Management of nursing homes using data envelopment analysis

Kleinsorge, Ilene K.; Karney, Dennis F.

doi:10.1016/0038-0121(92)90026-2

Cited by 45 publications

(28 citation statements)

References 11 publications

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“…Kleinsorge and Karney [12] conducted one of the early studies that demonstrated the usefulness of DEA for operational decision-making in nursing homes. It was a pilot study focused on a single nursing home chain that experimented with several models of efficiency based on financial, economic, and quality measures (such as number of bedsore-free days of care provided).…”

Section: Literature Reviewmentioning

confidence: 99%

Incorporating quality into data envelopment analysis of nursing home performance: A case study☆

Shimshak

Lenard

Klimberg

2009

Omega

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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. Each of these techniques requires some input from management as to the proper emphasis to be placed on the quality aspect of performance. We report the results of a case study in which we apply these techniques to a DEA model of nursing home performance. We examine in depth not only the resulting efficiency scores, but also the benchmark sets and the weights given to the input and output measures. We find that two of the techniques are effective in insuring that DEA results discriminate between high and low quality performance.

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Section: Literature Reviewmentioning

confidence: 99%

Incorporating quality into data envelopment analysis of nursing home performance: A case study☆

Shimshak

Lenard

Klimberg

2009

Omega

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“…Kleinsorge and Karney [36]). Most of the peer units have daily charges for residential services that are above the mean.…”

Section: Efficiency and Residential Chargementioning

confidence: 94%

Efficiency and quality of care in nursing homes: an Italian case study

Garavaglia

Lettieri

Agasisti

et al. 2010

Health Care Manag Sci

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This study investigates efficiency and quality of care in nursing homes. By means of Data Envelopment Analysis (DEA), the efficiency of 40 nursing homes that deliver their services in the north-western area of the Lombardy Region was assessed over a 3-year period (2005-2007). Lombardy is a very peculiar setting, since it is the only Region in Italy where the healthcare industry is organised as a quasi-market, in which the public authority buys health and nursing services from independent providers-establishing a reimbursement system for this purpose. The analysis is conducted by generating bootstrapped DEA efficiency scores for each nursing home (stage one), then regressing those scores on explanatory variables (stage two). Our DEA model employed two input (i.e. costs for health and nursing services and costs for residential services) and three output variables (case mix, extra nursing hours and residential charges). In the second-stage analysis, Tobit regressions and the Kruskall-Wallis tests of hypothesis to the efficiency scores were applied to define what are the factors that affect efficiency: (a) the ownership (private nursing houses outperform their public counterparts); and (b) the capability to implement strategies for labour cost and nursing costs containment, since the efficiency heavily depends upon the alignment of the costs to the public reimbursement system. Lastly, even though the public institutions are less efficient than the private ones, the results suggest that public nursing homes are moving towards their private counterparts, and thus competition is benefiting efficiency.

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“…DEA is the dominant approach to efficiency measurement in healthcare (Hollingsworth 2003(Hollingsworth , 2008. In relation to nursing homes, DEA was used to estimate technical efficiencies in the USA by Nyman and Bricker (1989), Nyman et al (1990), Fizel and Nunnikhoven (1992), Kleinsorge and Karney (1992), Chattopadhyay and Heffley (1994), Chattopadhyay and Ray (1996), Ozcan et al (1998), andDeLellis andOzcan (2013); and by Kooreman (1994) for the Netherlands; Bjorkgren et al (2001), and Laine et al (2005) for Finland; Borge and Haraldsvik (2009) for Norway; Garavaglia et al (2011) for Italy;and Wang and Chou (2005) and Chang and Cheng (2013) for Taiwan.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Technical and scale efficiency in public and private Irish nursing homes – a bootstrap DEA approach

Luasa

Dineen

Zieba

2016

Health Care Manag Sci

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This article provides methodological and empirical insights into the estimation of technical efficiency in the nursing home sector. Focusing on long-stay care and using primary data, we examine technical and scale efficiency in 39 public and 73 private Irish nursing homes by applying an input-oriented data envelopment analysis (DEA). We employ robust bootstrap methods to validate our nonparametric DEA scores and to integrate the effects of potential determinants in estimating the efficiencies. Both the homogenous and two-stage double bootstrap procedures are used to obtain confidence intervals for the bias-corrected DEA scores. Importantly, the application of the double bootstrap approach affords true DEA technical efficiency scores after adjusting for the effects of ownership, size, case-mix, and other determinants such as location, and quality. Based on our DEA results for variable returns to scale technology, the average technical efficiency score is 62%, and the mean scale efficiency is 88%, with nearly all units operating on the increasing returns to scale part of the production frontier. Moreover, based on the double bootstrap results, Irish nursing homes are less technically efficient, and more scale efficient than the conventional DEA estimates suggest. Regarding the efficiency determinants, in terms of ownership, we find that private facilities are less efficient than the public units. Furthermore, the size of the nursing home has a positive effect, and this reinforces our finding that Irish homes produce at increasing returns to scale. Also, notably, we find that a tendency towards quality improvements can lead to poorer technical efficiency performance.

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Management of nursing homes using data envelopment analysis

Cited by 45 publications

References 11 publications

Incorporating quality into data envelopment analysis of nursing home performance: A case study☆

Incorporating quality into data envelopment analysis of nursing home performance: A case study☆

Efficiency and quality of care in nursing homes: an Italian case study

Technical and scale efficiency in public and private Irish nursing homes – a bootstrap DEA approach

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