title: The Impact of a Pay-for-Performance Program on Central Line-Associated Blood Stream Infections in Pennsylvania.
abstract: Healthcare associated infections have significantly contributed to the rising cost of hospital care in the United States. The implementation of pay-for-performance (P4P) programs has been one approach to improve quality at a reduced cost. We quantify the impact of Highmark's Quality Blue (QB) hospital P4P program on central line-associated blood stream infections (CLABSI) in Pennsylvania. The impact of years of participation in QB on CLABSI is also evaluated. Data from 149 Pennsylvania hospitals on CLABSI from 2008-2013 are used. Negative binomial regression and fixed effects panel regression are performed. Hospitals participating in QB have 0.727 times the CLABSI as those hospitals that do not participate. Hospitals participating for four or more years have on average 3.13 fewer CLABSI per year compared to those participating for less than four years. Highmark's P4P program has shown improved outcomes with regards to CLABSI, but further research is needed to determine if QB is cost effective.
authors.affiliation: a Center for Integrated Healthcare Delivery Systems , Department of Industrial and Manufacturing Engineering, Pennsylvania State University , University Park , Pennsylvania , USA.
authors.forename: Nathaniel D
authors.initials: ND
authors.lastname: Bastian
authors.affiliation: b Department of Systems and Information Engineering , University of Virginia , Charlottesville , Virginia , USA.
authors.forename: Hyojung
authors.initials: H
authors.lastname: Kang
authors.affiliation: a Center for Integrated Healthcare Delivery Systems , Department of Industrial and Manufacturing Engineering, Pennsylvania State University , University Park , Pennsylvania , USA.
authors.forename: Harriet B
authors.initials: HB
authors.lastname: Nembhard
authors.affiliation: c Medical Policy Development , Highmark Medical Services , Camp Hill , Pennsylvania , USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bloschichak
authors.affiliation: d Center for Health and Humanitarian Systems , School of Industrial and Systems Engineering , Georgia Institute of Technology , Atlanta , Georgia , USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Griffin
mesh_terms: D016470:Bacteremia / Q000209:etiology*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D016208:Databases, Factual; D006801:Humans; D017053:Infection Control / Q000191:economics*; D010414:Pennsylvania; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000191:economics; D012052:Reimbursement, Incentive / Q000191:economics*; D014481:United States
keywords: Pay-for-performance; central line–associated blood stream infections; financial incentives; healthcare associated infections; quality improvement