D. S. Shepard - International Society for Quality in Health Care
Transcripción
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 1 2 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 3 4 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 • 5 • 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) – – – – – 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 6 – Study relatively inexpensive 1 Acknowledgments • Joint Commission International (sponsor) • Ministerio de Sanidad, Politica Social e Igualdad: Instituto de Informacion Sanitaria – – – • 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 – – 7 Thank you Agencia de Calidad Sanitaria de Andalusia – – • Paul Van-Ostenberg, Vice President Daniel San Martin, Investigador Yara Halasa, Research Associate 8 2