Average Efficiency Score Research Articles

Influence of environmental variables on the energy efficiency of drinking water treatment plants

Evaluating and benchmarking the energy efficiency of drinking water treatment plants (DWTPs) is essential to improve the environmental and economic performance of these facilities. However, robust and reliable methods should be used to compute energy efficiency scores to avoid biased conclusions. In this study, the stochastic non-parametric envelopment of data (StoNED) method was employed to assess the energy efficiency of a sample of 146 DWTPs. This methodological approach also allowed us to explore the influence of several environmental variables on the energy performance of DWTPs. The average energy efficiency score of the facilities evaluated was 0.461. It means that they could save 54% of the current energy consumption. 42% of the DWTPs evaluated presented an average energy efficiency score varied between 0.41 and 0.61. None of the 146 water treatment facilities was identified as fully energy efficient which evidences that all DWTPs could save energy. The source of raw water, the age of the DWTP and the main technology used to treat raw water were factors that statistically affected the energy efficiency of DWTPs. It was also estimated that a 1% increase in the removal of total dissolved solids and sulfates result in an increase in energy consumption by 0.340 and 0.409%, respectively, ceteris paribus. The information and conclusions of this study are of great interest for water managers and regulators to improve the operation of DWTPs and plan the design of new facilities.

Enhancing Police Efficiency in Detecting Crime in Hong Kong

In this study we examine how the process of crime detection by frontline and investigative police can be modified so that the same level of policing inputs (i.e. police strength) can produce more outcomes (i.e. crime detection rate). A pooled frontier analysis method is used to measure the relative efficiency of 18 police districts in Hong Kong from 2007 to 2015 (n = 18 districts × 9 years = 162 decision making units (DMUs)), demonstrating variable returns-to-scale. Findings reveal that 95 of the 162 DMUs were found to be inefficient compared to the benchmark DMUs (those police districts identified by the Free Disposable Hull (FDH) approach as efficient) with an average FDH efficiency score of 95.37 out of a possible score of 100. Efficient districts provide an exemplar on how an inefficient district could achieve an optimal input–output translation for the detection of crime. This evidence can be used to shape police policy at the district level. This study represents the first frontier analysis of police efficiency in the detection of crime in Hong Kong using the most recent efficiency technique. We produce evidence that can inform police policy regarding the deployment of finite resources that improve the efficiency of detection without compromising other institutional targets.

Technical Efficiency, Productivity, and Determinants of Technical Inefficiency of Local Hospitals in Oman: Using Data Envelopment Analysis

Purpose of the study: Evidence suggested that inefficiency is a significant problem for many health systems around the world and, in particular, in developing countries. Oman's health system increasingly faces critical resource constraints to deliver the same or better health services. Better utilization of hospital resources will enable more services to be provided and allow the redistribution of potential resources to ensure equity, accessibility, and the delivery of sustainable quality care. Therefore, this study aims to assess the technical efficiency, productivity, and determinates of technical inefficiency of local hospitals in Oman. Methodology: Input-oriented Data Envelopment Analysis (DEA) approach was used to assess the technical efficiency of 29 local hospitals in Oman under constant return to Scale (CRS), variable returns to scale (VRS) and scale efficiency (SE) using 2018 data. Tobit model was used to assess the determinants of hospital inefficiency. The DEA based Malmquist Productivity Index (MPI) was applied to the panel data to measure the Total Factor Productivity Change (TFPCH) between 2015 and 2018. The STATA IC 16 software was used to conduct this evaluation. Main Findings: 75.8% of local hospitals were technically efficient under VRS and SE assumptions, and 79.3% achieved technical efficiency under CRS assumption. The average technical efficiency score under CRS, VRS and SE were 96%, 97% and 99%, respectively. Tobit's model suggested that the number of physicians and pharmacists negatively correlated with the VRS score at p level < 0.05 and < 0.01, respectively. Furthermore, the Tobit model suggested that the number of outpatient’s visits positively correlated with the VRS efficiency score at p level < 0.01. Local hospitals showed a productivity growth by 18.1% during 2015-2018, mainly attributed to the increase in technological change by 42.6%. Research Implications: The results suggested that one-quarter of local hospitals in Oman were technically inefficient. This study identifies opportunities for improving local hospital performance through efficient utilization of health resources and proper redistribution of human resources. The novelty of the study: This is the first study to assess the technical efficiency, productivity, and determinants of technical inefficiency of local hospitals in Oman. It is hoped that the findings of this study can inform decision-makers to tailor their policies towards better and more efficient utilization of the existing resources.

