Do JCAHO accredited hospitals perform better on quality measures? An analysis of process-of-care measures and surgical indicators

Background: Although some studies have examined the relationship between Joint Commission on Accreditation of Healthcare Organization's (JCAHO) accreditation status and process-of-care measures, none have concurrently examined the relationship between accreditation status and surgical outcomes. We sought to examine the relationship between JCAHO accreditation and hospital performance on both process of care and surgical outcomes measures.

Methods: We determined which acute, non-federal, medical/surgical hospitals went through the JCAHO accreditation survey process between 2000 and 2003 and recorded the overall evaluation scores of those that did. We eliminated critical access hospitals from the analysis. We obtained process-of-care data from Hospital Compare and surgical outcomes indicator data for 14 high-risk surgical procedures. We used two-sample t –tests with unequal variances and one-way ANOVA to compare continuous variables and chi-squared tests to compare dichotomous or categorical variables. We determined whether JCAHO accredited hospitals were more likely to be in the best, as opposed to the worst, surgical outcomes performance quintile when compared to non-accredited hospitals. Further, among JCAHO accredited hospitals, we determined whether higher accreditation scores were associated with better performance.

Results: When comparing process-of-care measures for accredited and non-accredited hospitals, we found statistically significant differences in only five of 17 measures: accredited hospitals scored better on four measures, and worse one measure – antibiotic timing for community-acquired pneumonia. However, differences were quite small and were likely clinically irrelevant. Among accredited hospitals, higher overall evaluation scores did not consistently predict better process-of-care performance. In contrast, when comparing JCAHO accredited to non-accredited hospitals, we found statistically significant differences in surgical performance indicators for virtually every procedure examined. With two exceptions, non-accredited hospitals were less likely to be in the highest performing quintile and more likely to be in the lowest performing quintile. Among JCAHO accredited hospitals, higher accreditation scores did not consistently discern better surgical outcomes.

Discussion: Our findings support previous studies that found no association between accreditation scores and risk-adjusted mortality and modest associations between accreditation status and better process-of-care performance; however, we found fewer differences than previously reported. This can be logically explained: process-of-care performance appears to be improving overall, and, with less variation across all hospitals, accreditation status may less effectively differentiate performance. For the first time, our study found that JCAHO accreditation is associated with better surgical outcomes performance. Should surgical indicators become widely used, the same trajectory might be anticipated, and have a dramatic effect on surgical performance, nationwide.