Accreditation Benefits of Federally Qualified Clinics

Purpose:

Federally Qualified Health Centers (FQHCs) are currently the nation’s largest primary health care provider group with a projected patient census of 40 million patients by 2015. Accreditation of FQHCs is a federally endorsed process recognized as creating a framework to deliver increased quality of care. Nurse practitioners and nurses at the frontline of community health provide the microsystem level impetus to improve health in the populations they serve, and accreditation places pre-determined guidelines and standards in place that set the stage for macrosystem level redesign. However, sufficient empirical data showing improved clinical outcomes and cost-effectiveness related to accreditation do not exist. This study analyzes benefits and costs incurred by FQHCs as a result of the accreditation process.

Methods:

Using a semi-structured interview process, the data were collected from administrators of FQHCs that have obtained Joint Commission accreditation. The interview sessions were  directed toward qualitative/quantitative informationabout the benefits and costs associated with obtaining and maintaining accreditation status. Data were analyzed using qualitative, descriptive, and multivariate methods. 

Results:

Participants agreed that the process helped create a framework for specific quality indicator reporting by programs and departments. Participants were unable to make a clear distinction between costs that could be directly attributed to daily operations versus costs specific to the accreditation process, particularly in facilities that had been through more than one cycle of renewal. Although the process within inpatient facilities had historically consisted of chart reviews, FQHCs reported a greater focus on examination of clinical outcomes and patient specific processes in administering services. None of the participants knew the actual cost of the accreditation processing fees incurred every three years. 

Conclusion:

Improved clinical outcomes were perceived to be associated with accreditation, and the cost of accreditation was either unknown or relatively indiscernible from every day clinical operations; further research is needed. The power of this review process is most effective if all parties involved are aware of the costs, the effectiveness and the outcomes achieved. Structural design of FQHCs should empower and recognize the importance of nursing at the frontline in wellness centers, community clinics, schools, and public health. It is imperative that those responsible for the delivery of these services guide innovation, with the opportunity for frontline providers to give candid feedback on the processes.The effect of accreditation on innovation, work flow processes and resources needed to improve clinical outcomes in FQHCs should be examined in future studies.