Quality Improvement Spillovers: Evidence from the Hospital Readmissions Reduction Program
Management Science · 2025 · Mohamad Soltani、Robert J. Batt、Hessam Bavafa
中文摘要
质量知识溢出能够提升质量改进举措的整体有效性。我们研究这类溢出在多任务服务情境中的存在性及其调节因素，具体为医院住院护理。借助一项全国性质量改进法规——医院再入院减少计划（HRRP），该计划为医院减少再入院提供部分激励，我们在一个全国性数据库上采用双重差分计量模型，发现医疗部门存在正向质量溢出。我们的发现表明，HRRP的实施使那些临床病症或保险类型不属于政策针对对象的患者，其30天再入院率显著下降。此外，我们发现任务相似性在促进质量溢出方面发挥了正向作用，而医院对目标患者的运营聚焦程度（即政策所针对的医院业务量比例）并未调节这些溢出。值得注意的是，我们观察到医院在未提高所提供护理强度的前提下实现了这些质量改进，且质量的有意义改进与住院成本最高达3%的下降相关。本文就监管机构与政策制定者如何设计狭窄的公共政策与法规，通过利用部分激励所带来的有益质量改进溢出以实现更广泛的结果，提供了新颖洞见。
Abstract
Quality knowledge spillovers can enhance the overall effectiveness of quality improvement initiatives. We study the presence and moderators of such spillovers in a multitask service setting, specifically in hospital inpatient care. Leveraging a national quality improvement regulation, the Hospital Readmissions Reduction Program (HRRP), which offers partial incentives for hospitals to reduce readmissions, we employ difference-in-differences econometric models on a nationwide database and find positive quality spillovers in the healthcare sector. Our findings indicate that the implementation of HRRP led to a significant decrease in 30-day readmissions among patients with clinical conditions or insurance types that were not targeted by the policy. Additionally, we find that task similarity played a positive role in promoting quality spillovers, while a hospital’s operational focus on target patients (i.e., the proportion of hospital volume targeted by the policy) did not moderate these spillovers. Notably, we observe that hospitals achieved these quality improvements without increasing the intensity of care provided, and that meaningful improvements in quality were associated with up to a 3% reduction in hospitalization costs. This paper contributes novel insights into how regulators and policymakers can design narrow public policies and regulations that achieve broader results by exploiting the beneficial quality improvement spillovers of partial incentives.