Concerns about the level and variations in hospital quality
are not new. We have known for decades that hospitals differ in their ability
to provide high quality care to patients and our national strategy for ensuring
and improving care has been accreditation. The idea is simple: use an external
and independent body that applies objective criteria to ensure that hospitals
are implementing evidence-based practices to maximize patient outcomes.
Although the logic may be solid, it is unclear whether this approach works.
Despite a national strategy where our government, through
the Centers for State and Medical Healthcare Services (CMS) essentially pushes
most hospitals to obtain accreditation, patient outcomes are often lagging
behind. A 2017 news in the Wall Street Journal reported that hospitals
accredited with gold stars are struggling to ensure the basics of safety and
quality as well. The newspaper reported that 350 hospitals cited in inspection
reports in 2014 in violation of Medicare requirements had at the time accreditation
by the Joint Commission and that over a third with accreditation had suffered
further violations in 2014, 2015 and 2016. There seems to be a disconnect
between what accreditation is intended to do compared to what it could do.
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