Summary
Summary: The California Delivery System Reform Incentive Payment Program (DSRIP) provided incentive payments to Designated Public Hospitals (DPHs) to improve quality of care. Authors assessed the program's impact on reductions in sepsis mortality, central line-associated bloodstream infections (CLABSIs), venous thromboembolisms (VTEs), and hospital-acquired pressure ulcers (HAPUs).
Authors used 2009–2014 discharge data from California hospitals and a pre-post study design with a comparison group. Authors constructed propensity scores and used them to assign inverse probability weights according to their similarity to DPH discharges. Interaction term coefficients of time trends and treatment group provided significance testing.
This study used Patient Safety Indicators for CLABSI, HAPU, and VTE, and a sepsis mortality measure was constructed.
Findings: Discharges from DPHs and non-DPHs both saw decreases in the four outcomes over the DSRIP period (2010–2014). The difference-in-difference estimator (DD) for sepsis was only significant during two time periods, comparing 2010 with 2012 and 2010 with 2014; the DD estimator was not significant comparing 2010 with 2012 or comparing 2010 with 2013. For CLABSI, authors did not find any meaningful differences between DPHs and non-DPHs across the four time periods. For HAPU and VTE, the only significant DD estimator compared 2014 with 2010.
Authors did not find that DPHs participating in DSRIP outperformed non-DPHs during the DSRIP program. Results were robust to multiple sensitivity analyses. Given multiple concurrent inpatient safety initiatives, it was challenging to assign improvements over time periods to DSRIP.
Read the Publication:
- Journal Article: Evaluating Inpatient Adverse Outcomes Under California's Delivery System Reform Incentive Payment Program