Compliance with hospital accreditation and patient mortality: a Danish nationwide population-based study

Int J Qual Health Care. 2015 Jun;27(3):165-74. doi: 10.1093/intqhc/mzv023. Epub 2015 Apr 28.


Objective: To examine the association between compliance with hospital accreditation and 30-day mortality.

Design: A nationwide population-based, follow-up study with data from national, public registries.

Setting: Public, non-psychiatric Danish hospitals.

Participants: In-patients diagnosed with one of the 80 primary diagnoses.

Intervention: Accreditation by the first version of The Danish Healthcare Quality Programme for hospitals from 2010 to 2012. Compliance were assessed by surveyors on an on-site survey and awarded the hospital as a whole; fully (n = 11) or partially accredited (n = 20). A follow-up activity was requested for partially accredited hospitals; submitting additional documentation (n = 11) or by having a return-visit (n = 9).

Main outcome measures: All-cause mortality within 30-days after admission. Multivariable logistic regression was used to compute odds ratios (ORs) for 30-day mortality adjusted for six confounding factors and for cluster effect at hospital level.

Results: A total of 276 980 in-patients were identified. Thirty-day mortality risk for in-patients at fully (n = 76 518) and partially accredited hospitals (n = 200 462) was 4.14% (95% confidence interval (CI):4.00-4.28) and 4.28% (95% CI: 4.20-4.37), respectively. In-patients at fully accredited hospitals had a lower risk of dying within 30-days after admission than in-patients at partially accredited hospitals (adjusted OR of 0.83; 95% CI: 0.72-0.96). A lower risk of 30-day mortality was observed among in-patients at partially accredited hospitals required to submit additional documentation compared with in-patients at partially accredited hospitals requiring a return-visit (adjusted OR 0.83; 95% CI: 0.67-1.02).

Conclusion: Admissions at fully accredited hospitals were associated with a lower 30-day mortality risk than admissions at partially accredited hospitals.

Keywords: certification/accreditation of hospitals; external quality assessment; measurement of quality; patient outcomes (health status, quality of life, mortality).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accreditation / standards
  • Accreditation / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Denmark
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Hospital Mortality
  • Hospitals, Public / standards
  • Hospitals, Public / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Mortality*
  • Quality of Health Care / standards
  • Quality of Health Care / statistics & numerical data*
  • Risk Management