Nadereh Pourat is the Center's director of research and author of the new policy brief that summarizes the evaluation of a pilot program that aimed to improve health care delivery at a group of California's safety-net hospitals. In this brief interview, Pourat discusses what prompted the program, how the evaluation of hospitals was conducted, and how the hospital systems achieved success through the program.
Q: DSRIP was born out of a frustration with the rate of innovation and reform in public hospitals. What were the reasons for this?
In California, the majority of public hospitals are owned and operated by counties. They frequently face resource limitations and high demand from uninsured patients who cannot pay for their care and disabled and elderly Medicaid patients with poor health. Most of the resources go to providing care for the patients and there are limitations on how much effort can go towards innovations, improving quality of care, or improving patient experiences. Overtime these organizations have lagged behind many private hospitals with more resources. The improvements taken on by hospitals under DSRIP are essential for the ability of these organizations to keep up and remain competitive.
Q: Participating California public hospitals met 97 percent of their milestones. That seems almost too good to be true. How was the program so successful over so many categories?
The hospitals had five years to plan, implement and improve their outcomes. They had time to achieve their goals. The goals ranged from more easy to achieve to more complex and this variation was also helpful. Most importantly, the hospitals had a mix of optional and required milestones. When possible, they chose projects that were consistent with their prior goals, which were not previously implemented due to lack of resources.
Q: DSRIP was a $3.3 billion program involving 17 public hospitals serving millions of patients. How did you evaluate such a large, complex project with so many different kinds of interventions?
These evaluations require significant effort and an army of analysts. Some components were evaluated primarily using multiple hospital reports, in-depth surveys, and lengthy interviews. Others further involved analyses of large, confidential, and statewide datasets. We leveraged available data from another Medicaid Waiver evaluation ― the Low Income Health Program ― for one set of analyses, and we analyzed California hospital discharge data for another set of analyzes. We engaged experts in questionnaire design, quality of care assessment, and HIV care. We consulted with various other experts and worked closely with DHCS and CMS to complete the evaluation.