Patient Mortality During Unannounced Accreditation Surveys at US Hospitals
JAMA Internal Medicine (03/20/17) Barnett, Michael L.; Olenski, Andrew R.; Jena, Anupam B.
Patients who are admitted to hospitals during weeks in which the Joint Commission conducted unannounced on-site inspections have significantly lower mortality than those admitted during nonsurvey weeks, according to a new study. To determine whether increased vigilance during survey weeks is associated with improved patient outcomes compared with nonsurvey weeks, Harvard researchers conducted a quasi-randomized analysis of Medicare admissions at 1,984 surveyed hospitals from 2008 through 2012 in the period from three weeks before to three weeks after surveys. The primary outcome was 30-day mortality. The study sample included 244,787 and approximately 1.5 million admissions during survey and nonsurvey weeks, respectively, with similar patient characteristics, reason for admission and in-hospital procedures across both groups. The researchers found a significant reversible decrease in 30-day mortality for admissions during survey compared with nonsurvey weeks. This observed reduction was greater than 99.5 percent of mortality changes among 1,000 random permutations of hospital survey date combinations, which indicates the observed mortality changes were likely not attributable only to chance. Major teaching hospitals had the largest mortality change associated with survey weeks, with researchers reporting a 5.9 percent adjusted relative decrease in 30-day mortality attributable to survey weeks at these institutions. The findings suggest the difference in 30-day mortality for admissions during survey and nonsurvey weeks could be attributed to increased attention by hospital staff to a number of patient care aspects during intense surveyor observation. "Differential behavior during survey weeks may have meaningful effects on patient mortality," the researchers conclude.
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