Patient mortality during unannounced accreditation surveys at US hospitals.

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Barnett ML, Olenski AR, Jena AB. JAMA Intern Med. 2017;177:693-700.

Prior research has demonstrated that hospital accreditation by The Joint Commission is associated with improved hospital performance on certain quality of care measures. However, it has not been established whether the survey periods themselves are associated with a change in patient outcomes. Researchers analyzed Medicare admissions at 1984 hospitals surveyed by The Joint Commission between 2008 and 2012 from 3 weeks prior to a survey up to 3 weeks afterward. They compared patient outcomes between survey periods and the surrounding weeks. For the primary outcome—30-day mortality—patients admitted to the hospital during survey periods had significantly lower mortality than those admitted during nonsurvey weeks, suggesting that heightened vigilance during survey weeks and resultant changes in practice may explain this finding. This interpretation captured much attention and calls for making heightened vigilance a year-round phenomenon. The study reported detectable reductions in mortality at the outset of survey weeks and reversion to previsit levels when survey weeks end. A past PSNet interview with the president of The Joint Commission discussed his role in the organization.

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