Measuring efficiency of community health centers: a multi-model approach considering quality of care and heterogeneous operating environments.

Over 1300 federally-qualified health centers (FQHCs) in the US provide care to vulnerable populations in different contexts, addressing diverse patient health and socioeconomic characteristics. In this study, we use data envelopment analysis (DEA) to measure FQHC performance, applying several techniques to account for both quality of outputs and heterogeneity among FQHC operating environments. To address quality, we examine two formulations, the Two-Model DEA approach of Shimshak and Lenard (denoted S/L), and a variant of the Quality-Adjusted DEA approach of Sherman and Zhou (denoted S/Z).