Health Care Benchmarking and Performance Evaluation: An Assessment using Data Envelopment Analysis (DEA)

226 Pages·2008·6.319 MB·English

by  Yasar A. Ozcan (auth.)

HEALTH CARE BENCHMARKING
(cid:561)
AND PERFORMANCE EVALUATION
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Medical Supplies 64 H5 H1H2H8H7 H10
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NursingHours
DEAFrontier Software Included
Yasar A. Ozcan
Virginia Commonwealth University
Richmond, VA, USA
Series Editor:
Fred Hillier
Stanford University
Stanford, CA, USA
Library ofCongress Control Number:2007935930
ISBN 978-0-387-75447-5 e-ISBN 978-0-387-75448-2
©2008 Springer Science+Business Media, LLC
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Printed on acid-free paper.
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TomywifeGulperiOzcan
Acknowledgments
Writing this book could not have been achieved without the help and encourage-
mentofmanyindividuals.Itakethisopportunitytothankthem;ifImissanyone,it
isthroughauthorialoversightonly,asallthehelpreceivedwasdeeplyappreciated.
Firstofall,IthankmycolleagueLiamO’Neil,whoprovidedvaluableinsightsand
editsforthemethodchapters.Manythanksgotomydoctoralstudents,whoreceived
the early draft of the manuscript and pointed out many corrections. Especially,
IthankdoctoralcandidatesNailyaDeLellisandChynthiaChildresswholenttheir
classprojectsbecomepartofthisbookinChaps.10and12,respectively.
IwouldliketoacknowledgeJenniferSmithforhereditingofthemanuscriptfrom
covertocover.IalsoextendmysincerethankstoSpringerpublishingeditors,Gary
FlovenandFredS.Hiller,fortheirencouragementandcooperativenessinthepro-
ductionofthismanuscript.SpecialthanksgotoProfessorJoeZhuwhograciously
lentlimitededitionofDEAFrontiersoftwaretobedistributedwiththisbook.
No book can be written without the support and encouragement of loved ones.
IamindebtedtomywifeGulperiOzcan,whoservedasmysoundingboardforevery
aspectofthistext.Moreover,sheextendedhersupportthroughoutthedevelopment
ofthemanuscriptevenasIdeprivedherofmytimeinfavorthismanuscript.Ithank
herforthesustainedsupportshehasgivenmethroughoutmyacademiccareerand
ourpersonallives.
YasarA.Ozcan
Richmond,VA
Contents
Dedication........................................................ v
Acknowledgments ................................................. vii
ListofFigures .................................................... xv
ListofTables ..................................................... xix
Foreword......................................................... xxi
Preface........................................................... xxiii
LicensingAgreement ..............................................xxvii
PartI Methods
1 EvaluationofPerformanceinHealthCare ....................... 3
1.1 Introduction ............................................. 3
1.2 PerformanceMeasurement ................................. 4
1.3 PerformanceEvaluationMethods ........................... 6
1.3.1 RatioAnalysis.................................... 7
1.3.2 TheLeast-SquaresRegression....................... 9
1.3.3 TotalFactorProductivity(TFP)...................... 11
1.3.4 StochasticFrontierAnalysis(SFA)................... 12
1.3.5 DataEnvelopmentAnalysis(DEA) .................. 12
1.4 MeasurementDifficultiesinHealthCare ..................... 13
1.5 Summary................................................ 13
2 PerformanceMeasurementUsingDataEnvelopmentAnalysis(DEA) 15
2.1 DEAinHealthCare....................................... 15
2.2 EfficiencyandEffectivenessModels ......................... 15
2.2.1 EfficiencyMeasures ............................... 16
x Contents
2.2.2 EfficiencyEvaluationsUsingDEA................... 17
2.2.3 EffectivenessMeasures ............................ 21
2.3 DataEnvelopmentAnalysis(DEA) .......................... 21
2.4 ModelOrientation ........................................ 23
2.5 BasicFrontierModels ..................................... 23
2.6 DecisionMakingUnit(DMU) .............................. 24
2.7 ConstantReturnstoScale(CRS)Model ...................... 24
2.8 ExampleforInput-OrientedCRSDEAModel................. 25
2.9 InterpretationoftheResults ................................ 28
2.9.1 EfficiencyandInefficiency.......................... 28
2.9.2 Slacks........................................... 29
2.9.3 EfficientTargetsforInputsandOutputs............... 30
2.10 Input-OrientedModelBenchmarks .......................... 31
2.11 Output-OrientedModels ................................... 32
2.12 Output-OrientedCRSDEAModel .......................... 33
2.13 InterpretationofOutput-OrientedCRSResults ................ 34
2.13.1 EfficiencyandInefficiency.......................... 35
2.13.2 Slacks........................................... 35
2.13.3 EfficientTargetsforInputsandOutputs............... 36
2.14 Output-OrientedModelBenchmarks......................... 37
2.15 Summary................................................ 37
A.1 MathematicalDetails...................................... 38
A.2 AssessmentoftheWeights ................................. 38
B.1 MathematicalDetailsforSlacks............................. 39
B.2 DeterminationofFullyEfficientandWeaklyEfficientDMUs .... 40
B.3 EfficientTargetCalculationsforInput-OrientedCRSModel ..... 40
C.1 CRSOutput-OrientedModelFormulation .................... 41
C.2 EfficientTargetCalculationsforOutput-OrientedCRSModel.... 41
3 ReturnstoScaleModels........................................ 43
3.1 ConstantReturnsFrontier.................................. 43
3.2 VariableReturnsFrontier .................................. 43
3.3 AssessmentofRTS ....................................... 47
