Assessing hospital quality of care: Is there a link between accreditation and mortality?

Abstract

Health care quality is an increasingly important issue in today's society. In hospital quality assessment, two prevalent measures of quality are accreditation and mortality. This research hypothesizes that hospitals with higher accreditation scores have lower mortality rates. A review of the literature indicated that there is a significant gap in the research that tests associations between different evaluation mechanisms of organizational performance. A cross-sectional study design was used with the hospital serving as the unit of analysis and the study period representing data primarily from 1996. The hospital sample consisted of 965 nonfederally owned, general acute care, U.S. hospitals. Using secondary data sources, logistic regression modeling was performed with the independent variables consisting of hospital control variables (hospital ownership, teaching status, bed size, volume), environmental control variables (geographic location and setting) and hospital accreditation scores and the dependent variable consisting of mortality rate. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation scores measured the accreditation variables and the mortality variable was measured by risk-adjusted, statistically significant mortality rate differences. Three main conclusions can be drawn from the results: (1) The direction of the correlation between the accreditation and mortality variables is in support of the hypothesis that hospitals with higher accreditation scores have lower mortality rates; (2) The associations between the accreditation and mortality variables are generally not statistically significant; and (3) Of the accreditation variables, the Accreditation Decision variable exhibits the strongest relationship with mortality (and was statistically significant). Although the results linking hospital accreditation scores and mortality were not consistently strong, given the limitations of data variance, variable construction and measurement error, the presence of an association between accreditation and mortality is notable. Accreditation is a significant force in health care quality and mortality rates and other outcome measures are also widely used as markers of quality. Additionally, with increasing consumer demand for health care quality information and the advancement of outcomes measurement, finding associations between different organizational performance evaluations is critical if the science of quality (assessment, assurance and improvement) is to contribute towards better health care.