Researchers reveal link between hospital accreditation level and mortality rate among patients

For the first time, researchers from Aarhus University, Aarhus University Hospital and the Region of Southern Denmark can now demonstrate an association between level of hospital accreditation and the mortality rate among patients.

Since 2009, Danish hospitals have been covered by an accreditation programme, the Danish Healthcare Quality Programme (DDKM), which was introduced to improve quality and patient pathways. Accreditation programmes have been used internationally for decades. Nevertheless, until now there has been sparse documentation for any differences in quality of care or patient outcome s according to whether patients are treated at hospitals which fully meet the requirements of the accreditation standards or not. However, a new study including more than 276,000 patients who had been admitted to Danish hospitals has now for the first time examined this question and found an association:

"Our study shows that the mortality rate was lower among patients admitted to the hospitals that fully met the requirements in the Danish Healthcare Quality Programme (DDKM), compared with the hospitals that only partially met the requirements. We are talking about significant results that are relevant for how the hospitals organise the efforts to improve the level of quality and patient safety in future," says PhD student Anne Mette Falstie-Jensen from the Department of Clinical Epidemiology at Aarhus University and Aarhus University Hospital, and the Centre for Quality in the Region of Southern Denmark, which are jointly behind the study.

The study was recently published in the recognised scientific journal International Journal of Quality in Health Care.

Unique study

Using the Danish National Patient Register, the researchers followed a total of 276,980 Danes who were admitted to a public hospital between 2009-2012. The patients were classified according to whether they had been admitted to a hospital that fully met the requirements of the first version of the DDKM, or whether they were admitted to a hospital that only partially met the requirements. The researchers subsequently looked at the differences in 30 day mortality after hospitalisation - and it is here that the hospitals that fully met the accreditation requirements do best:

"We can see both when we look at the accreditation system as a whole and when we only look at parts of it that there is an association between a high-level of compliance with the requirements and lower 30 day mortality.

Specifically, we can see that the mortality rate was lower in hospitals that fully met requirements for handling patients whose condition deteriorates or for treating cardiac arrest, to take a couple of examples," says Anne Mette Falstie-Jensen.

The scope of the study and its use of data from unique Danish registers has stirred international attention.

Better treatment through systematic quality improvement

The results are important for planning the healthcare system of the future:

"The study shows that how good the hospital is to effectively implement a quality improvement system probably has a significant impact. An important next step could be to try to identify the quality requirements which have the greatest impact on mortality, as a lean and focused but still effective approach is preferred when working with quality of care improvement," says Anne Mette Falstie-Jensen.

Facts about the study

• 276,980 patients were admitted to hospital with one of the 80 diagnoses accounting for 80 per cent of all deaths within 30 days of hospitalisation.
• 31 public hospitals were included in the study. Of these, eleven hospitals to a large extent meet the requirements of the accreditation standards and were "accredited", while twenty hospitals to a lesser extent lived up to the requirements and were "accredited with comments".
• 11,755 (4.24 per cent) of the patients died within 30 days of hospitalisation.
• For patients admitted to fully accredited hospitals, the mortality rate was approximately 17 per cent lower than mortality among patients admitted to hospitals which were only partially accredited, once factors such as differences in the distribution of age, gender, reasons for hospitalisation and other competing illnesses were taken into account.
• The study was based on data from the Danish National Patient Register and the Danish Civil Registration System (CPR), as well as from the hospitals' accreditation reports (survey reports) in the period between 15 November 2009 and 13 December 2012 (inclusive).

Facts about the Danish Healthcare Quality Programme

• The Danish hospitals were first accredited in accordance with the Danish Healthcare Quality Programme in the period from 2010 to 2012.
• The completion of the requirements of the accreditation standards at the hospitals was measured by an onsite visit from a group of surveyors in the form of an "external survey".