Hospital credentialing and quality of care

• Published in: Social science & medicine (1982) Vol. 50; no. 1; pp. 77 - 88
• Main Authors: Sloan, Frank A, Conover, Christopher J, Provenzale, Dawn
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 2000; Elsevier; Pergamon Press Inc
• Series: Social Science & Medicine
• Subjects: Accreditation; Adolescent; Adult; Aged; Biological and medical sciences; Certification; Certification Clinical competence Cholecystectomy Laparascopic Intraoperative complications Surgery Medical licensure United States; Child; Child, Preschool; Cholecystectomy; Clinical competence; Clinical outcomes; Credentialing; Female; General aspects; Health care; Health services; Health Services Research; Health systems. Social services; Hospital management; Hospital Mortality; Hospitals; Hospitals, Community - standards; Humans; Infant; Intraoperative complications; Laparascopic; Length of Stay - statistics & numerical data; Licenses; Logistic Models; Male; Medical licensure; Medical sciences; Medical Staff Privileges - standards; Middle Aged; Multivariate Analysis; North Carolina; Outcome Assessment (Health Care) - organization & administration; Outcomes; Postoperative Complications - etiology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Health Care; Quality of service; Relationship; Surgery; Surgical Procedures, Operative - adverse effects; Surgical Procedures, Operative - mortality; Surgical Procedures, Operative - standards; Surveys and Questionnaires; Treatment Outcomes; U.S.A; United States; USA; Workforce; Clinical competence; Cholecystectomy; Intraoperative complications; Medical licensure; United States; Surgery; Laparascopic; Certification; Human; Postoperative; Health system; Evaluation; Prognosis; Health staff; Health service; Indicator; Care; Quality assurance; Hospital organization; Professional practice; Quality; Accreditation; Public health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(99)00269-5

The purpose of this study was to evaluate the impact of hospital credentialing standards on surgical outcomes for selected procedures. The study used hospital credentialing practices from a 1996 survey of North Carolina community hospitals, with surgical outcomes derived from a statewide database of inpatient surgical discharges in 1995. Hospital mortality, complications and elevated lengths of stay were used as outcome indicators in an analysis of 6 surgical procedures. Multivariate logit analysis was used to calculate the effects of hospital credentialing stringency and nine credentialing practices on outcomes, controlling for patient demographic characteristics, type of admission, severity of illness and hospital characteristics. Teaching hospitals adopted more stringent credentialing practices, with almost no difference between metropolitan and nonmetropolitan nonteaching facilities in their use of various credentialing policies. Surgical outcomes typically were not related to stringency of the hospital credentialing environment. Generally, the effect of specific practices was inconsistent (associated with improved outcomes for certain procedures and significantly worse outcomes for others) or counterintuitive (showing worse outcomes for selected surgical procedures where effects were statistically significant). More stringent hospital credentialing does not appear likely to improve patient outcomes.