Objetivo. Adaptar y validar instrumento para medir elemen­tos del contexto que pueden favorecer iniciativas de mejora­miento de la calidad y acreditación de hospitales. Material y métodos. Se adaptó y validó modelo y cuestionario Model for Understanding Success in Quality (MUSIQ) para aplicación en países hispanoparlantes y uso específico para proyectos de acreditación de hospitales. Se realizó un análisis factorial confirmatorio (test de Bartlett e índice Kaiser-Meyer-Olkim) del constructo teórico de sus dimensiones y se comprueba consistencia interna en estudio realizado en muestra de 54 hospitales de mediana y alta complejidad en Colombia. Re­sultados. Instrumento con cuatro dimensiones de contexto (ambiente, macrosistema, microsistema, equipo de calidad), compuestas por 23 elementos medidos a través de 35 va­riables. El análisis factorial mostró significancia estadística y adecuación de las dimensiones que tuvieron también buena consistencia interna. Conclusión. Instrumento adaptado con utilidad para monitorizar elementos del contexto que pueden favorecer iniciativas de mejora y acreditación en hospitales.

Background: To identify context factors associated with and predicting success in the hospital accreditation process, and to contribute to the understanding of the relative relevance of context factors and their organizational level in the success of QI initiatives. Methods: Analytical study of cases and controls in a sample of hospitals of medium and high complexity in Colombia. Cases (n = 16) are accredited hospitals by the time of preparation of the study (2016) and controls (n = 38) are similar facilities, which have not succeeded to obtain accreditation. Eligibility criteria for both groups included complexity (medium and high), having emergency services, an official quality assurance license, and being in operation for at least 15 years. Besides eligibility criteria, geographical location, and type of ownership (public/ private) are used to select controls to match cases. Context measures are assessed using a survey instrument based on the MUSIQ model ("Model for Understanding Success in Quality") adapted and tested in Colombia. Statistical analysis includes descriptive measures for twentythree context factors, testing for significant statistical differences between accredited and non-accredited hospitals, and assessing the influence and strength of association of context factors on the probability of success in the accreditation process. A multivariate model assesses the predictive probability of achieving accreditation. Results: Eighteen (78.3%) of the twenty-three context factors are significantly different when comparing cases and controls hospitals, particularly at the Microsystem level; all factors are statistically significant in favor of accredited hospitals. Five context factors are strongly associated to the achievement of accreditation but in the logistic multivariable model, only two of them remain with significant OR, one in the Macrosystem, "Availability of economic resources for QI" (OR: 22.1, p: 0,005), and the other in the Microsystem, "Involvement of physicians" (OR: 4.9, p: 0,04). Conclusion: This study has applied an instrument, based on the MUSIQ model, which allows assessing the relevance of different context factors and their organizational level in hospitals, to explain success in the accreditation process in Colombia. Internal macrosystem and microsystem seem to be more relevant than external environment factors.

Objective Characterizing and contrasting the current state of affairs concerning patients' rights-associated accreditation standards in a sample of drug-addiction treatment centers in Colombia. Methods This was mixed methodology research (i.e. descriptive and hermeneutic); a pilot sample of 21 drug-addiction treatment centers in Colombia was used for determining the current state of patients' rights accreditation standards. The possible relationship or independence between categorical variables was evaluated by using Fisher's exact test (0.05 significance level). A contrasting documentary review was made at the same time. Results Drug-addiction treatment centers provided more information for families (95 %) than patients (90 %) or minors (81 %). Possible barriers to gaining access for treatment were being HIV positive (29 %), being part of the LGTB population (14 %) and being female (10 %); religion and ethnicity were not seen as grounds for discrimination or treatment barriers. The patients' rights standards group coincided with Colombia´s accreditation system and Joint Commission standards; however, the latter accreditation entity has made significant progress regarding a specific manual for drug-addiction treatment centers. Conclusions The centers assessed in Colombia had made advances regarding accrediting patients' rights, but such standards require revision for being adapted to international developments and specific matters involved in treating addicts and the specific conditions for institutions dealing with such treatment.

RESUMENObjetivos Determinar y comparar entre hospitales públicos y privados, los elementos y factores del contexto que pueden favorecer el logro de la acreditación en salud. Métodos y Materiales De un estudio fuente de casos y controles, realizado en hospitales de mediana y alta complejidad en Colombia, 16 acreditados y 38 no-acreditados, se realiza estudio auxiliar en los 38 hospitales no-acreditados según su naturaleza público o privado. Para la recolección de información se utilizó como referencia instrumento MUSIQ ("Model for Understanding Sucess in Quality") y se realizó análisis comparativo entre elementos y factores del contexto en sus dimensiones "Ambiente-Macrosistema-Microsistema-Equipos de Calidad", mediante prueba Chi cuadrado y t de Student ó U de Mann-Whitney, previa comprobación de normalidad en su distribución con la prueba de Shapiro Wilk. En todos los casos se consideró significativo valor de p menor o igual a 0,05. Resultados Evaluados los 23 elementos y factores que conforman las cuatro dimensiones del contexto en hospitales públicos y privados para el logro de la acreditación en salud, tres presentan diferencias significativas con mayor avance en hospitales privados: en el Macrosistema los sistemas de Información de apoyo para el mejoramiento de la calidad y la estabilidad laboral y en el microsistema el factor motivación. Los demás 20 elementos y factores del contexto evaluados en este estudio, no presentaron diferencias significativas. conclusiones Existen diferencias en elementos y factores del contexto entre hospitales públicos y privados que pueden favorecer en estos últimos el logro de la acreditación en salud.Palabras Clave: Acreditación de hospitales; mejoramiento de la calidad; gestión de la calidad (fuente: DeCS, BIREME). ABSTRACT ObjectiveTo determine and compare the contextual elements and factors that may favor the achievement of accreditation of public and private healthcare hospitals. Materials and Methods Based on a source study of cases and controls conducted in medium and high complexity hospitals of Colombia, 16 accredited and 38 non-accredited, this auxiliary study investigated the 38 non-accredited hospitals according to their public or private nature. The MUSIQ instrument ("Model for Understanding Success in Quality") was used to collect data used as reference, while the dimensions "Environment-Macrosystem-Microsystems-Quality Equipment" of the elements and context factors underwent a comparative analysis by means of Chi square test and Student's t or Mann-Whitney`s U test after distribution normality verification using the Shapiro-Wilk test. In all cases, a p-value equal to or less than 0.05 was considered significant. Results The 23 elements and factors that make up the 4 context dimensions for the achievement of accreditation in health in public and private hospitals were evaluated. It