Apakah Bank Syariah di Indonesia Tergolong Efisien? (Dea Window Analysis)

The purpose of this study is to analyze the level of efficiency of Islamic commercial banks in Indonesia for the period 2015 - 2019. This study uses a quantitative approach with the DEA Window Analysis method. The results of this study state that the average score for the efficiency of Islamic Commercial Banks in 2015-2019 assuming CRS is 90%, while the average efficiency score for the assumption of VRS is 96%. The best efficiency measurement for 2015-2019 is the assumption of Variable Return to Scale (VRS), because in the VRS assumption there are Islamic commercial banks that have an efficient score. Bank Mandiri Syariah and Bank Victoria Syariah, on the assumption of VRS, are the banks that have the efficiency score and are the most stable compared to other banks.

Association between efficiency and quality of care of public healthcare facilities: Evidence from Pakistan.

Maternal and child health is an important component of the Sustainable Development Goals. Pakistan has one of the worst maternal and neonatal health outcomes in the world. This is despite significant health system investments across the country. The objectives of this study are twofold. First, the study estimates the technical efficiency of the public healthcare facilities in Pakistan, defined as the number of obstetric deliveries compared to the number of medical specialists, nurses, and other health and non-health staff members. Second, the study evaluates the relationship between efficiency and quality of care; the latter is measured in terms of maternal and neonatal mortality. The data were taken from the Pakistan Health Facility Assessment Survey. Efficiency score was calculated for 843 public healthcare facilities, using Stochastic Frontier Analysis. We then used two-stage residual inclusion approach with bootstrapping to evaluate the relationship between efficiency and quality. The average efficiency score was 0.48 (range: 0-1) and none of the public healthcare facilities were on the frontier, implying that efficiency gains can be made across the board. The relationship between efficiency and quality is found to be positive and statistically significant, that is, more efficient healthcare facilities also had lower rates of maternal and neonatal mortality. We conclude that more efficient public healthcare facilities also had lower mortality rates, probably due to better infrastructure and health system financing.

Measuring technical, environmental and eco-efficiency in municipal solid waste management in Chile

ABSTRACT Moving towards a circular and sustainable economy requires improving the management of municipal solid waste (MSW) increasing recycling rates while minimising unsorted waste and operational costs. It is essential to evaluate the economic and environmental efficiency of MSW services. Previous studies focused on developed countries and employed radial parametric and non-parametric methods. By contrast, this study assessed the technical efficiency, environmental efficiency and eco-efficiency of several Chilean municipalities employing the non-radial range adjusted measure approach. A second stage of assessment was conducted to explore the influence of a set of environmental variables on efficiency scores. Results revealed that the evaluated Chilean municipalities performed poorly from a technical perspective since the average technical efficiency score was 0.484. By contrast, average environmental efficiency and eco-efficiency scores were 0.899 and 0.922, respectively. Nevertheless, the percentage of eco-efficient municipalities was lower than 1%. It was also found that tourism had a major and negative impact on all types of efficiency. By contrast, population density had a significant and positive impact on environmental efficiency. The assessment of three types of efficiency provides relevant information to policymakers to define specific strategies to improve MSW management according to sustainability and circular economic objectives.

Efficiency of Public and Private Service Delivery: The Case of Secondary Education

A current issue is the evaluation of the efficiency of various types of education service providers. This paper aims to evaluate the efficiency of the services of secondary education provided by a variety of types of providers. The evaluation of secondary education is performed on a sample of 26 grammar schools in the Prešov region of the Slovak Republic. The method of data envelopment analysis (DEA) is used. The results of the efficiency of 26 grammar schools in the period 2012-2013 to 2016-2017 showed that grammar schools from the sample established by all providers (public, private, church entity) reached the full efficiency score. By contrast, six grammar schools were evaluated as the least efficient. The evaluation of the set of grammar schools based on the average efficiency score also showed that, from the viewpoint of the types of providers, public grammar schools reach higher efficiency scores, in comparison with church and private grammar schools. These findings expand on the theory of public goods with respect to their production and render valuable information for not only education providers but also creators of regional strategic plans in education policies.

