Strategies for the quality assessment of the health care service providers in the treatment of Gastric Cancer in Colombia

Abstract

BackgroundWhile, at its inception in 1993, the health care system in Colombia was publicized as a paradigm to be copied across the developing world, numerous problems in its implementation have led to, what is now, an inefficient and crisis-ridden health system. Furthermore, as a result of inappropriate tools to measure the quality of the health service providers, several corruption scandals have arisen in the country. This study attempts to tackle this situation by proposing a strategy for the quality assessment of the health service providers (Entidades Promotoras de Salud, EPS) in the Colombian health system. In particular, as a case study, the quality of the treatment of stomach cancer is analyzed.MethodsThe study uses two complementary techniques to address the problem. These techniques are applied based on data of the treatment of gastric cancer collected on a nation-wide scale by the Colombian Ministry of Health and Welfare. First, Data Envelopment Analysis (DEA) and the Malmquist Index (MI) are used to establish the most efficient EPS’s within the system, according to indicators such as opportunity indicators. Second, sequential clustering algorithm, related to process mining a field of data mining, is used to determine the medical history of all patients and to construct typical care pathways of the patients belonging to efficient and inefficient EPS’s. Lastly, efforts are made to identify traits and differences between efficient and inefficient EPS’s.ResultsEfficient and inefficient EPS were identified for the years 2010 and 2011. Additionally, a Malmquist Index was used to calculate the relative changes in the efficiency of the health providers. Using these efficiency rates, the typical treatment path of patients with gastric cancer was found for two EPSs: one efficient and another inefficient. Finally, the typical traits of the care pathways were established.ConclusionsCombining DEA and process mining proved to be a powerful approach understanding the problem and gaining valuable insight into the inner workings of the Colombian Health System, especially in terms of the treatment process performed by health care providers in critical illnesses such as cancer. However, no sufficiently compelling results were found to establish the contribution of such a combination to evaluate the quality in the delivery of health services.

Health care quality in nonparametric efficiency studies: a review

“…Assuming weak disposability for undesirable outcome indicators is another possibility (e.g., Prior 2006). Still, others use sophisticated metrics such as directional distance functions or hyperbolic measures, which do not require a transformation of undesirable outputs (e.g., Giménez et al 2019;Villamil et al 2017).…”

“…This collective DMU category comprises physician effectiveness studies (Dowd et al 2014;Fiallos et al 2017), insurance efficiency studies (Bryce et al 2000;Villamil et al 2017), and medical laboratory efficiency assessments (Ghafari Someh et al 2020;Lamovšek and Klun 2020). A single article evaluates the quality of life of Diabetes Type-1 patients (Borg et al 2019).…”

Data Envelopment Analysis (DEA) in health: a literary review of Latin America

“…Del Pilar Villamil et al (2017) To propose a strategy for the quality assessment of the health service providers in the Colombian health system.…”