Hospital Characteristics and Outcomes of Care Associated with Disease Specific Care Certification Programs.

Abstract

Background: Consumers and purchasers of health care are seeking value, indicated by the best possible quality of care for the dollars spent. Providers are trying to implement the best evidence and manage complex patient needs. These forces have contributed to the growth of disease-specific care certification (DSCC) programs. In 2014, more than 600 hospitals have one or more The Joint Commission (TJC) DSCCs. Yet, there is little understanding of why hospitals seek these recognitions. Furthermore, there is limited evidence that patient outcomes are associated with DSCCs. Purposes: This study: 1) examined hospital and market characteristics that might be associated with having one or more of TJC DSCCs, 2) assessed the impact of having TJC Heart Failure (HF) and Advanced HF DSCCs on patient outcomes (readmission and mortality), and 3) evaluated how outcomes change over the certification cycle. Methods: Administrative data from 2009-2013 was used from four sources: 1) TJC on-line data, 2) American Hospital Association data, 3) CMS Hospital Compare, and 4) Area Health Resources Files. More than 600 short-term, non-Federal community hospitals were examined for the descriptive comparative analysis and 125 hospitals with HF certifications were compared to non HF certified hospitals. Results: Hospitals with higher Medicare discharges, higher expenses, higher competitive forces, and not rural were more likely to have any TJC DSCCs. GEE marginal models with a linear link showed that in comparison with non-certified hospitals, having HF TJCDSCC was associated with lower mortality rates (OR 0.67; 95%, CI 0.51-0.89) and lower readmission rates (OR 0.67; 95%, CI 0.46-0.97). In longitudinal analysis, both mortality and readmission changed significantly between pre-certification and the year of certification. The significant reduction in readmission was sustained 2 years after certification (B=-3.7, SE= 0.35, t(93) = -10.68, p<0.0001). Conclusions: This is the first study to investigate the hospital characteristics associated with DSCCs and the first to examine the relationship between HF DSCCs and patient outcomes longitudinally. While the findings enhance the knowledge of factors associated with having these types of voluntary certifications, studies of other certifications, using more granular hospital characteristics and over a longer period of time are needed.