Evaluating Technical Efficiency of Nursing Care Using Data Envelopment Analysis and Multilevel Modeling

Non-human and human service efficiency of long-term care facilities in China

Introduction

Care services provided by long-term care facilities (LTCFs) are currently plagued by care resource shortages and insufficient utilization. The analysis on the temporal and spatial distribution of human resources and non-human resources in LTCFs, could provide a basis to optimize resource allocation and efficient use of limited resources.

Methods

This study used data envelopment analysis to comprehensively evaluate the efficiency of human and non-human resources in different time spans and regions. The spatial Markov chain and spatial correlation were also applied to explore the heterogeneity of and correlation between the service efficiency of LTCFs in different regions and then analyzes the influencing factors of efficiency using Tobit regression model.

Results

The quantitative changes in the service efficiency of LTCFs in various provinces showed a "W" shape in two periods, ranging from 0.8 to 1.6. The overall efficiency of LTCFs in different regions had a lower probability to achieve short-term cross-stage development. Non-human resource efficiency presented a "cluster" distribution mode, demonstrating a great probability to achieve cross-stage development, which might be due to the regional disparities of economic development and land resource. Tobit regression analysis results also showed that the comprehensive efficiency of LTCFs decreases by 0.210 for every square increase in construction space variation. However, human resource efficiency had a significant spatial polarization, making it difficult to develop area linkages. The reason for this might be the nursing staff have relatively stable regional characteristics, weakening the inter-provincial spatial connection. We also found that female workers, aged between 35 and 45 can positively affect the efficiency of LTCFs. Those staff stay focused and improve their skills, which might improve the efficiency of LTCFs. So improving technology and service quality changes by increasing female workers, aged between 35 and 45, and avoiding excessive construction space changes can enhance the growth of service quality and personnel stability of LTCFs.

Conclusion

There is an urgent trade-off among staff quality improvement, resource reduction, construction excessive and substantial regional variation in efficiency. Therefore, strengthening policy support to encourage inter-regional initiatives, particularly highlighting the development of human resources interaction and common development is urgent.

Investigation of Longitudinal Data Analysis: Hierarchical Linear Model and Latent Growth Model Using a Longitudinal Nursing Home Dataset

The appropriate use of the data analysis method in a longitudinal design remains controversial in gerontological nursing research. The objective of the current study is to compare statistical approaches between a hierarchical-linear model (HLM) and a latent-growth model (LGM) in random effects, variance explained, growth trajectory, and model fitness. Secondary analysis of longitudinal data was used. Two variables were chosen to demonstrate the comparison between statistical methods. The HLM was superior in addressing unbalanced data in repeated-measures analysis of variance (ANOVA) and multivariate ANOVA because its nested data structure and random effects could be estimated. The LGM had advantages in modeling growth trajectories and model-fit comparisons. Superior to the HLM, the LGM reported more acceptable data fit, reporting a quadratic model, and successfully differentiated between and within components. The current research provides some evidence for applying appropriate statistical methods when addressing longitudinal datasets in gerontological nursing research. [Research in Gerontological Nursing, 12(6), 275-283.].

Improving Efficiency Assessment of Psychiatric Halfway Houses: A Context-Dependent Data Envelopment Analysis Approach

This study proposes the approach of context-dependent data envelopment analysis (DEA) to measure operating performance in halfway houses to enable suitable adjustments at the current economic scale. The proposed approach can be used to discriminate the performance of efficient halfway houses and provide more accurate DEA results related to the performance of all halfway houses in a region or a country. The relative attractiveness and progress were also evaluated, and individual halfway houses’ competitive advantage and potential competitors could be determined. A case study of 38 halfway houses in Taiwan was investigated by our proposed approach. Findings suggest that fifteen halfway houses belong to the medium level, which can be classified into a quadrant by examining both their attractiveness score and progress score. The results can be used to allocate community resources to improve the operational directions and develop incentives for halfway houses with attractive and progressive values, which can reduce the institutionalization and waste of medical resources caused by the long-term hospitalization of patients with mental illnesses. Our proposed approach can also provide references for operators and policy makers to improve the management, accreditation, and resource allocation of institutions.

