Leapfrog Hospital Safety Score, Magnet Designation, and Healthcare-Associated Infections in United States Hospitals.

Objective: Healthcare-associated infections (HAIs) pose a challenge to patient safety. Although studies have explored individual level, few have focused on organizational factors such as a hospital's safety infrastructure (indicated by Leapfrog Hospital Safety Score) or workplace quality (Magnet recognition). The aim of the study was to determine whether Magnet and hospitals with better Leapfrog Hospital Safety Scores have fewer HAIs.

Improving the performance of surgery-based clinical pathways: a simulation-optimization approach.

This paper aims to improve the performance of clinical processes using clinical pathways (CPs). The specific goal of this research is to develop a decision support tool, based on a simulation-optimization approach, which identify the proper adjustment and alignment of resources to achieve better performance for both the patients and the health-care facility. When multiple perspectives are present in a decision problem, critical issues arise and often require the balancing of goals.

The Efficiency of Ophthalmic Ambulatory Surgery Centers.

Ambulatory surgery centers (ASCs) are important providers of ambulatory surgeries. However, little research exists examining the efficiency of ASCs in providing ambulatory surgical services. This study examined the technical efficiency of ASCs that concentrated on performing cataract surgeries, which are among the surgeries most commonly performed in the outpatient setting.

An examination of competition and efficiency for hospital industry in Turkey.

The two particular reforms that have been undertaken under the Health Transformation Program in Turkey are enhancing efficiency and increasing competition. However, there is a lack of information about the relationship between competition and hospital efficiency. The purpose of this paper is to analyze the effect of competition on technical efficiency for the hospital industry in Turkey.

Assessment of physician performance for diabetes: a bias-corrected data envelopment analysis model.

Background: In most national health systems, especially when universal coverage is provided, family physicians act as gatekeepers, because most healthcare services are only delivered if there is a formal prescription provided by a primary care physician. Although the consumption of healthcare resources is initiated by prescriptions coming from family physicians, studies that evaluate their performance, especially those using a consolidated methodology (e.g.

Use of data envelopment analysis to quantify opportunities for antibacterial targets for reduction of health care-associated Clostridium difficile infection.

Clostridium difficile infection (CDI) is an important health care-associated infection that leads to increased morbidity and mortality. Antibacterial medications used in hospitals serve as targets for antibacterial stewardship programs to reduce C difficile. The objective was to create a benchmark strategy targeting high-risk antibacterials for C difficile.

Freestanding inpatient rehabilitation facility performance following the 60 percent rule: a matter of fit.

The 60 percent rule has served as a controversial policy change within the postacute care sector since its revision in 2004, requiring inpatient rehabilitation facilities (IRFs) to admit no less than 60% of patients according to 1 of 13 specific conditions or else risk the loss of IRF designation according to Medicare's prospective payment system. Using a contingency theory framework, this study proposes that the 60 percent rule introduced considerable uncertainty into freestanding IRFs' operational environment, and as a result, IRFs' operational performance varied according to their "fit" between certain structural characteristics and the pervasive environmental uncertainty. The results suggest that operational performance, as measured by facility Malmquist Index scores, decreased on average for freestanding IRFs following the 60 percent rule's enforcement in 2005.

Benchmarking urban acute care hospitals: efficiency and quality perspectives.

Background: Over the last couple of decades, hospitals in the United States are facing pressures to maximize performance in terms of production efficiency and quality. An increasing emphasis on value-based purchasing on the part of third-party payers as well as the prevalence of pay for performance initiatives create an imperative for more accurate assessments of health care provider performance.

Purposes: The objectives of this study were to measure hospital performance in terms of both technical efficiency and quality using data envelopment analysis (DEA) models in urban acute care hospitals.

Quality outcomes among efficient and inefficient nursing homes: a national study.

Background: With an anticipated increased use of nursing homes to serve an aging population in the United States, questions regarding the quality and cost of nursing home services come to the fore. Such questions are the concern of nursing home residents, their families, private and public payers, policy makers, regulators, and nursing home operators.

Purposes: The purpose of this study was to examine the relationship between quality of care and efficiency of nursing homes to determine the characteristics of facilities that achieve high quality and high efficiency.

Hospital electronic medical record enterprise application strategies: do they matter?

Background: Successful implementations and the ability to reap the benefits of electronic medical record (EMR) systems may be correlated with the type of enterprise application strategy that an administrator chooses when acquiring an EMR system. Moreover, identifying the most optimal enterprise application strategy is a task that may have important linkages with hospital performance.

Purpose: This study explored whether hospitals that have adopted differential EMR enterprise application strategies concomitantly differ in their overall efficiency.

Health care delivery restructuring and productivity change: assessing the Veterans Integrated Service Networks (VISNs) using the Malmquist approach.

This study evaluates the productivity changes for the Veterans Integrated Service Networks (VISNs) that the Veterans Health Administration (VHA) created, comparing performance in 1994 with that in 2004. This represents periods before and after the VHA in 1995 reconfigured provider units into 21 regionalized delivery systems and engaged in other important system innovations. Productivity is measured using the Malmquist Index approach (a longitudinal version of the data envelopment analysis [DEA]).

