The Effect of Pay for Performance in the Emergency Department on XXXX Waiting Times and Quality of Care in Ontario, Canada: A Difference-in-Differences Analysis.

@entity1 @entity27399 @entity341 @entity2613 @entity13830 @entity13831
STUDY OBJECTIVE: In 2008, a pay-for-performance program was implemented in sequential waves in Ontario @entity341 ( @entity341 ), with the aim of reducing length of stay. We seek to evaluate its effects on @entity2613 length of stay and quality of care. METHODS: This was a retrospective observational study of @entity2613 visits in Ontario from April 1, 2007, to March 31, 2011, using multivariable difference-in-differences analysis. Pay-for-performance hospitals and matched control sites were selected for each of 3 waves of the program. The primary outcome was 90th percentile @entity2613 length of stay; we also examined quality-of-care indicators. RESULTS: Pay-for-performance hospitals had a modest reduction in overall adjusted 90th percentile @entity2613 length of stay in @entity13830 (-36 minutes; 95% confidence interval [CI] -50 to -21 minutes), but not in @entity13831 (-14 minutes; 95% CI -30 to 2 minutes) or @entity27399 (-7 minutes; 95% CI -23 to 8 minutes). @entity2613 admitted @entity1 had a pronounced reduction in adjusted 90th percentile length of stay in @entity13830 (-225 minutes; 95% CI -263 to -188 minutes) and @entity13831 (-133 minutes; 95% CI -175 to -91 minutes). Nonadmitted low-acuity @entity1 had reductions in adjusted 90th percentile @entity2613 length of stay in @entity13830 (-24 minutes; 95% CI -29 to -18 minutes) and @entity27399 (-19 minutes; 95% CI -24 to -14 minutes). The program did not negatively affect @entity2613 quality-of-care measures, such as 30-day mortality or readmission rates. CONCLUSION: Pay-for-performance was associated with modest overall benefits for @entity2613 length of stay without adversely affecting quality of care.