Effects of Mechanization and Investments on the Technical Efficiency of Cassava Farms in Cambodia

Cassava is one of the most important cash crops in Cambodia. Agricultural mechanization promotes productivity, but overinvestment may disrupt the balance between inputs and outputs. Depending on the production scale, sometimes hiring equipment is considered better than purchasing it. While we can hypothesize that mechanization and investments might be crucial factors of productivity, technical efficiency analysis for estimating their effects has not yet been conducted. Therefore, this study investigates the impact of mechanization and investments on cassava yield and producers’ technical efficiency in Cambodia using the Cobb-Douglas stochastic frontier production model. For the study, 205 respondents were randomly selected and interviewed in the Battambang and Pailin provinces in northwestern Cambodia in 2017. Our results show that tractor or truck-hire cost was positively significant, and the cassava uprooting machine-hire cost was negatively significant. The average technical efficiency score of 0.62 indicates that cassava producers can increase their level of technical efficiency. Although cassava production in Cambodia is mechanized and investors are investing, it would be more beneficial to producers if they were provided with financial assistance when uprooting the cassava at the harvest time. Appropriate control of input costs can effectively improve cassava yield, following the implementation of the National Policy on Cassava 2020–2025 by the Royal Government of Cambodia.

Technical efficiency measurement of urban industrial water: a case study of cities in China

PurposeWith the rapid economic growth and urbanization development, regional environmental problems have attracted increasing attention. The study on analyzing cities’ capacity on resource utilization and environmental protection is practically significant because of the industrial agglomeration in an urban area. This study aims to measure environmental efficiency of urban industrial water utilization by comparing input, output and undesirable outputs variables of cities.Design/methodology/approachThis paper combines data envelopment analysis basic approach with regression to discover the environmental efficiency score of cities and their influence factors. A set of slack-based measure (SBM) model is constructed for calculating the environmental efficiency score by considering both desirable and unendurable outputs.FindingsThis paper analyzes the industrial water utilization efficiency for China from the city level by evaluating the performance for up to 200 mainland Chinese cities during 2012–2016 under SBM model. Then, 2C Tobit regression is used to measure the determining factors of industrial water utilization efficiency from the angle of natural, social, municipal and industrial structure factors. The empirical study results show huge room for improvement in industrial water utilization in China, while the average citizen efficiency scores maintain a level of about 0.5.Originality/valueSignificant differences exist in the regional efficiency in different cities in China. Per capita GDP, a total length of drainage pipe and whether the area is coastal or not have significant positive impacts on the water utilization efficiency, while the proportion of secondary industry to GDP has a significant negative influence. Specific recommendations are proposed based on the local industrial water utilization efficiency scores, such as improving urban infrastructure and adopting a more flexible water pricing system.

Overhead Grants’ Usage and Educational Institutions in Nigeria: Data Envelopment Analysis Perspective

This study appraised the utilization of overhead grants’ efficiency among federal educational institutions in Nigeria between2011-2019. Data for the study were sourced from the Annual Audited Financial Statements of the public sector entities. The sampled size for the study comprised (25) federal educational institutions out of 69 federal educational institutions drawn across the country among four (4) geo-political zones. Data were analyzed using Data Envelopment Analysis. The results of the average efficiency scores from both CCR and BBC models showed that the entities were averagely efficient in overhead grants’ utilization. Overall results showed that federal educational institutions have high capacity to absorb sufficient overhead grants from the center. The study therefore concluded that there is need for an improved overhead grants releases to the federal educational institutions to achieve effective service deliveries of their core mandates. The study recommended a continuous assessment and periodic appraisal of the overhead grants’ utilization among the institutions by their supervising ministry to achieve full efficiency.

