The Determinants of the Technical Efficiency of Acute Inpatient Care in Canada

Wang, Li; Grignon, Michel; Perry, Sheril; Chen, Xi‐Kuan; Ytsma, Alison; Allin, Sara; Gapanenko, Katerina

doi:10.1111/1475-6773.12861

Cited by 7 publications

(5 citation statements)

References 37 publications

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“…This result implies that since VA hospitals with complexity level 1 are likely to deal with high-risk mortality and provide complex treatments to high-risk patients, they should consume more input resources than VA hospitals with complexity levels 2 or 3. This finding was consistent with previous research that shows that a high Case Mix Index is the main cost driver for a hospital [ 26 ] and that a higher proportion of less complex patients contributes to the higher efficiency of a hospital [ 14 ].…”

Section: Resultssupporting

confidence: 93%

“…In this paper, we use the concepts of technical efficiency and frontier analysis to examine how the efficiency of VA hospitals changed before and after the Veterans Choice Act of 2014. Numerous scholars have used the concept of technical efficiency to measure performance and identify inefficient areas of hospitals in either the private or public sectors [ 3 , 4 , 5 , 6 , 12 , 13 , 14 ]. However, there has been little research on the determinants of VA hospital technical efficiency.…”

Section: Theoretical Explanations Of Technical Efficiency Determinantsmentioning

confidence: 99%

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The Veterans Choice Act and Technical Efficiency of Veterans Affairs (VA) Hospitals

Lee

Park

2022

Healthcare

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The Veterans Health Administration (VHA), responsible for providing 9 million veterans with quality healthcare, is not insulated from concerns about efficiency. In the aftermath of the Veterans Affairs (VA) hospital scandal in 2014, Congress passed the Veterans Choice Act of 2014, which allows eligible veterans to use non-VA hospitals instead of VA hospitals. After analyzing 118 or 119 VA hospitals each year from 2012 through 2017 in the U.S, this paper evaluates the efficiency scores of VA hospitals and examines how the 2014 Act has influenced their technical efficiency over time. Slack analysis shows that inefficient VA hospitals can improve efficiency by reallocating input resources, and regression analysis demonstrates that the overall technical efficiency of VA hospitals decreased by 0.164 after the implementation of the Act. This means that as more veterans used non-VA hospitals under the 2014 Act, the technical efficiency of VA hospitals decreased considerably. Given that a substantial portion of veterans’ demands for healthcare transferred out to non-VA hospitals, the VHA should evaluate whether the current capacity of VA hospitals is appropriate and try to reduce wasted input resources to improve efficiency.

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Section: Resultssupporting

confidence: 93%

Section: Theoretical Explanations Of Technical Efficiency Determinantsmentioning

confidence: 99%

The Veterans Choice Act and Technical Efficiency of Veterans Affairs (VA) Hospitals

Lee

Park

2022

Healthcare

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“…First, we observed a heterogeneous picture for studies that directly included undesirable outcome indicators in the efficiency model. While some authors treat undesirable outcome indicators as inputs (e.g., Guo et al 2017), others apply a linear transformation (e.g., Adang et al 2016), while still others transform them a nonlinear way (e.g., Wang et al 2018). Assuming weak disposability for undesirable outcome indicators is another possibility (e.g., Prior 2006).…”

Section: Discussionmentioning

confidence: 99%

Health care quality in nonparametric efficiency studies: a review

Sommersguter-Reichmann

2021

Cent Eur J Oper Res

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Scientists are increasingly considering quality in nonparametric frontier efficiency studies in health care. There are many ways to include quality in efficiency analyses. These approaches differ, among other things, in the underlying assumptions about the influence of quality on the attainable efficiency frontier and the distribution of inefficiency scores. The aim is to provide an overview of how scholars have taken quality into account in nonparametric frontier efficiency studies and, at the same time, to address the underlying assumptions on the relationship between efficiency and quality. To this end, we categorized empirical efficiency studies according to the methodological approaches and quality dimensions and collected the quality indicators used. We performed a Web of Science search for studies published in journals covered by the Science Citation Index Expanded, the Social Sciences Citation Index, and the Emerging Sources Citation Index between 1980 and 2020. Of the 126 studies covered in this review, 78 are one-stage studies that incorporate quality directly into the efficiency model and thus assume that quality impacts the attainable efficiency frontier. Forty-four articles are two-stage studies that consider quality in the first and the second stage or the second stage only. Four studies do not assume a priori a specific association between efficiency and quality. Instead, they test for this relationship empirically. Outcome quality is by far the most frequently incorporated quality dimension. While most studies consider structural quality as an environmental variable in the second stage, they include outcome quality predominantly directly in the efficiency model. Process quality is less common.

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“…Future research could expand on the results of this study by including additional ICU's. Further research could consider contrasting the communication practices between a teaching hospital and a non-teaching hospital as different hierarchies and resources exist in these settings (Wang et al, 2018). Similarly, future research could compare the results of this study with studies conducted in the community or in long-term care facilities.…”

Section: Implications For Future Researchmentioning

confidence: 97%

Communication of code status escalation for nurses and doctors in the ICU: a case study

Paddley

2023

Preprint

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Interprofessional team members working in the Intensive Care Unit (ICU) care for patients requiring varying degrees of life sustaining therapy. A patient’s code status can assist healthcare professionals understand the appropriate life support measures to deliver to patients in this setting. Utilizing Stake’s approach to case study research, this study explored the communication processes that occurred between nurses and doctors in an ICU in Toronto, Canada. Participants included nurses and physicians working in the ICU. Data were collected using semi-structured interviews, observations of health care rounds and a chart review. The themes that emerged from this study include: (1) engaging in a multidisciplinary discussion, (2) finding consistent documentation, (3) revisiting the code status, and (4) telling the story. The results of this study elucidate current communication methods to guide future practices on how to effectively disseminate code status decisions amongst interprofessional ICU team members.

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The Determinants of the Technical Efficiency of Acute Inpatient Care in Canada

Abstract: The main drivers of efficiency of acute inpatient care vary by hospital peer groups. Thus, the results provide different policy and managerial implications for teaching, large, and medium hospitals to achieve efficiency gains.

Cited by 7 publications

References 37 publications

The Veterans Choice Act and Technical Efficiency of Veterans Affairs (VA) Hospitals

The Veterans Choice Act and Technical Efficiency of Veterans Affairs (VA) Hospitals

Health care quality in nonparametric efficiency studies: a review

Communication of code status escalation for nurses and doctors in the ICU: a case study

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