Evaluating inpatient adverse outcomes under California's Delivery System Reform Incentive Payment Program

Abstract

Objective The California Delivery System Reform Incentive Payment Program (DSRIP) provided incentive payments to Designated Public Hospitals (DPHs) to improve quality of care. We 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). Data Sources We used 2009‐2014 discharge data from California hospitals. Study Design We used a pre‐post study design with a comparison group. We 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. Data Extraction We used Patient Safety Indicators for CLABSI, HAPU, and VTE, and constructed a sepsis mortality measure. Principal 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 (DD: −2.90 percent, 95% CI: −5.08, −0.72 percent) and 2010 with 2014 (DD: −5.74, 95% CI: −8.76 percent, −2.72 percent); the DD estimator was not significant comparing 2010 with 2012 (DD: −1.30, 95% CI: −3.18 percent, 0.58 percent) or comparing 2010 with 2013 (DD: −3.05 percent, 95% CI: −6.50 percent, 0.40 percent). For CLABSI, we 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. Conclusions We did not find that DPHs participating in DSRIP outperformed non‐DPHs during the DSRIP program. Our results were robust to multiple sensitivity analyses. Given multiple concurrent inpatient safety initiatives, it was challenging to assign improvements over time periods to DSRIP.

Effectiveness of national and subnational interventions for prevention and control of health-care-associated infections in acute hospitals in high-income and upper-middle-income counties: a systematic review update

“…48 It has been suggested that at the national level, the main goal should be on supporting the implementation of effective IPC interventions, through appropriate regulations and funding allocation. 49 Yet, the evidence on the effectiveness of regulations remains inconclusive, with only four 25,27,44,45 out of nine 19,[22][23][24][25]27,37,44,45 interventions demonstrating a significant effect on HAI rates from mandatory reporting, national bench marking, non-payment for HAI and investment in HAI prevention. However, all were high risk of bias, apart from McKinley et al, 27 whose risk of bias was unclear.…”

“…Most were conducted in USA (n=25). [12][13][14]17,19,20,[22][23][24][25][26][27][29][30][31][34][35][36][37]39,40,42,[44][45][46] The remaining studies derived from England (n=2), 11,33 Taiwan (n=2), 16,21 Australia (n=1), 28 Brazil (n=1), 15 Germany (n=1), 18 Israel (n=1), 38 Italy (n=1), 43 New Zealand (n=1), 32 and Republic of Ireland (n=1). 41 Study designs included 21 ITS, 12,14,[17][18][19][20][21]24,[29][30][31][32][33][34]…”

“…11,36 Interventions were categorised according to the type of intervention, including care bundles, 16,39 care bundles with implementation strategies, [11][12][13]18,21,26,31,43,46 IPC programmes 14,15,17,20,[28][29][30][32][33][34][35][36]38,[40][41][42] and regulations. 19,[22][23][24][25]27,37,44,45 Study outcomes are presented in Error! Reference source not found.…”

“…Interestingly, during the intervention year, a significant reduction in BSIs was observed in the intervention states, but after the funding stopped no further significant reductions were observed. 45 Another CBA study, 22 evaluated the effect of the incentive payment program on a number of patient safety measures, including CLABSI rates amongst patients discharged from Designated Public Hospitals compared to non-designated hospitals not participating in the programme. The findings showed that while the adjusted predicted probability of developing CLABSI decreased for both the intervention and control hospitals, no significant differences were found between the groups over time.…”

“…27 Of the nine regulation studies, five investigated the effects of the American non-payment for HAI policy; 19,23,24,37,44 however, they were heterogeneous in terms of the populations and outcomes, and only one 44 showed a significant effect of the intervention on CLABSI and CAUTI rates. The remaining four studies 22,25,27,45 differed in relation to populations, interventions and outcomes, with three 25,27,45 demonstrating a significant effect. These were for investment funding, 45 reporting systems 25 and national benchmarking 27 interventions.…”