Table 3.
Performance Change and Difference in Performance Change From 2004 to 2008 by Joint Commission Accreditation Status
| Change in Performance* | |||||
|---|---|---|---|---|---|
| Characteristic | Never Accredited (n = 762) | Always Accredited (n = 2,917) | Absolute Difference, Always vs Never (95% CI)† | Relative Difference, % Always vs Never | P Value† |
| AMI | |||||
| Aspirin at admission | −1.1 | 2.0 | 3.2 (1.2–5.2) | 160 | 0.001 |
| Aspirin at discharge | 4.7 | 8.0 | 3.2 (1.4–5.1) | 40 | 0.008 |
| ACE inhibitor for LV dysfunction | 8.5 | 15.9 | 7.4 (3.7–11.5) | 47 | <0.001 |
| Beta blocker at discharge | 4.4 | 8.4 | 4.0 (2.0–6.0) | 48 | <0.001 |
| Smoking cessation advice | 18.6 | 22.4 | 3.7 (1.1–6.9) | 17 | 0.012 |
| PCI received within 90 min | 6.3 | 13.0 | 6.7 (0.3–14.2) | 52 | 0.070 |
| Thrombolytic agent within 30 min | −0.6 | 5.4 | 6.1 (−9.5–20.4) | 113 | 0.421 |
| Composite AMI score | 2.0 | 5.8 | 3.9 (2.2–5.5) | 67 | <0.001 |
| Heart failure | |||||
| Discharge instructions | 24.2 | 35.6 | 11.4 (8.7–14.0) | 32 | <0.001 |
| Assessment of LV function | 4.6 | 12.8 | 8.3 (6.6–10.0) | 65 | <0.001 |
| ACE inhibitor for LV dysfunction | 10.1 | 15.2 | 5.1 (3.5–6.8) | 34 | <0.001 |
| Smoking cessation advice | 20.5 | 26.4 | 6.0 (3.3–8.7) | 23 | <0.001 |
| Composite heart failure score | 10.8 | 20.9 | 10.1 (8.3–12.0) | 48 | <0.001 |
| Pneumonia | |||||
| Oxygenation assessment | 0.9 | 1.4 | 0.6 (0.3–0.9) | 43 | <0.001 |
| Pneumococcal vaccination | 33.4 | 40.9 | 7.5 (5.6–9.4) | 18 | <0.001 |
| Timing of initial antibiotic therapy | 19.2 | 21.1 | 1.9 (1.1–2.7) | 9 | <0.001 |
| Smoking cessation advice | 21.8 | 27.9 | 6.0 (3.8–8.3) | 22 | <0.001 |
| Initial antibiotic selection | 13.6 | 14.3 | 0.7 (−0.5–1.9) | 5 | 0.293 |
| Composite pneumonia score | 13.7 | 17.5 | 3.7 (2.8–4.6) | 21 | <0.001 |
| Overall composite | 12.0 | 16.1 | 4.2 (3.2–5.1) | 26 | <0.001 |
Abbreviations: ACE angiotensin-converting enzyme; AMI, acute myocardial infarction; CI, confidence interval; LV, left ventricular; PCI, percutaneous coronary intervention.
Performance calculated as the proportion of all eligible patients who received the indicated care. Change in performance estimated based on multivariate regression adjusting for baseline performance, profit status, bed size, rural setting, critical access hospital status, and region except for PCI received within 90 minutes and thrombolytic agent within 30 minutes which did not adjust for critical access hospital status.
P values and CIs calculated based on bootstrapped standard errors.