Evaluating the technical efficiency of care among long-term care facilities in Xiamen, China: based on data envelopment analysis and Tobit model

Background

The technical efficiency (TE) of care among the elderly in long-term care facilities (LTCF) have become increasingly crucial policy concerns faced by developing countries and Asia, especially China. The purpose of this study was to evaluate the TE and the quality of care and identify its influencing factors among LTCF.

Methods

A total of 32 registered LTCF in Xiamen of China were surveyed in 2016. The Banker-Charnes-Cooper (BCC) model and Slacks-Based Measure (SBM) model of Data Envelopment Analysis (DEA) were used to evaluate the TE of LTCF. The TE has been decomposed into pure technical efficiency and scale efficiency. Utilization of DEA with human, financial, and material resources as inputs and quantity, quality of nursing care as outputs allowed estimation of the relative TE of care in LTCF. In addition, this study applied SBM to measuring the efficiencies and slacks. Furthermore, Tobit model was performed to explore factors associated with TE.

Results

There were 7 public and 25 private LTCF respectively, with a total of 6729 beds and 3154 elderly people. 17 LTCF were technically efficient (53.1%). In the BCC model, the average TE was 0.963. The average pure technical efficiency and scale efficiency of LTCF were 0.979, 0.984, respectively. There were 5 LTCF with increasing returns to scale, 8 LTCF with decreasing returns to scale. In the SBM model, the average TE was 0.813, and it had the same effective decision-making unit with SBM model. Depending on TE score from high to low, the top eight are private LTCF, and the last four were public LTCF. The slack analysis showed that they can be reduced in 8 LTCF with decreasing returns to scale such as 53.31% administrative staffs, 67.73% medical staffs, 33.1% caregivers, 51.66% paramedical staffs and 4.1% beds on average. The TE of private LTCF was higher than that of public LTCF. The LTCF in urban were more effective than rural. The TE of LTCF raised by increasing of working hours, training frequency and institutional occupancy.

Conclusions

The overall TE of LTCF in Xiamen of China was relatively high, especially in private institutions. However, LTCF still needs to further improve the utilization of physical resources and the management and training of human resources. The TE of LTCF was associated to their location, institutional nature, allocation of human resources and occupancy rate. It was needed to focus on promoting the efficiency and quality of LTCF in order to achieve sustainability.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7571-x) contains supplementary material, which is available to authorized users.

Public Reporting on the Quality Ratings of Nursing Homes in the Republic of Korea

BACKGROUND

Quality ratings could provide vital information to help people in choosing a nursing home.

PURPOSE

This study investigated factors aligned with quality ratings of nursing homes.

METHODS

We employed a cross-sectional descriptive design to assess publicly available data on 1,354 nursing homes with 30 or more beds in the Republic of Korea. After excluding 289 nursing homes with no reported quality-evaluation ratings, we analyzed the 2015 data of 1,065 nursing homes. To prevent multicollinearity among independent variables, we carefully selected the final set of variables based on clinical and theoretical meaningfulness to direct nursing care. Quality, the ordinal outcome, was scored from 1 to 5 with a higher score indicating higher quality of the organization. We constructed a multivariate ordered logistic regression model.

RESULTS

Higher quality ratings of nursing homes was significantly related to the number of unoccupied beds (OR=0.99, p=.024), registered nurses (RNs) (OR=1.30, p=.003), qualified care workers (OR=1.03, p=.011), cognitive-improvement programs (OR=1.05, p=.024), and other programs for residents' activities (OR=1.09, p<.001).

CONCLUSION

The number of RNs had the strongest influence on the publicly reported quality rating, while the rating of qualified care workers demonstrated little effect and that of nursing assistants had no effect. The number of RNs could be used as a crucial indicator for high-quality homes; more resident-engaging programs also demonstrated better quality of nursing home care.

