Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales 2052, Australia.
BMC Health Serv Res. 2012 Sep 20;12:329. doi: 10.1186/1472-6963-12-329.
Healthcare accreditation standards are advocated as an important means of improving clinical practice and organisational performance. Standard development agencies have documented methodologies to promote open, transparent, inclusive development processes where standards are developed by members. They assert that their methodologies are effective and efficient at producing standards appropriate for the health industry. However, the evidence to support these claims requires scrutiny. The study's purpose was to examine the empirical research that grounds the development methods and application of healthcare accreditation standards.
A multi-method strategy was employed over the period March 2010 to August 2011. Five academic health research databases (Medline, Psych INFO, Embase, Social work abstracts, and CINAHL) were interrogated, the websites of 36 agencies associated with the study topic were investigated, and a snowball search was undertaken. Search criteria included accreditation research studies, in English, addressing standards and their impact. Searching in stage 1 initially selected 9386 abstracts. In stage 2, this selection was refined against the inclusion criteria; empirical studies (n = 2111) were identified and refined to a selection of 140 papers with the exclusion of clinical or biomedical and commentary pieces. These were independently reviewed by two researchers and reduced to 13 articles that met the study criteria.
The 13 articles were analysed according to four categories: overall findings; standards development; implementation issues; and impact of standards. Studies have only occurred in the acute care setting, predominately in 2003 (n = 5) and 2009 (n = 4), and in the United States (n = 8). A multidisciplinary focus (n = 9) and mixed method approach (n = 11) are common characteristics. Three interventional studies were identified, with the remaining 10 studies having research designs to investigate clinical or organisational impacts. No study directly examined standards development or other issues associated with their progression. Only one study noted implementation issues, identifying several enablers and barriers. Standards were reported to improve organisational efficiency and staff circumstances. However, the impact on clinical quality was mixed, with both improvements and a lack of measurable effects recorded.
Standards are ubiquitous within healthcare and are generally considered to be an important means by which to improve clinical practice and organisational performance. However, there is a lack of robust empirical evidence examining the development, writing, implementation and impacts of healthcare accreditation standards.
医疗保健认证标准被倡导为改善临床实践和组织绩效的重要手段。标准制定机构已经记录了促进标准由成员制定的开放、透明、包容的发展过程的方法。他们声称，他们的方法在制定适合医疗保健行业的标准方面是有效和高效的。然而，支持这些说法的证据需要仔细审查。本研究的目的是审查为医疗保健认证标准的制定方法和应用提供依据的实证研究。
在 2010 年 3 月至 2011 年 8 月期间采用了多方法策略。查询了五个学术健康研究数据库（Medline、Psych INFO、Embase、Social work abstracts 和 CINAHL），调查了与研究主题相关的 36 个机构的网站，并进行了滚雪球式搜索。搜索标准包括以英语撰写的认证研究，涉及标准及其影响。在第一阶段的搜索中，最初选择了 9386 个摘要。在第二阶段，根据纳入标准对该选择进行了细化；确定了 2111 项实证研究，并对其进行了细化，以选择 140 篇论文，排除临床或生物医学和评论文章。这些由两名研究人员独立审查，并减少到符合研究标准的 13 篇文章。
根据四个类别对 13 篇文章进行了分析：总体发现；标准制定；实施问题；以及标准的影响。研究仅发生在急症护理环境中，主要发生在 2003 年（n = 5）和 2009 年（n = 4），以及美国（n = 8）。多学科焦点（n = 9）和混合方法方法（n = 11）是常见特征。确定了三项干预性研究，其余 10 项研究具有研究设计，以调查临床或组织影响。没有研究直接检查标准制定或与其进展相关的其他问题。只有一项研究注意到实施问题，确定了几个促进因素和障碍。标准被报告为提高组织效率和员工环境。然而，临床质量的影响好坏参半，记录了改进和缺乏可衡量效果的情况。
标准在医疗保健中无处不在，通常被认为是改善临床实践和组织绩效的重要手段。然而，缺乏关于医疗保健认证标准的制定、编写、实施和影响的强有力的实证证据。
