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      Panorama da acreditação (inter)nacional no Brasil Translated title: Panorama de la acreditación (inter) nacional en Brasil Translated title: Overview of (inter)national accreditation in Brazil

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          Abstract

          RESUMO Objetivo delinear o panorama da Acreditação nacional e internacional no Brasil. Método estudo descritivo, de abordagem quantitativa e fonte documental. Os campos de inquérito foram as páginas online de acesso irrestrito das seguintes metodologias acreditadoras: Organização Nacional de Acreditação (ONA), Joint Commission International (JCI), Accreditation Canada International (ACI) e QMentum Internacional, além da página do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e/ou sites institucionais. Foram extraídas as variáveis: tipo de instituição/estabelecimento de saúde; regime de gestão setorial; localidade; nível de certificação (em caso de selo concedido pela ONA) e porte (para hospitais). Empregou-se análise estatística descritiva. Resultados apuraram-se os dados de 1.122 certificações, especialmente da ONA (77,2%) e QMentum International (13,2%). Os hospitais prevaleceram na adesão à Acreditação (35,3%), principalmente os de grande porte (60,3%) e do setor privado (75,8%). Houve concentração dos selos de qualidade na região Sudeste do Brasil (64,5%), e a região Norte apresentou menor proporção de estabelecimentos certificados (3%). Conclusões e implicações para a prática as certificações de Acreditação no Brasil remetem à metodologia nacional, com enfoque na área hospitalar privada e na região Sudeste do país. O mapeamento delineado pode sustentar assertividade em políticas de incentivo à gestão da qualidade e avaliação externa no Brasil.

          Translated abstract

          RESUMEN Objetivo delinear el panorama de la Acreditación nacional e internacional en Brasil. Método estudio descriptivo, con enfoque cuantitativo y fuente documental. Los campos de consulta fueron las páginas en línea de libre acceso de las siguientes metodologías de acreditación: Organización Nacional de Acreditación (ONA), Joint Commission International (JCI), Accreditation Canada International (ACI) y QMentum Internacional, además del Registro Nacional de Establecimientos Salud (CNES) y/o sitios web institucionales. Se extrajeron las variables: tipo de institución/establecimiento de salud; régimen de gestión sectorial; localidad; nivel de certificación (en caso de sello otorgado por la ONA) y tamaño (para hospitales). Se utilizó análisis estadístico descriptivo. Resultados se recogieron datos de 1.122 certificaciones, especialmente de ONA (77,2%) y QMentum International (13,2%). Los hospitales prevalecieron en la adhesión a la Acreditación (35,3%), en especial los hospitales grandes (60,3%) y el sector privado (75,8%). Hubo concentración de sellos de calidad en la región Sudeste de Brasil (64,5%), y la región Norte tuvo la menor proporción de establecimientos certificados (3%). Conclusiones e implicaciones para la práctica las certificaciones de acreditación en Brasil se refieren a la metodología nacional, con foco en el área hospitalaria privada y la región Sudeste del país. El mapeo esbozado puede apoyar la asertividad en las políticas de fomento de la gestión de la calidad y la evaluación externa en Brasil.

          Translated abstract

          ABSTRACT Objective to outline the panorama of national and international Accreditation in Brazil. Method a descriptive study, of quantitative approach and documental source. The survey fields were the unrestricted access online pages of the following accrediting methodologies: National Accreditation Organization (ONA), Joint Commission International (JCI), Accreditation Canada International (ACI), and QMentum International, besides the page of the National Registry of Health Establishments (CNES) and/or institutional sites. Variables were extracted: type of institution/health care facility; sector management regime; location; level of certification (in case of a seal granted by ONA), and size (for hospitals). Descriptive statistical analysis was used. Results data from 1,122 certifications was obtained, especially from ONA (77.2%) and QMentum International (13.2%). Hospitals prevailed in the Accreditation adherence (35.3%), mainly the large ones (60.3%) and from the private sector (75.8%). There was a concentration of quality seals in the Southeast region of Brazil (64.5%), and the North region presented the lowest proportion of certified establishments (3%). Conclusions and implications for practice the Accreditation certifications in Brazil refer to the national methodology, focusing on the private hospital area and the Southeast region of the country. The mapping outlined can support assertiveness in incentive policies for quality management and external evaluation in Brazil.

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          Hospital accreditation: lessons from low- and middle-income countries

          The growth of accreditation programs in low- and middle-income countries (LMICs) provides important examples of innovations in leadership, governance and mission which could be adopted in developed countries. While these accreditation programs in LMICs follow the basic structure and process of accreditation systems in the developed world, with written standards and an evaluation by independent surveyors, they differ in important ways. Their focus is primarily on improving overall care country-wide while supporting the weakest facilities. In the developed world accreditation efforts tend to focus on identifying the best institutions as those are typically the only ones who can meet stringent and difficult evaluative criteria. The Joint Learning Network for Universal Health Coverage (JLN), is an initiative launched in 2010 that enables policymakers aiming for UHC to learn from each other’s successes and failures. The JLN is primarily comprised of countries in the midst of implementing complex health financing reforms that involve an independent purchasing agency that buys care from a mix of public and private providers [Lancet 380: 933-943, 2012]. One of the concerns for participating countries has been how to preserve or improve quality during rapid expansion in coverage. Accreditation is one important mechanism available to countries to preserve or improve quality that is in common use in many LMICs today. This paper describes the results of a meeting of the JLN countries held in Bangkok in April of 2013, at which the current state of accreditation programs was discussed. During that meeting, a number of innovative approaches to accreditation in LMICs were identified, many of which, if adopted more broadly, might enhance health care quality and patient safety in the developed world. Electronic supplementary material The online version of this article (doi:10.1186/s12992-014-0065-9) contains supplementary material, which is available to authorized users.
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            Association between patient outcomes and accreditation in US hospitals: observational study