Impact of cooperative membership on production efficiency of smallholder goat farmers in Nepal

Goat is a source of cash income to smallholders in many developing countries. The productivity of goat farmers is poorly understood and assumed similar across all households. Cooperatives are hailed as an institution that can provide market power to smallholders in developing countries. We assess the impact of cooperatives on the technical efficiency of goat farmers in Nepal. Multistage sampling and in-person interviews were used to collect information from 334 nonmember and 327 member cooperative farmers from two prominent goat production districts in Nepal. We use translog production function to calculate the technical efficiency. The endogeneity associated with cooperative membership is addressed through an instrumental variable approach. The one-step analysis was used to avoid bias due to the one-sided stochastic frontier analysis error. All conventional inputs have significant and positive impact on performance. Cooperative membership shows positive and significant impact on technical efficiency. The average technical efficiency score of cooperative members was 93.2%, while of nonmembers was 90.7%, and the difference was significant. Variables positively affecting technical efficiency include number of family members in agriculture, education, and training on goat production. Cooperative membership encourages farmers to embark on commercial production, fodder tree planting, farm byproducts utilization and kitchen waste utilization.

Comparison of potential CO2 reduction and marginal abatement costs across in the China and Korea manufacturing industries

Here, we use an input distance function approach to determine the shadow price of carbon dioxide (CO2), technical efficiency and potential for emission reductions of the industrial sectors of China and Korea, and impact of carbon trading on costs. Data from 20 industries in the manufacturing sectors of South Korea and China were analyzed during 2015–2019. The potential for CO2 emission reductions and cost-saving effects of emissions trading were compared between the two countries. The average technical efficiency score of 20 manufacturing industries in Korea was 0.71, indicating that production costs could be reduced by almost 30%, while for China, the potential cost savings were 4% higher. The average marginal abatement cost in Korea was estimated as US$6.46/ton, while the weighted average marginal abatement cost for CO2 emissions (p^us), was US$15.1/ton. For China, the respective values were similar, at US$3.21/ton and US$6.57/ton.

Measuring the environmental efficiency of the investment for offshore wind power site in Taiwan

Many of the studies is based on parameters with the requirement of pre-estimation and huge function clause format. But in the proposed method, no pre-estimation is required and there is no need to establish a functional relationship between the described and dependent variables. This research investigates the environmental performance and the factors affecting the environmental performance of offshore wind energy companies in Taiwan using super-efficiency data envelopment analysis (SE-DEA) and Tobit regression model, respectively. SE-DEA model was theoretically used in the first step of analysis, followed by Tobit model in the second step. The study was based on 2019 cross-sectional data obtained from seven locations of Taiwan including Songshan, Taoyuan, Nantou, Zhongzheng, Xinyu, and Changhua. It was found that offshore wind power companies in Taiwan had an average environmental efficiency score of 1.8953, which was very high. Moreover, this performance score could be further increased by improving the factors that affected the efficiency. Such factors included age of company, numbers of internal boards, number of shareholders, research and development, ISO 45,001, government policy, personnel quality, and wind speed. Increase in number of shareholders resulted in higher technical efficiency by a significant level at 1%. When the number of internal boards increased 2.20 %, the efficiency score increased up to 100 %. Amount of research and development factors increased by 12.16 %, the effective score was 100 %, with a 5% prioritization with a positive coefficient front sign. This shows how much the company has research and development relating to offshore wind power. Higher amount of research and development resulted in higher technical efficiency. When I.S.O 45,001 factor increased by 41.94 %, the effective score was 100 %, with a 1% significant level and a positive coefficient front mark. The government policy increased the technical efficiency by a significant level at 1%. When government policy increased to 36.54 %, the efficient score enhanced up to 100 %. The factor quality personnel showed positive signs. Increasing number of qualified personnel enhanced the technical efficiency, with the efficiency level at 25.23 %. The factor wind speed had a positive coefficient, corresponded with the hypothesis. Increase in wind speed leaded to higher technical performance score, with a focus of 5%. When wind speed rose to 2.98 %, the efficiency score increased up to 100 %. The best environmental performance was of Wpd Taiwan Energy Co., Ltd company which had the highest score of 3.2521, while the Copenhagen Infrastructure Partners Association company had the lowest score of 0.9136, indicating the worst environmental efficiency. Inefficient companies can improve their environmental efficiency based on their efficiency scores and ratings in order to be a leading offshore wind power facility in Taiwan.

