The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality

IF 3.1 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES Health Services Research Pub Date : 2011-01-06 DOI:10.1111/j.1475-6773.2010.01224.x

Andrew M. Ryan, Jan Blustein

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引用次数: 61

Abstract

Objective. To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP).

Data. Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N=62) and other states (N=3,676) and American Hospital Association data on hospital characteristics from 2005.

Study Design. Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics.

Principal Findings. Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (−0.67 percentage points, p>.10) and SIP (−0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications.

Conclusions. Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation.

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大众健康医院绩效付费计划对质量的影响

目标。为了测试2008年实施的马萨诸塞州医疗补助(MassHealth)基于医院的绩效付费(P4P)计划对肺炎和手术感染预防(SIP)护理质量的影响。马萨诸塞州(N=62)和其他州(N=3,676)急诊医院2004 - 2009年护理质量数据与美国医院协会2005年医院特征数据的比较过程。研究设计。估计具有医院固定效应和医院特定趋势的面板数据模型，以检验P4P对肺炎和SIP综合质量的影响。这个基本模型被扩展到控制度量报告的完整性。进一步的敏感性检查包括对倾向得分匹配的对照医院进行估计，排除其他P4P计划中的医院，改变计划假设产生效果的时间段，并在医院特征中测试计划效果。主要的发现。根据我们的首选规范，包括医院固定效应、趋势和测量完整性的控制，估计表明对肺炎(- 0.67个百分点，p> 0.10)和SIP(- 0.12个百分点，p> 0.10)的计划效应很小且不显著。敏感性检查表明不同规格的发现模式相似。尽管提供了大量的财政激励，但在实施的头几年里，大众健康P4P计划并没有提高质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.