Compliance with hospital accreditation and patient mortality: a Danish nationwide population-based study

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Abstract

To examine the association between compliance with hospital accreditation and 30-day mortality.

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Health sector accreditation research: a systematic review.

David Greenfield, Jeffrey Braithwaite (2008)

The purpose of this study was to identify and analyze research into accreditation and accreditation processes. A multi-method, systematic review of the accreditation literature was conducted from March to May 2007. The search identified articles researching accreditation. Discussion or commentary pieces were excluded. From the initial identification of over 3000 abstracts, 66 studies that met the search criteria by empirically examining accreditation were selected. DATA EXTRACTION AND RESULTS OF DATA SYNTHESIS: The 66 studies were retrieved and analyzed. The results, examining the impact or effectiveness of accreditation, were classified into 10 categories: professions' attitudes to accreditation, promote change, organizational impact, financial impact, quality measures, program assessment, consumer views or patient satisfaction, public disclosure, professional development and surveyor issues. The analysis reveals a complex picture. In two categories consistent findings were recorded: promote change and professional development. Inconsistent findings were identified in five categories: professions' attitudes to accreditation, organizational impact, financial impact, quality measures and program assessment. The remaining three categories-consumer views or patient satisfaction, public disclosure and surveyor issues-did not have sufficient studies to draw any conclusion. The search identified a number of national health care accreditation organizations engaged in research activities. The health care accreditation industry appears to be purposefully moving towards constructing the evidence to ground our understanding of accreditation.

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Six Persistent Research Misconceptions

Kenneth J. Rothman (2014)

ABSTRACT Scientific knowledge changes rapidly, but the concepts and methods of the conduct of research change more slowly. To stimulate discussion of outmoded thinking regarding the conduct of research, I list six misconceptions about research that persist long after their flaws have become apparent. The misconceptions are: 1) There is a hierarchy of study designs; randomized trials provide the greatest validity, followed by cohort studies, with case–control studies being least reliable. 2) An essential element for valid generalization is that the study subjects constitute a representative sample of a target population. 3) If a term that denotes the product of two factors in a regression model is not statistically significant, then there is no biologic interaction between those factors. 4) When categorizing a continuous variable, a reasonable scheme for choosing category cut-points is to use percentile-defined boundaries, such as quartiles or quintiles of the distribution. 5) One should always report P values or confidence intervals that have been adjusted for multiple comparisons. 6) Significance testing is useful and important for the interpretation of data. These misconceptions have been perpetuated in journals, classrooms and textbooks. They persist because they represent intellectual shortcuts that avoid more thoughtful approaches to research problems. I hope that calling attention to these misconceptions will spark the debates needed to shelve these outmoded ideas for good.

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Explaining differences in English hospital death rates using routinely collected data.

S Gault, John B. Jarman, S. Dolan … (1999)

To ascertain hospital inpatient mortality in England and to determine which factors best explain variation in standardised hospital death ratios. Weighted linear regression analysis of routinely collected data over four years, with hospital standardised mortality ratios as the dependent variable. England. Eight million discharges from NHS hospitals when the primary diagnosis was one of the diagnoses accounting for 80% of inpatient deaths. Hospital standardised mortality ratios and predictors of variations in these ratios. The four year crude death rates varied across hospitals from 3.4% to 13.6% (average for England 8.5%), and standardised hospital mortality ratios ranged from 53 to 137 (average for England 100). The percentage of cases that were emergency admissions (60% of total hospital admissions) was the best predictor of this variation in mortality, with the ratio of hospital doctors to beds and general practitioners to head of population the next best predictors. When analyses were restricted to emergency admissions (which covered 93% of all patient deaths analysed) number of doctors per bed was the best predictor. Analysis of hospital episode statistics reveals wide variation in standardised hospital mortality ratios in England. The percentage of total admissions classified as emergencies is the most powerful predictor of variation in mortality. The ratios of doctors to head of population served, both in hospital and in general practice, seem to be critical determinants of standardised hospital death rates; the higher these ratios, the lower the death rates in both cases.