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2018, vol. 75, br. 8, str. 803-808
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Uticaj akreditacije na kvalitet zdravstvene zaštite u bolničkim ustanovama
The impact of accreditation on health care quality in hospitals
aPrimary Healthcare Center Zemun, Department of Social Medicine, Belgrade bGeneral Hospital Valjevo, Education Center cUniverzitet u Beogradu, Medicinski fakultet, Institut za socijalnu medicinu
e-adresa: gm5rovic@gmail.com
Sažetak
Uvod/Cilj. Akreditacija se smatra najstarijim i najrasprostranjenijim nezavisnim mehanizmom spoljašnjeg ocenjivanja kvaliteta zdravstvene zaštite i sprovodi se u preko 70 zemalja širom sveta. Uprkos velikom broju istraživanja u ovoj oblasti i dalje nema čvrstih dokaza o njenom uticaju na kvalitet zdravstvene zaštite i bezbednost bolesnika. Cilj ovog rada je da se istraži da li proces akreditacije utiče na razliku u vrednostima pokazatelja kvaliteta zdravstvene zaštite. Metode. Istraživanje je sprovedeno u dve bolnice tercijernog nivoa zdravstvene zaštite, od kojih je jedna akreditovana, a druga nije. Poređene su vrednosti sedam pokazatelja kvaliteta u periodu pre, za vreme i neposredno posle završene akreditacije (od 2007-2015 godine), koji mere kvalitet zdravstvene zaštite, bezbednost bolesnika, efikasnost i produktivnost ustanove. Rezultati. Od sedam praćenih pokazatelja kvaliteta, pozitivnom uticaju procesa akreditacije se može pripisati kraće čekanja na zakazan prvi pregled za nivo ustanove, kraće čekanje na prvi pregled kod hirurga, niža stopa bolesnika sa dekubitusima, kao i pad dužine bolničkog lečenja bolesnika sa akutnim infarktom miokarda. Nije nađen uticaj akreditacije na stopu mortaliteta, procenat umrlih u prvih 48h hospitalizacije i prosečnu dužinu bolničkog lečenja za nivo ustanove. Zaključak. Proces akreditacije nesumnjivo intenzivira aktivnosti koje doprinose unapređenju kvaliteta zdravstvene zaštite, što rezultira i boljim zdravstvenim ishodima. Potrebna su dodatna istraživanja u ovoj oblasti i novi dokazi o povezanosti akreditacije sa unapređenjem kvaliteta u zdravstvenim institucijama, jer bi to moglo motivisati njihove menadžere da se lakše odluče za ulazak u ovaj proces i njegovu realizaciju uprkos dodatnom trudu i finansijskim ulaganjima povezanih sa akreditacijom.
Abstract
Background/Aim. Accreditation is considered to be the oldest and most widespread mechanism of independent external evaluation of health care quality and is implemented in over 70 countries worldwide. Despite numerous studies in this field, there is still no solid evidence about its impact on health care quality and patient safety. The goal of this paper was to investigate if the accreditation process has an effect on the difference in values of health care quality indicators. Methods. The study was conducted in two tertiary level health care hospitals, one accredited, the other non-accredited. Values of seven quality indicators in the period before, during and immediately after the completion of accreditation (from 2007-2015), which measure health care quality, patient safety, the efficiency and productivity of the institution, were compared. Results. Of the seven monitored quality indicators, a positive effect of the accreditation process can be attributed to a shorter length of waiting for the first scheduled health check at the institution, shorter length of waiting for the first scheduled surgical check, lower rate of patients with decubitus as well as a decrease of the rate of hospital days per patient with acute myocardial infarction. No effect of accreditation was found on the mortality rate, mortality rate within the first 48 hours of hospitalization, and the average rate of hospital days per patient at the level of the institution. Conclusion. The process of accreditation undoubtedly intensifies activities that contribute to improving health care quality, which results in better health outcomes. Additional research in this field and new evidence about the relationship between accreditation and quality upgrading in health care institutions are required because this could motivate their managers to decide more easily to enter into this process and implement it, despite the additional efforts and financial investments associated with accreditation.
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