Incorporating Quality into Data Envelopment Analysis of Nursing Home Performance: A Case Study.

When using data envelopment analysis (DEA) as a benchmarking technique for nursing homes, it is essential to include measures of the quality of care. We survey applications where quality has been incorporated into DEA models and consider the concerns that arise when the results show that quality measures have been effectively ignored. Three modeling techniques are identified that address these concerns.

Benchmarking nursing home performance at the state level.

This paper reports the results of a state-level comparison of the performance of nursing homes. The results were obtained by applying data envelopment analysis (DEA) to data (obtained from OSCAR, the online survey, certification and reporting database [2004]) for all the skilled nursing facilities in each of the 50 states and the District of Columbia. DEA produces an efficiency score for each state that can serve as a single comprehensive measure of its overall performance.

Health care utilization by patients with temporomandibular joint disorders.

The claims data base of a large New England managed care organization was used to compare the health care utilization patterns of patients with TMJ disorders to non-TMJ subjects. Inpatient, outpatient and psychiatric claims data were examined over a wide range of diagnostic categories. Age and sex adjusted results showed that, overall, patients with TMJ disorders were greater utilizers of health care services and had higher associated costs than non-TMJ subjects.

Medical claims profiles of subjects with temporomandibular joint disorders.

The primary goal of this study was to evaluate the claims profiles of subjects with TMJ disorders relative to a control group without the disorders and to provide a characterization of the type of healthcare services received and the associated costs of healthcare for patients with TMJ disorders. The administrative data base of a major medical insurer was used to compare the claims history of 1,819 patients diagnosed with TMJ disorders to matched controls. The analysis was based only on medical claims.

Controlling disenrollment in health maintenance organizations.

With increasing competition, health maintenance organizations (HMOs) are struggling to maintain their enrollment levels. As a result, growing interest has emerged in studies of disenrollment, including factors associated with disenrollment and its implications for the HMO manager, as well as approaches for measuring and monitoring disenrollment.

Managing liability/recovery programs in health maintenance organizations.

Liability/recovery programs play a major role in attempts by insurers to contain the cost of health care. Because of the controls they have over their organization, HMOs are in an exceptional position to take advantage of the monetary rewards that accompany a liability/recovery program.