The Joint Commission’s response to the October 2018 BMJ article by Lam et. al.

Wednesday, November 07 2018

Maureen Lyons
Corporate Communications
(OAKBROOK TERRACE, Illinois, November 7, 2018) – A recent study “Association between patient outcomes and accreditation in US hospitals: observational study” questioned the benefit of Joint Commission accreditation for patients. However, the study has methodological problems that bias the study against accredited hospitals.

The researchers examined risk-adjusted 30-day mortality and readmission rates for selected medical and surgical conditions among Medicare inpatients using billing data. They compared two radically different groups of hospitals: state-surveyed hospitals—93% with fewer than 100 beds—and Joint Commission-accredited hospitals that are often larger, as 66% have more than 100 beds. Major teaching hospitals made up 216 of the Joint Commission-accredited hospitals examined in the study, but none in the state-surveyed group. Similarly, only four state-surveyed hospitals were 400 beds or larger, compared to 403 Joint Commission-accredited hospitals. It is not possible to make valid comparisons when the two groups are so radically different.

In assessing outcomes, the study selected six “common and costly surgical procedures.” Four of the six—coronary artery bypass graft surgery, open repair of abdominal aortic aneurysm, endovascular repair of abdominal aortic aneurysm, and pulmonary lobectomy—are rarely performed in hospitals with fewer than 100 beds. Only one—hip replacement—is performed with any volume in small hospitals.

In studies of mortality risks following hospital admission, measuring the severity of the illness responsible for admission is consistently the strongest predictor of risk of death. This research did not include such measures of severity in its attempt to adjust for differences in risks of death or readmission.

Despite this study’s methodology and conclusions, the data actually showed that for patients with the medical conditions cited, Joint Commission-accredited hospitals demonstrated lower mortality than state-surveyed hospitals, at conventional levels of statistical significance. Similarly, patients with medical conditions admitted to Joint Commission-accredited hospitals had lower readmission rates.

While study authors considered the differences “modest”, applying them to the more than 3 million patients with medical conditions addressed in this study indicates that patients treated in Joint Commission-accredited hospitals experienced 12,000 fewer deaths and 24,000 fewer readmissions. We believe that makes a difference to patients as much as it does to us.

In the end, the data aligns with more than 100 studies demonstrating positive impact and improved health care through Joint Commission accreditation and certification. The large number of scientific studies of the value of accreditation, and the overwhelming majority show benefits. A searchable database is publicly available.


About The Joint Commission
Founded in 1951, The Joint Commission seeks to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Joint Commission accredits and certifies more than 21,000 health care organizations and programs in the United States. An independent, nonprofit organization, The Joint Commission is the nation’s oldest and largest standards-setting and accrediting body in health care. Learn more about The Joint Commission at