Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #109794

Laura L. Morlock, PhD¹, Lilly Engineer, MBBS, MHA¹, Marlene R. Miller, MD, MSc², Andrew Shore, PhD¹, Cyrus Engineer, MHA, MHS¹, T. Maureen Fahey, MA¹, Rebecca D. Clark, BA¹, Stephen S. Mick, PhD³, Peter J. Pronovost, MD, PhD⁴, and David Salkever¹. (1) Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, 410-955-3121, lenginee@jhsph.edu, (2) Johns Hopkins Childrens Center, 600 North Wolfe Street, CMSC 2-125A, Baltimore, MD 21287, (3) Department of Health Administration, Virginia Commonwealth University, 1008 E Clay Street, Grant House, Richmond, VA 23298, (4) Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Meyer 295, 600 N. Wolfe Street, Baltimore, MD 21205

Research Objective: Fewer than 60% of rural hospitals seek accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in contrast to 95% of urban hospitals. In a recent survey of rural hospitals, 79% of respondents indicated that the cost of accreditation was a major deterrent. It is not known whether JCAHO accreditation is associated with quality indicators based on patient outcomes in rural hospitals. The objective of this analysis was to examine relationships among JCAHO accreditation, financial status and the clinical performance of rural hospitals. Study Design: This analysis utilizes hospital discharge data for a three year time period (1999-2001) from a random sample of approximately half (N=186) of the rural hospitals in nine states (Arizona, California, Colorado, Florida, Iowa, Kentucky, New York, Washington and Wisconsin). Information on the most recent accreditation status was obtained from the JCAHO. Indicators of financial performance were derived from the Medicare Cost Report Files; total margins averaged over fiscal years 1999-2001 were used to measure financial status. The AHRQ-sponsored Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases for the nine states were used to construct Inpatient Quality Indicators. We used three of these risk-adjusted indicators to assess clinical performance, including in-hospital mortality rates for congestive heart failure (CHF), stroke, and pneumonia. We selected these three indicators because the majority of both JCAHO accredited and non-accredited rural hospitals met a volume threshold of at least 30 patients with these conditions over the three year time period. Our analyses were based on multivariate regressions using Generalized Estimating Equations to adjust for the clustering of hospitals within states. Principal Findings: Among these rural hospitals, 110 (59%) were accredited by the JCAHO. Rural hospital size, as measured by number of beds (p<.0001), and better financial status (p<.05) were both associated with the likelihood of having sought and obtained JCAHO accreditation. In the bivariate analyses, and after controlling for hospital size and financial status, JCAHO accreditation was significantly associated with lower in-hospital, risk-adjusted mortality rates for CHF (p<.05), stroke (p<..01) and pneumonia (p<.0001). Conclusions: JCAHO accreditation is associated with better outcomes for patients treated in rural hospitals for CHF, stroke and pneumonia. These relationships remain statistically significant after taking into consideration hospital size and financial status. These findings, if corroborated by other studies, suggest that JCAHO accreditation status may be a useful indicator of hospital clinical performance for rural health care consumers, payers and regulators.

Learning Objectives:

• At the conclusion of the session, the participant will be able to describe differences between rural hospitals accredited and not accredited by the Joint Commission on Accreditation of Healthcare Organizations with respect to selected indicators of health care quality as measured by risk-adjusted mortality rates.

Keywords: Rural Health Care Delivery System, Quality of Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation