Monday, October 17, 2011

Does the Joint Commission improve the quality of hospitals?

Well, a study just published in the Journal of Hospital Medicine implies that maybe it does. Investigators looked at publicly reported performance data for accredited and non-accredited hospitals. Here are the findings:

Hospitals accredited by The Joint Commission tended to have better baseline performance in 2004 than non-accredited hospitals. Accredited hospitals had larger gains over time, and were significantly more likely to have high performance in 2008 on 13 out of 16 standardized clinical performance measures and all summary scores.

While Joint Commission-accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures in the early days of public reporting, these differences became significantly more pronounced over 5 years of observation. Future research should examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance.

So does this mean that the Joint Commission improves the quality in our hospitals? No. Does it even mean that Joint Commission accreditation is associated with better quality? No. We need to examine some questions.

First, what about these non-accredited hospitals? Well I was surprised to learn from the paper that as many as 18% of hospitals are not accredited. The study compared those hospitals that were never accredited for the entire study period with those that were accredited the whole time. Although the authors were not explicit about it, the strong sense I got from reading the paper is that these were all hospitals which chose not to seek accreditation rather than those which tried and flunked year after year. It seems to me that accreditation by the Joint is a lot like a hospital's report on performance measures. They share almost identical incentives. Both amount to public report cards. So if your hospital administrators are not interested in one they're not likely to be as interested in the other, compared to hospitals that seek accreditation. In my view the study demonstrated nothing more than that.

But the fundamental flaw in this paper, to me, is that the authors seem to confuse performance with quality. I've blogged extensively before on this fallacy. The authors are smart folks (Bob Wachter among them). Surely they are aware of the difference. I only wish that in their discussion they had made a clear distinction.

HT to Hospital Medicine Quick Hits.


Unlikely Hospitalist said...

The question, as you so rightly state isn't "Does the Joint Commission improve quality?" it is does performance measures? I have seen no data to support this contention.

R. W. Donnell said...

Right. There are no data that performance measures improve quality. In fact there is reason to believe they may be harmful in some cases.