Williams Scott C, Morton David J, Braun Barbara I, Longo Beth Ann, Baker David W
The Joint Commission, One Renaissance Blvd, Oakbrook Terrace, IL.
The Joint Commission, One Renaissance Blvd, Oakbrook Terrace, IL.
J Am Med Dir Assoc. 2017 Jan;18(1):24-29. doi: 10.1016/j.jamda.2016.07.025. Epub 2016 Sep 3.
Compare quality ratings of accredited and nonaccredited nursing homes using the publicly available Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare data set.
This cross-sectional study compared the performance of 711 Joint Commission-accredited (TJC-accredited) nursing homes (81 of which also had Post-Acute Care Certification) to 14,926 non-Joint Commission-accredited (non-TJC-accredited) facilities using the Nursing Home Compare data set (as downloaded on April 2015). Measures included the overall Five-Star Quality Rating and its 4 components (health inspection, quality measures, staffing, and RN staffing), the 18 Nursing Home Compare quality measures (5 short-stay measures, 13 long-stay measures), as well as inspection deficiencies, fines, and payment denials. t tests were used to assess differences in rates for TJC-accredited nursing homes versus non-TJC-accredited nursing homes for quality measures, ratings, and fine amounts. Analysis of variance models were used to determine differences in rates using Joint Commission accreditation status, nursing home size based on number of beds, and ownership type. An additional model with an interaction term using Joint Commission accreditation status and Joint Commission Post-Acute Care Certification status was used to determine differences in rates for Post-Acute Care Certified nursing homes. Binary variables (eg, deficiency type, fines, and payment denials) were evaluated using a logistic regression model with the same covariates.
After controlling for the influences of facility size and ownership type, TJC-accredited nursing homes had significantly higher star ratings than non-TJC-accredited nursing homes on each of the star rating component subscales (P < .05) (but not on the overall star rating), and TJC-accredited nursing homes with Post-Acute Care Certification performed statistically better on the overall star rating, as well as 3 of the 4 subscales (P < .05). TJC-accredited nursing homes had statistically fewer deficiencies than non-TJC-accredited nursing homes (P < .001), were less likely to have immediate jeopardy or widespread deficiencies (P < .001), and had fewer payment denials (P < .001) and lower fines (P < .001).
Despite recent changes made to the CMS NHC star-rating methodology, results confirm previous findings that demonstrate a consistent pattern of superior performance among nursing homes accredited by The Joint Commission when compared to non-TJC-accredited facilities across a broad range of indicators in the Nursing Home Compare data set. It is important to note, however, that a cross-sectional study cannot determine causation, so it is unclear if accreditation assists nursing homes in achieving better care, or if higher-performing nursing homes are more likely to pursue accreditation.
Accreditation status remains a significant predictor of nursing home quality across multiple dimensions, independent of facility size and ownership type.
使用公开可得的医疗保险和医疗补助服务中心（CMS）疗养院比较数据集，比较经认可和未经认可的疗养院的质量评级。
这项横断面研究使用疗养院比较数据集（于2015年4月下载），将711家获得联合委员会认可（TJC认可）的疗养院（其中81家还拥有急性后护理认证）与14,926家未获得联合委员会认可（非TJC认可）的机构进行了绩效比较。测量指标包括总体五星级质量评级及其4个组成部分（健康检查、质量指标、人员配备和注册护士人员配备）、18项疗养院比较质量指标（5项短期指标、13项长期指标），以及检查缺陷、罚款和付款拒绝情况。t检验用于评估TJC认可的疗养院与非TJC认可的疗养院在质量指标、评级和罚款金额方面的比率差异。方差分析模型用于确定使用联合委员会认可状态、基于床位数的疗养院规模和所有权类型的比率差异。另一个包含联合委员会认可状态和联合委员会急性后护理认证状态交互项的模型用于确定急性后护理认证疗养院的比率差异。二元变量（如缺陷类型、罚款和付款拒绝）使用具有相同协变量的逻辑回归模型进行评估。
在控制了机构规模和所有权类型的影响后，TJC认可的疗养院在每个星级评级组成部分子量表上的星级评级显著高于非TJC认可的疗养院（P <.05）（但在总体星级评级上没有），并且具有急性后护理认证的TJC认可的疗养院在总体星级评级以及4个子量表中的3个上表现出统计学上的更好成绩（P <.05）。TJC认可的疗养院在统计学上的缺陷比非TJC认可的疗养院少（P <.001），发生立即危险或广泛缺陷的可能性较小（P <.001），付款拒绝较少（P <.001）且罚款较低（P <.001）。
尽管CMS NHC星级评级方法最近有所变化，但结果证实了先前的发现，即与疗养院比较数据集中广泛指标的非TJC认可设施相比，联合委员会认可的疗养院在绩效方面表现出一致的卓越模式。然而，需要注意的是，横断面研究无法确定因果关系，因此尚不清楚认可是否有助于疗养院实现更好的护理，或者表现较好的疗养院是否更有可能寻求认可。
认可状态仍然是疗养院多个维度质量的重要预测指标，独立于机构规模和所有权类型。