A Systematic Literature Review of Efficiency Measurement in Nursing Homes

Background: As our population ages at an increasing rate, the demand for nursing homes is rising. The challenge will be for nursing homes to maintain efficiency with limited resources while not compromising quality. This study aimed to review the nursing home efficiency literature to survey the application of efficiency methods and the measurements of inputs, outputs, facility characteristics and operational environment, with a special focus on quality measurement. Methods: We systematically searched three databases for eligible studies published in English between January 1995 and December 2018, supplemented by an exhaustive search of reference lists of included studies. The studies included were available in full text, their units of analysis were nursing homes, and the analytical methods and efficiency scores were clearly reported. Results: We identified 39 studies meeting the inclusion criteria, of which 31 accounted for quality measures. Standard efficiency measurement techniques, data envelopment analysis and stochastic frontier method, and their specifications (orientation, returns to scale, functional forms and error term assumptions) were adequately applied. Measurements of inputs, outputs and control variables were relatively homogenous while quality measures varied. Notably, most studies did not include all three quality dimensions (structure, process and outcome). One study claimed to include quality of life; however, it was not a well-validated and widely used measure. The impacts of quality on efficiency estimates were mixed. The effect of quality on the ranking of nursing home efficiency was rarely reported. Conclusions: When measuring nursing home efficiency, it is crucial to adjust for quality of care and resident's quality of life because the ultimate output of nursing homes is quality-adjusted days living in the facility. Quality measures should reflect their multidimensionality and not be limited to quality of throughput (health-related events). More reliable estimation of nursing home efficiencies will require better routine data collection within the facility, where well-validated quality measures become an essential part of the minimum data requirement. It is also recommended that different efficiency methods and assumptions, and alternative measures of inputs, outputs and quality, are used for sensitivity analyses to ensure the robustness and validity of findings.

Technical efficiency and its influencing factors in Malaysian hospital pharmacy services

Various pharmacy services are offered in public health facilities, ranging from distributive activities (dispensing) to patient-oriented services (pharmaceutical care). These activities are monitored through indicators established at the national level. In Malaysia, the indicators have not been transformed into a measurement of hospital pharmacy service efficiency. The main objectives of this study were to assess the relative performance of hospital pharmacy services and to investigate the factors that may affect the performance levels. Double-bootstrap data envelopment analysis was applied to measure the technical efficiency levels of 124 public hospital pharmacies in 2014. An input-oriented variable returns to scale model was adopted in the study, while bootstrap truncated regression was conducted to identify the factors that may explain the differences in the efficiency levels. The average bias-corrected technical efficiency score varies according to the hospital size (0.84, 0.78 and 0.82 in small, medium and large hospitals, respectively). The hospital size, hospital age, urban location and information technology are important determinants of the efficiency levels. The study contributes to establishing baseline technical efficiency information for public hospital pharmacy services in Malaysia. The measurement of hospital pharmacy efficiency can guide future policy making to improve performance and ensure the optimum level of available resources.

Organizational Factors Associated With Technical Efficiency of Nursing Care in US Intensive Care Units

BACKGROUND

Few studies have evaluated technical efficiency of nursing care, and no such studies have been conducted in intensive care units (ICUs).

PURPOSE

To explore relative technical efficiency of US ICUs and identify organizational factors associated with efficiency in providing quality of nursing care.

METHODS

A total of 404 adult ICUs from the 2014 National Database of Nursing Quality Indicators were included. Data envelopment analysis was used to estimate technical efficiency, and multilevel modeling was employed to determine effects of organizational factors on efficiency.

RESULTS

Nurse-to-patient ratio showed the strongest positive correlation with technical efficiency. Units in non-Magnet and small-size hospitals had higher technical efficiency than those in Magnet and medium- or large-size hospitals.

CONCLUSIONS

A higher nurse-to-patient ratio greatly improved technical efficiency of nursing care in ICUs and the effect differed between hospitals. Administrators and policy makers can translate the study findings into management strategies to provide efficient nursing care in ICUs.