An examination of technical efficiency, quality, and patient safety in acute care nursing units.

Using an innovative statistical approach-data envelopment analysis-the authors examined the technical efficiency of 226 medical, surgical, and medical-surgical nursing units in 118 randomly selected acute care hospitals. The authors used the inputs of registered nurse, licensed practical nurse, and unlicensed hours of care; operating expenses; and number of beds on the unit. Outputs included case mix adjusted discharges, patient satisfaction (as a quality measure), and the rates of medication errors and patient falls (as measures of patient safety).

Performance evaluation of ambulatory surgery centres: an efficiency approach.

This paper evaluates the performance of 198 ambulatory surgery centres (ASCs) operating in the State of Pennsylvania during the fiscal year 2006. Performance is assessed from technical efficiency view using data envelopment analysis (DEA). Multi-input/output model included two inputs: number of operating rooms and labour, and patient surgical visits differentiated by age groups: 0-17, 18-64, 65+ as three outputs.

The efficiency of hospital-based clusters: evaluating system performance using data envelopment analysis.

Background: The rapid increase in the number of hospitals becoming members of multihospital systems in recent decades has led to the formation of local and regional clusters that have the potential to function as regional systems, a model long advocated as a policy strategy for improving health system performance.

Purpose: This study addresses both cluster efficiency and the hierarchical configuration with which hospitals are grouped into clusters.

Methodology/approach: This study uses 2004 data from the American Hospital Association Annual Survey multihospital system designations updated to 2005.

The economics of cancer care: longitudinal changes in provider efficiency.

Renewed debate over competition in healthcare suggests that greater specialization is good for the health economy. In essence, greater specialization is hypothesized to lead to lower average costs, due to learning curve effects, scale, or other operating efficiencies. This hypothesis was tested in oncology care, since this disease group is one of the few with existing specialized cancer centers already in place.

Data envelopment analysis comparison of hospital efficiency and quality.

Using a sample of Virginia hospitals, performance measures of quality were examined as they related to technical efficiency. Efficiency scores for the study hospitals were computed using Data Envelopment Analysis (DEA). The study found that the technically efficient hospitals were performing well as far as quality measures were concerned.

Do hospitals with electronic medical records (EMRs) provide higher quality care?: an examination of three clinical conditions.

This study investigates how hospital electronic medical record (EMR) use influences quality performance. Data include nonfederal acute care hospitals in the United States. Sources of the data include the American Hospital Association, Hospital Quality Alliance, the Healthcare Information and Management Systems Society, and the Centers for Medicare and Medicaid Services case-mix index sets.

Organizational and environmental determinants of hospital EMR adoption: a national study.

The recent focus on health care quality improvement and cost containment has led some policymakers and practitioners to advocate the adoption of health information technology. One such technology is the Electronic Medical Record (EMR), which is predicted to change and improve health care in the USA. Little is known about factors that influence hospital adoption of this relatively new technology.

Longitudinal analysis of efficiency in multiple output dialysis markets.

Provider efficiency in the dialysis industry in the U.S.A.

Evaluation of performance of dental providers on posterior restorations: does experience matter? A data envelopment analysis (DEA) approach.

The purpose of this study is to discern what factors affect the longevity of amalgam and of composite restorations by dentists who perform posterior restorations. Data are obtained from the Washington Dental Service and contain 1.5 million patient encounters representing visits to 23,000 providers from January 1993 through 31 December 1999.

The influence of previous breast cancer upon mammography utilization.

Women with a previous history of breast cancer are at increased risk for developing cancer in the opposite breast. However, the literature is inconsistent regarding whether a previous history of breast cancer is associated positively with mammography utilization. Some studies indicate that women with a previous history of breast cancer are less likely to utilize mammography, although behavioral models of health care theorize that women with a history of breast cancer may be more vigilant regarding the disease.

A national study of efficiency for dialysis centers: an examination of market competition and facility characteristics for production of multiple dialysis outputs.

Objective: To examine market competition and facility characteristics that can be related to technical efficiency in the production of multiple dialysis outputs from the perspective of the industrial organization model.

Study Setting: Freestanding dialysis facilities that operated in 1997 submitted cost report fonns to the Health Care Financing Administration (HCFA), and offered all three outputs--outpatient dialysis, dialysis training, and home program dialysis.

Data Sources: The Independent Renal Facility Cost Report Data file (IRFCRD) from HCFA was utilized to obtain information on output and input variables and market and facility features for 791 multiple-output facilities.

Benchmarking mechanical ventilation services in teaching hospitals.

The purpose of this investigation was to examine the technical efficiency of mechanical ventilation nonsurgery (DRG 475) among University Hospital Consortium (UHC) hospitals that consists of volunteer, teaching hospitals across the nation. The data for this study was retrieved from the 1997 UHC database that includes charge and discharge information for 69 hospitals. Data on 7961 patients classified with mechanical ventilation were aggregated to the hospital level.