Prediction of the efficiency in the water industry: An artificial neural network approach

The measurement of efficiency of water utilities has been traditionally carried out using econometric methods or linear programming techniques. Alternatively, in this study a data mining non-parametric method is used, such as an artificial neural network (ANN) approach, to predict the efficiency of several water companies in England and Wales. The further use of a regression tree model allowed us to visualize and quantify the impact of operating characteristics on efficiency. The average efficiency score for the water industry was 0.411. Average scores for water only companies and water and sewerage companies were 0.210 and 0.626, respectively. Only one water company was identified as being fully efficient. This indicates that most of the English and Welsh water companies need to make substantial improvements in their managerial practices to catch-up with the most efficient ones in the industry. Several operating characteristics such as water leakage, water taken from different sources and population density were found to influence efficiency. The percentage of water leakage was identified as the most relevant operational variable influencing the efficiency of water companies. The findings of our study aim to support benchmarking analysis in regulated industries and to get a better insight on what drives efficiency.

Opening the Black-box of Bank Efficiency in Turkey with Two-stage Data Envelopment Analysis: A Study on Capital Adequacy Ratio

Banks constitute approximately 90% of the Turkish financial system, so an efficiently operating banking sector is essential for financial consolidation. To ensure the efficient functioning of the banking production process, capital adequacy ratio (CAR), which is a basic indicator in controlling financial risk, should be managed properly. Additionally, the production process of banks fits into a typical two-stage system, thus opening the black-box on bank efficiency is necessary for an accurate efficiency measurement. By focusing on the link between efficiency, risk and return, this study aims to present a two-stage efficiency evaluation of the commercial banks in Turkey for the year 2018. In addition to the efficiency scores, frontier projections are determined, and an examination is made on the CAR targets. The empirical findings indicate that the inefficiency in the Turkish banking sector mainly stems from the operational performance and the average efficiency score of the state-owned banks is the highest. According to the target values, a pattern is detected between the efficiency scores and CAR. We also conclude that the minimum capital adequacy of 10.5% set by Basel III is not high to guide the commercial banks in Turkey to the efficient frontier.

Financial and Social Efficiency Analysis of Islamic Microfinance Institutions

PurposeThe purpose of this paper was to investigate the impact of credit risk-taking on financial and social efficiency and examine the relationship between credit risk, capital structure and efficiency in the context of Islamic microfinance institutions (MFIs) compared to their conventional counterparts.Design/methodology/approachThe stochastic frontier approach was used to estimate the financial and social efficiency scores, in a first step. In a second step, the impact of risk-taking on efficiency was evaluated. The authors also took into account the moderating role of capital structure in this effect using the fixed and random effects generalized least squares (GLS) with a first-order autoregressive disturbance. The used dataset covers 326 conventional MFIs and 57 Islamic MFIs in six different regions of the world over the period of 2005–2015.FindingsThe overall average efficiency scores are less than 50%, where CMFIs could have produced their outputs using 48% of their actual inputs. IMFIs record the lowest financial (cost) efficiency that is equal to 28% on average. The estimation results also reveal a negative impact of nonperforming loan on financial and social efficiency. Finally, the moderating effect of leverage funding on the relationship between credit risk-taking and financial efficiency was confirmed in CMFIs. However, leverage seems to moderate the effect of risk-taking behavior on social efficiency for IMFIs.Originality/valueThis paper makes an initial attempt to evaluate the effect of risk-taking decision and its implication on efficiency and MFIs' sustainability. Besides, it takes into consideration the role played by the mode of governance through the ownership structure. In addition, this research study sheds light on the importance of the financial support for the development and sustainability of these institutions, which in return, contributes to a sustainable economic

Evaluation of energy efficiency of wastewater treatment plants: The influence of the technology and aging factors

