title: Performance contracting and quality improvement in outpatient treatment: effects on waiting time and length of stay.
abstract: We evaluate the effects of a performance contract (PC) implemented in Delaware in 2001 and participation in quality improvement (QI) programs on waiting time for treatment and length of stay (LOS) using client treatment episode level data from Delaware (n = 12,368) and Maryland (n = 147,151) for 1998-2006. Results of difference-in-difference analyses indicate that waiting time declined 13 days following the PC, after controlling for client characteristics and historical trends. Participation in the PC and a formal QI program was associated with a decrease of 20 days. LOS increased 22 days under the PC and 24 days under the PC and QI programs, after controlling for client characteristics. The PC and QI programs were associated with improvements in LOS and waiting time, although we cannot determine which aspects of the programs (incentives, training, and monitoring) resulted in these changes.
authors.affiliation: Institute for Behavioral Health, Schneider Institutes for Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, USA. mstewart@brandeis.edu
authors.forename: Maureen T
authors.initials: MT
authors.lastname: Stewart
authors.forename: Constance M
authors.initials: CM
authors.lastname: Horgan
authors.forename: Deborah W
authors.initials: DW
authors.lastname: Garnick
authors.forename: Grant
authors.initials: G
authors.lastname: Ritter
authors.forename: A Thomas
authors.initials: AT
authors.lastname: McLellan
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration* / Q000592:standards; D003284:Contract Services / Q000458:organization & administration* / Q000592:standards; D003691:Delaware; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008396:Maryland; D058996:Quality Improvement; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration* / Q000592:standards; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D013997:Time Factors; D014850:Waiting Lists