            Abstract Objectives To determine whether patients admitted to US hospitals that are accredited have better outcomes than those admitted to hospitals reviewed through state surveys, and whether accreditation by The Joint Commission (the largest and most well known accrediting body with an international presence) confers any additional benefits for patients compared with other independent accrediting organizations. Design Observational study. Setting 4400 hospitals in the United States, of which 3337 were accredited (2847 by The Joint Commission) and 1063 underwent state based review between 2014 and 2017. Participants 4 242 684 patients aged 65 years and older admitted for 15 common medical and six common surgical conditions and survey respondents of the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS). Main outcome measures Risk adjusted mortality and readmission rates at 30 days and HCAHPS patient experience scores. Hospital admissions were identified from Medicare inpatient files for 2014, and accreditation information was obtained from the Centers for Medicare and Medicaid Services and The Joint Commission. Results Patients treated at accredited hospitals had lower 30 day mortality rates (although not statistically significant lower rates, based on the prespecified P value threshold) than those at hospitals that were reviewed by a state survey agency (10.2% v 10.6%, difference 0.4% (95% confidence interval 0.1% to 0.8%), P=0.03), but nearly identical rates of mortality for the six surgical conditions (2.4% v 2.4%, 0.0% (−0.3% to 0.3%), P=0.99). Readmissions for the 15 medical conditions at 30 days were significantly lower at accredited hospitals than at state survey hospitals (22.4% v 23.2%, 0.8% (0.4% to 1.3%), P<0.001) but did not differ for the surgical conditions (15.9% v 15.6%, 0.3% (−1.2% to 1.6%), P=0.75). No statistically significant differences were seen in 30 day mortality or readmission rates (for both the medical or surgical conditions) between hospitals accredited by The Joint Commission and those accredited by other independent organizations. Patient experience scores were modestly better at state survey hospitals than at accredited hospitals (summary star rating 3.4 v 3.2, 0.2 (0.1 to 0.3), P<0.001). Among accredited hospitals, The Joint Commission did not have significantly different patient experience scores compared to other independent organizations (3.1 v 3.2, 0.1 (−0.003 to 0.2), P=0.06). Conclusions US hospital accreditation by independent organizations is not associated with lower mortality, and is only slightly associated with reduced readmission rates for the 15 common medical conditions selected in this study. There was no evidence in this study to indicate that patients choosing a hospital accredited by The Joint Commission confer any healthcare benefits over choosing a hospital accredited by another independent accrediting organization.
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              The impact of hospital accreditation on the quality of healthcare: a systematic literature review

              Background Accreditation is viewed as a reputable tool to evaluate and enhance the quality of health care. However, its effect on performance and outcomes remains unclear. This review aimed to identify and analyze the evidence on the impact of hospital accreditation. Methods We systematically searched electronic databases (PubMed, CINAHL, PsycINFO, EMBASE, MEDLINE (OvidSP), CDSR, CENTRAL, ScienceDirect, SSCI, RSCI, SciELO, and KCI) and other sources using relevant subject headings. We included peer-reviewed quantitative studies published over the last two decades, irrespective of its design or language. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers independently screened initially identified articles, reviewed the full-text of potentially relevant studies, extracted necessary data, and assessed the methodological quality of the included studies using a validated tool. The accreditation effects were synthesized and categorized thematically into six impact themes. Results We screened a total of 17,830 studies, of which 76 empirical studies that examined the impact of accreditation met our inclusion criteria. These studies were methodologically heterogeneous. Apart from the effect of accreditation on healthcare workers and particularly on job stress, our results indicate a consistent positive effect of hospital accreditation on safety culture, process-related performance measures, efficiency, and the patient length of stay, whereas employee satisfaction, patient satisfaction and experience, and 30-day hospital readmission rate were found to be unrelated to accreditation. Paradoxical results regarding the impact of accreditation on mortality rate and healthcare-associated infections hampered drawing firm conclusions on these outcome measures. Conclusion There is reasonable evidence to support the notion that compliance with accreditation standards has multiple plausible benefits in improving the performance in the hospital setting. Despite inconclusive evidence on causality, introducing hospital accreditation schemes stimulates performance improvement and patient safety. Efforts to incentivize and modernize accreditation are recommended to move towards institutionalization and sustaining the performance gains. PROSPERO registration number CRD42020167863. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07097-6.
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                Author and article information

                Journal
                ean
                Escola Anna Nery
                Esc. Anna Nery
                Universidade Federal do Rio de Janeiro (, RJ, Brazil )
                1414-8145
                2177-9465
                2022
                : 26
                : e20220024
                Affiliations
                [01] Porto Alegre Rio Grande do Sul orgnameUniversidade Federal do Rio Grande do Sul orgdiv1Escola de Enfermagem Brazil
                [02] Porto Alegre Rio Grande do Sul orgnameUniversidade Federal do Rio Grande do Sul orgdiv1Programa de Pós-graduação de Enfermagem Brazil
                Article
                S1414-81452022000100290 S1414-8145(22)02600000290
                10.1590/2177-9465-ean-2022-0024pt
                830a786b-4d1b-4ed2-a6f8-0b6a623346d6

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 01 August 2022
                : 18 March 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 0
                Product

                SciELO Revista de Enfermagem

                Categories
                Pesquisa

                Total Quality Management,Gestión en Salud,Gestión de la Calidad Total,Garantía de la Calidad de Atención de Salud,Administración Hospitalaria,Acreditación,Gestão em Saúde,Gestão da Qualidade Total,Avaliação da Qualidade dos Cuidados de Saúde,Administração Hospitalar,Acreditação,Hospital Administration,Health Management,Health Care Quality Assurance,Accreditation

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