3.4 Input-OrientedVRSModelExample......................... 47
3.5 Input-OrientedVRSDEAModelResults ..................... 48
3.6 SlacksandEfficientTargetsforInput-OrientedVRSModel ..... 49
3.7 BenchmarksforInput-OrientedVRSModel .................. 50
3.8 Output-OrientedVRSModelExample ....................... 50
3.9 Output-OrientedVRSModelResults ........................ 51
3.10 ComparisonofCRSandVRSModels,andScaleEfficiency ..... 54
3.11 Summary................................................ 55
D.1 VRSInput-OrientedModelFormulation...................... 55
D.2 EfficientTargetCalculationsforInput-OrientedVRSModel..... 56
Contents xi
E.1 VRSOutput-OrientedModelFormulation .................... 56
E.2 EfficientTargetCalculationsforOutput-OrientedVRSModel ... 56
4 MultiplierModels ............................................. 57
4.1 Introduction ............................................. 57
4.2 MultiplierModels ........................................ 58
4.3 AssuranceRegionsorConeRatioModels .................... 59
4.4 AssessmentofUpperandLowerBoundWeights............... 61
4.5 Multiplier(WeightRestricted)ModelExample ................ 64
4.6 Summary................................................ 68
F.1 Input-orientedmultipliermodelformulation................... 68
F.2 Output-orientedmultipliermodelformulation ................. 68
5 Non-OrientedandMeasureSpecificModels ...................... 71
5.1 Non-Oriented(Slack-Based)Models......................... 71
5.2 MeasureSpecificModels .................................. 75
5.3 Summary................................................ 78
H.1 Input-OrientedMeasureSpecificModelFormulation ........... 79
H.2 Efficient Target Calculations for Input-Oriented Measure
SpecificModel ........................................... 80
I.1 Output-OrientedMeasureSpecificModels.................... 80
I.2 Efficient Target Calculation for Output-Oriented Measure
SpecificModel ........................................... 81
6 Longititudunal(Panel)EvaluationsUsingDEA ................... 83
6.1 MalmquistIndex ......................................... 83
6.2 Malmquist-DEAEfficiencyExample ........................ 84
6.3 Summary................................................ 90
7 EffectivenessandOtherModelsofDEA.......................... 93
7.1 IncorporationofQualityintoDEAModels.................... 93
7.2 QualityasanAdditionalOutput............................. 93
7.3 QualityasanIndependentOutput ........................... 95
7.4 CombiningEfficiencyBenchmarksandQualityScores ......... 97
7.5 OtherDEAModels ....................................... 99
7.5.1 CongestionDEA.................................. 99
7.5.2 SuperEfficiencyDEAModels ...................... 99
7.5.3 EconomiesofScope ............................... 99
7.6 Summary................................................ 100
PartII Applications
8 HospitalApplications .......................................... 103
8.1 Introduction ............................................. 103
8.2 DefiningServiceProductionProcessinHospitalSector ......... 104
xii Contents
8.3 InputsandOutputsforGeneralHospitals ..................... 106
8.3.1 HospitalInputs ................................... 106
8.3.2 HospitalOutputs .................................. 107
8.4 AcuteandGeneralHospitalApplications ..................... 109
8.5 LargeSizeGeneralHospitalPerformanceEvaluation........... 110
8.6 FederalGovernmentHospitals(VAandDoD) ................. 115
8.7 AcademicMedicalCenterApplications ...................... 116
8.8 Summary................................................ 117
9 PhysicianPracticeandDiseaseSpecificApplications............... 119
9.1 Introduction ............................................. 119
9.2 ProductionofServicesinPhysicianPractice .................. 120
9.2.1 PhysicianPracticeInputs ........................... 121
9.2.2 RelatedCostsforVisits,ER,Hospitalizations,
LabandRadiology,Medications,andDurable
MedicalEquipment................................ 123
9.2.3 PhysicianPracticeOutputs.......................... 123
9.3 PhysicianPracticeApplications ............................. 124
9.3.1 MeasuringPhysicianPerformanceforOtitisMedia ..... 124
9.3.2 MeasuringPhysicianPerformanceforSinusitis ........ 130
9.3.3 MeasuringPhysicianPerformanceforAsthma ......... 132
9.4 Summary................................................ 139
J.1 ProceduresforDevelopmentofanEpisode ................... 140
J.2 CPTCodeCreep ......................................... 141
J.3 AdjustmentAlgorithm..................................... 141
10 NursingHomeApplications..................................... 143
10.1 Introduction ............................................. 143
10.2 NursingHomePerformanceStudies ......................... 144
10.3 PerformanceModelforNursingHomes ...................... 146
10.4 DataforNursingHomePerformanceEvaluations .............. 148
10.5 AnExampleofPerformanceModelforNursingHomes......... 149
10.5.1 InputsandOutputsoftheNursingHomeModel........ 149
10.5.2 HomogeneousGroupsandDescriptiveStatistics ....... 150
10.5.3 DEAResults ..................................... 151
10.5.4 Conclusion....................................... 152
10.6 Summary................................................ 153
Acknowledgment......................................... 153
11 HealthMaintenanceOrganization(HMO)Applications............ 155
11.1 Introduction ............................................. 155
11.2 HMOPerformanceStudies................................. 155
11.3 PerformanceModelforHMOs.............................. 157
11.4 DataforHMOPerformanceEvaluations...................... 157
11.5 Summary................................................ 158