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The CMS Home Health Quality Reporting Program (HH QRP) requires home health agencies (HHAs) to report quality data to measure their performance. This study aimed to assess the relationship between voluntary accreditation with The Joint Commission (TJC) and the ability of HHAs to sustain higher performance over multiple years compared to non-TJC-accredited HHAs. This was a multi-year observational study that analyzed CMS HHA performance data for each year, 2013 to 2019. Measures of interest were the star ratings and 8 quality measures in the HHC dataset with enough variability where a difference between the top and bottom quartile would be meaningful. Close to half of HHAs did not attain the top quartile for any of the study years, but TJC-accredited HHAs generally have a lower proportion of HHAs with 0 year and a higher proportion with 4 to 7 years with top-quartile performance for all measures except the 2 immunization measures. Given a HHA was in the top quartile on a measure the previous year, TJC-accredited HHAs were significantly more likely to remain in the top quartile the year following compared to non-TJC-accredited HHAs. These findings demonstrate better sustained performance among TJC-accredited HHAs compared to non-TJC-accredited agencies. These findings suggest that accreditation requirements may address some of the factors that can threaten the sustainability of positive performance in HHAs. Further research is needed to explore these factors more closely. [ABSTRACT FROM AUTHOR]

Accreditation evaluates healthcare organization quality of care and patient safety processes, but the influence of this activity on the patient experience is not well understood. This study was designed to explore the relationship between accreditation survey scoring and patient experience of care using a subset of The Joint Commission (TJC) accreditation standards that are conceptually aligned with the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Special Care Issues composite. This was an observational study that used 2018 to 2019 CMS HHCAHPS data and TJC survey findings for 1464 accredited HHAs. The presence or absence of Requirements for Improvement (RFIs) indicating observed noncompliance and the Survey Analysis for Evaluating Risk (SAFER) score were used as independent variables in the analysis. Dependent variables included 3 HHCAHPS composite measures and 2 global rating measures. Data were analyzed using 2 sets of random effects logistic regression models. We found that an increase in RFIs scored on an HHA survey was associated with lower HHCAHPS score on all measures. When the frequency of RFIs and SAFER scores increased, there was a corresponding decline in HHCAHPS ratings, suggesting that patient experience ratings can potentially identify quality of care issues, when experience questions and quality concepts are sufficiently aligned. Adherence to Joint Commission accreditation standards may positively influence some aspects of the patient experience of care. While causality remains uncertain, accreditation appears to play a role in contributing to these outcomes. [ABSTRACT FROM AUTHOR]

BackgroundEvaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS).ObjectivesTo examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases.Design, setting, and patientsPerformance data for 2004 and 2008 from U.S. acute care and critical access hospitals were obtained using publicly available CMS Hospital Compare data augmented with Joint Commission performance data.MeasurementsChanges in hospital performance between 2004 and 2008, and percent of hospitals with 2008 performance exceeding 90% for 16 measures of quality-of-care and 4 summary scores.ResultsHospitals accredited by The Joint Commission tended to have better baseline performance in 2004 than non-accredited hospitals. Accredited hospitals had larger gains over time, and were significantly more likely to have high performance in 2008 on 13 out of 16 standardized clinical performance measures and all summary scores.ConclusionsWhile Joint Commission-accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures in the early days of public reporting, these differences became significantly more pronounced over 5 years of observation. Future research should examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance. Journal of Hospital Medicine 2011;6:458-465. © 2011 Society of Hospital Medicine.