Wastewater treatment is an energy-intensive process and therefore, improving the energy efficiency of wastewater treatment plants (WWTPs) is relevant from an economic and environmental perspective. Water companies managing WWTPs operate under monopolistic conditions and thus, benchmarking their performance using robust methods is fundamental for regulation. This study evaluates the energy efficiency of a sample of Chilean WWTPs using a newly developed technique, called stochastic non-parametric envelopment of data (StoNED). This technique integrates non-parametric (non-linear programming) methods with stochastic noise (parametric techniques) and therefore, it overcomes the limitations of both methodological approaches. Moreover, it allows exploring the influence of operating environment on the energy performance of WWTPs. Results evidenced that the Chilean WWTPs were considerably inefficient (average score was 0.433) presenting therefore significant opportunities to save energy (average savings were 203,413 MWh/year). Only 8 out of 203 facilities reported an average energy efficiency score which was greater than 0.81. It was also found that the age of the facilities negatively affected energy efficiency. Recently built WWTPs showed an average energy efficiency score of 0.489, whereas older facilities were found to be considerably inefficient, 0.340 on average. WWTPs using suspended-growth processes, i.e., conventional activated sludge and extended aeration, as secondary treatment were those with the lowest levels of energy efficiency on average. The results and conclusions of this study are useful for policy makers and WWTP operators who want to reduce energy consumption of WWTPs and therefore, their operational costs and environmental impacts.

Efficiency of malaria service delivery in selected district-level hospitals in Ghana

ABSTRACT Malaria remains an important public health concern. Sub-Saharan African countries carry over 95% of the global burden. Unfortunately, there are also major resource constraints that have limited efforts to reduce the burden. Our study sought to estimate efficiency in the use of malaria resources and to identify potential determinants. We used primary data collected from district-level health facilities in three administrative regions in Ghana from 2014 to 2016. The Data Envelopment Analysis technique was used to estimate efficiency. The Malmquist productivity index was estimated and disaggregated to reflect the sources of productivity change. The findings show an average technical efficiency score of 0.61 with private facilities being more efficient. Productivity changes were driven by changes in technology/innovation advancements. Facility revenue mix and ownership type were important determinants of efficiency. The findings highlight the need to improve resource use in the delivery of specific services such as malaria.

Technical efficiency evaluation of colorectal cancer care for older patients in Dutch hospitals.

Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors. Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians' judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores. Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = <0.001). After case-mix correction, higher technical efficiency was associated with larger practice size (p = <0.001), surgery performed in a general hospital versus a university hospital (p = <0.001) and implementation of prehabilitation (p = <0.001). This study showed considerable variation in technical efficiency of preoperative colorectal cancer care for older patients as provided by Dutch hospitals. In addition to higher technical efficiency in high-volume hospitals and general hospitals, offering a care pathway that includes prehabilitation was positively related to technical efficiency of hospitals offering colorectal cancer care.

Impact of a pharmacist-run refill and prior authorization program on physician workload

BackgroundPharmacist-led programs centralizing prescription renewals and prior authorization processing have been implemented within health care systems; however, their impact on physician efficiency and the perception of impact on workload are unknown. ObjectivesThe primary objective of this study was to measure the change in physician efficiency score after implementation of the refill and prior authorization pilot program (RPAPP). Secondary objectives included changes in physician and staff perception of workload, changes in Center for Medicare and Medicaid Services (CMS) Star Measures, and program productivity. MethodsThis was a retrospective cohort study comparing patient and physician data 12 months before and after RPAPP implementation at an academic medical center. Physician efficiency was an average of 5 metrics that measure performance utilizing the electronic health record. Physician and staff perceptions were measured at baseline and 12 months via a pre- and postsurvey. Changes in CMS Star Measures were captured using the institution’s Population Health Department data. RPAPP productivity was defined as the number of refills/prior authorizations processed and laboratory parameters ordered. ResultsOn implementation, positive results were seen in average physician efficiency scores for 1 of 2 clinics (P < 0.05). Survey results indicated significantly positive changes in physician and staff perception of workload and satisfaction. The RPAPP appeared to help improve institutional performance for 2 of the 3 CMS Star measures evaluated (P < 0.05). ConclusionEvaluation of primary care physician workload is complex. Although external variables may have impacted consistent results, the RPAPP appears to have positive effects on physician efficiency and satisfaction. These results may assist other health care institutions interested in initiating an RPAPP.