencia de Calidad Sanitaria de Andalusia
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•
Paul Van-Ostenberg, Vice President
Daniel San Martin, Investigador
Yara Halasa, Research Associate
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