White-tailed deer (Odocoileus virginianus) are a serious accident hazard, especially in suburban communities with high deer densities. Such areas are becoming more common as deer populations continue to grow throughout the northeastern United States. This study analyzed deer-vehicle collision data collected from police reports in Connecticut for 2000, 2001 and 2002. The purpose of this project was to integrate the use of standard crime mapping tools, multi-temporal remotely sensed vegetation imagery, human infrastructure, and the behavioral aspect of white-tailed deer to create a spatially explicit model of gender-specific deer-vehicle accident probabilities. We found marked differences between number, location, and seasonality of male and female accidents. Through most of the year, the number of males and females involved in accidents were relative to their proportion in the population. However, during the breeding season, there were a higher proportion of males involved in accidents. The spatial distribution of accidents involving deer also varied by season and sex – outside of the breeding season, accidents involving male deer were concentrated in a few key locations in the state. The difference in the spatial location of male and female accidents could be the result of resource partitioning exhibited by the species, with males occupying broader ranges in peripheral habitats. This model can be used to predict high risk areas as they change over the different seasons and design warning programs and adaptive education to these target areas.

While both chronic white-tailed deer (Odocoileus virginianus Zimmermann) overbrowsing and invasive shrubs have been linked to native regeneration failure in temperate hardwood forests, little is known of their relative importance and possible synergistic effects. Therefore, we established three study areas in Connecticut to examine the interaction of three levels of invasive shrub control and absence or presence of deer herbivory on forest regeneration over 9 years. Five observations suggest that obtaining forest regeneration requires a comprehensive management strategy. First, competitive interference by invasive shrubs in intact thickets continued to impede forest regeneration, especially taller seedlings, after deer were excluded. Second, density of small seedlings increased following removal of the competitive interference by invasive shrubs. Third, deer browsing depressed growth of small seedlings into taller height classes. Fourth, preferential browsing reduced species richness, especially in taller seedling classes, by favoring growth of low palatability species such as beech. Lastly, if a disturbance (e.g., cutting) does not kill the root system of the invasive shrubs, the window of forest regeneration recruitment may be narrow because invasive shrubs can quickly recover. In stands with both established shrub thickets and high deer densities, invasive shrub control and multiyear reduction of deer densities are both recommended to obtain adequate forest regeneration. Key words: Berberis thunbergii, exclosure, non-native, Odocoileus virginianus, Quercus. Bien que le broutage excessif chronique du cerf de Virginie (Odocoileus virginianus Zimmermann) et l'envahissement par des arbustes aient ete lies a l'echec de la regeneration d'especes indigenes dans les forets feuillues temperees, leur importance relative et leurs possibles effets synergiques sont encore peu connus. Ainsi, nous avons etabli trois aires d'etude au Connecticut pour etudier l'interaction entre trois niveaux de maitrise des arbustes envahissants et la presence de broutement par le cerf sur la regeneration forestiere pendant 9 ans. Cinq observations indiquent que l'obtention d'une regeneration forestiere necessite une strategie globale d'amenagement. Premierement, a la suite de l'exclusion des cerfs, l'interference concurrentielle exercee par les arbustes envahissants dans les fourres intacts a continue d'entraver la regeneration forestiere, particulierement les plus hauts semis. Deuxiemement, la densite des petits semis a augmente apres l'enlevement de l'interference concurrentielle exercee par les arbustes envahissants. Troisiemement, le broutement du cerf a diminue le passage des petits semis vers les classes de hauteur superieures. Quatriemement, le broutement preferentiel a diminue la richesse en especes, surtout chez les semis dans les classes de hauteur les plus elevees, en favorisant la croissance des especes a faible palatabilite comme le hetre. Finalement, si une perturbation (p. ex. : une coupe) ne detruit pas le systeme racinaire des arbustes envahissants, la periode de recrutement de la regeneration forestiere peut etre courte parce que les arbustes envahissants peuvent se retablir rapidement. Dans les peuplements ayant a la fois des fourres d'arbustes etablis et de fortes densites de cerf, la maitrise des arbustes envahissants et la reduction pluriannuelle des densites de cerfs sont toutes deux recommandees pour obtenir une regeneration forestiere adequate. [Traduit par la Redaction] Mots-cles: Berberis thunbergii, exclos, non indigene, Odocoileus virginianus, Quercus., Introduction Among the myriad of factors that can depress establishment and growth of forest regeneration are chronic damage caused by white-tailed deer (Odocoileus virginianus Zimmermann) herbivory and the relatively recent [...]