Hospital Efficiency Research Articles

Evaluation and ranking of fuzzy sets under equivalence fuzzy relations as [formula omitted]certainty and [formula omitted]possibility

In this paper, we deal with a finite collection of fuzzy sets that are used to represent a given linguistic variable in real-world problems. These fuzzy sets are usually represented as fuzzy singletons, fuzzy numbers, or fuzzy G-numbers. In many cases, there are significant interactions between elements of a given set, so it is useful to evaluate and rank elements while taking the degree of interactions into consideration. To find the degree of interaction, we develop a fuzzy equivalence relation based on a similarity function and a triangular norm operator. The compositions of the (max -(T-norm)) and (min -(S-norm)) cause the membership function to change from the minimum values (certainty version) to the maximum values (possibility version). These concepts are also useful for improving fuzzy data mining, rough fuzzy set theory, etc. Furthermore, two indices, α and β, are introduced to determine the degree of certainty (α-certainty) and degree of possibility (β-possibility). Examples are provided to compare the proposed method with the existing method. After comparing the experimental results, it can be concluded that the proposed approach is satisfactory for many situations. Finally, we apply the proposed methodology to evaluate the results of a hospital efficiency study conducted for the Office of Inspector General(OIG)-Eastern Virginia Department of Health and Human Services.

The residency levels' effect on pediatric dental rehabilitation operation time

BackgroundPostgraduate pediatric dental residents' competency, to perform dental rehabilitation procedures under General anesthesia (GA), at different levels of training is challenging for operation time control. An adequate operation time (OT) for children decreases morbidity risk and improves hospital time utilization efficiency. The aim of the study is to assess the effect of pediatric dental resident training level on OT for pediatric dental rehabilitation procedures under GA at King Abdulaziz Medical City (KAMC).MethodsA cross-sectional study included pediatric dental rehabilitation performed under GA by pediatric dental residents at (KAMC) -Jeddah from October/2015 to September/2022. The primary outcome was OT, and the predictive variable was resident training levels. A linear regression analysis was used to compare OT between procedures performed by junior (years 1–2) or senior (years 3–4) trainees, adjusting for patient and operative factors.ResultsOne thousand seven pediatric dental rehabilitation cases were performed under GA by junior (13) and senior (31) residents. The univariant analysis indicated that OT for senior residents was significantly longer (13 min) than for junior residents. However, the linear regression analysis showed that senior residents had a significantly shorter OT when considering the more dental procedures performed per case under GA than junior residents. Senior residents took significantly more radiographs and performed more primary pulp therapies and multi-surface anterior colored restorations under GA than junior residents.ConclusionsThe OT for pediatric dental rehabilitation procedures under GA is associated with resident training level. The total OT was significantly longer based on procedure number, type, and resident level. The study indicated that senior residents could manage more complex cases in a shorter time. The finding emphasizes the importance of assigning GA cases to residents based on their level and the case's complexity. Additionally, it helps standardize the resident privileges under GA and understand the impact of residency training on hospital efficiency.

Is austerity good for efficiency, at least? A counterfactual assessment for the Italian NHS

In recent decades, austerity measures have been widely adopted in public healthcare systems, so as to cope with financial constraints. This paper assesses the impact of a specific austerity policy implemented in Italy since 2007, with the purpose of reducing the budget deficit of regional governments originated by an excessive healthcare expenditure, the so called Recovery Plans (Piani di rientro). We exploit this context for a counterfactual analysis of the effects of Recovery Plans on the technical efficiency of hospitals operating in the regions where the Plans have been implemented, using as a control group similar hospitals in the regions where the policies were not enacted. The empirical analysis is based on a unique sample of administrative data relative to a large panel of hospitals in the period 2003–2010, and it employs, as identification strategy, the exogenous introduction of the austerity policy in some regions. We find that the policy had a detrimental effect on the efficiency of the hospitals operating in the regions subjected to the policy. The results show that the efficiency loss grows over time, suggesting the existence of negative cumulative effects of the austerity policy.

New Public Management and hospital efficiency: the case of Norwegian public hospital trusts

New Public Management-inspired reforms in the Norwegian hospital sector have introduced several features from the private sector into a predominantly public healthcare system. Since the late 1990s, several reforms have been carried out with the intention of improving the utilization of resources. There is, however, limited knowledge about the long-term, and sector-wide effects of these reforms. In this study, using a panel data set of all public hospital trusts spanning nine years, we provide an analysis of the efficiency of hospital trusts using data envelopment analysis (DEA), as well as a Malmquist productivity index. Thereafter we use the efficiency scores as the dependent variable in a second-stage panel data regression analysis. We show that during the period between 2011 and 2019, on average, efficiency has increased over time. Further, in the second-stage analysis, we show that New Public Management features related to incentivization are associated with the level of hospital efficiency. We find no association between degree of competition and efficiency.

A Study on the Effectiveness and Efficiency of Public or Private Hospitals within Pakistan

Hospitals play a very important role in human lives. People are in search of quality and timely healthcare facilities. This paper talks about the efficiency and effectiveness of healthcare services. One needs to identify the factors and mechanisms to enhance the performance of government and private hospitals. This study aims to find the important variables that were required to find the best solution for public and private hospitals in Pakistan. The major contributions of the paper are as follows. The paper first deliberates on the need for technical excellence as compared to interpersonal excellence for hospital management. It also performs a qualitative review of the literature on the important variables for determining the effectiveness and efficiencies of the hospital. Then, the paper presents a public survey about the effectiveness and efficiency of public and private hospitals using different questionnaires. These questionnaires were filled by the relatives of patients or patients themselves when they visited hospitals. On this dataset, the paper applies a machine learning algorithm i.e., random forest, to predict which hospital type is suitable for them while considering the variables. These variables include; the services of the hospital, admission process, treatment, doctor's behavior, timely treatment, and knowledge of the staff about SOPs. The data was split into 75 % training and 25 % testing dataset. Python’s Library SK-learn was used for implementation. The accuracy of the classifier on the test dataset is 96.91 %. The paper then determines the variables that are contributing the most to the measure of effectiveness and efficiencies of hospitals. The algorithm also ranks these features that can be used to improve a hospital's performance. It also provides a benchmark to the patients in the selection of hospitals for healthcare facilities.

Health & Productivity Management Associated With Improved Efficiency of Inpatient Health Care: Cross-sectional Study Using FY2021 Bed Function Report.

This study examined the relationship between health and productivity management (H&PM) and inpatient health care efficiency in hospitals. This cross-sectional study is based on 1108 hospitals using data from the FY2021 Bed Function Report. The presence of Certified H&PM Organization was the proxy variable for H&PM implementation. The efficiency value obtained using the input-oriented Banker-Charners-Cooper model of data envelopment analysis was a proxy variable for inpatient health care efficiency. The input variables were the number of hospital beds, registered physicians, ward nurses, and other staff members in the ward. The output variable was the total number of patients in the ward per year. We conducted a Wilcoxon rank-sum test and compared certified and non-certified hospitals. The efficiency value was the objective variable, and certification presence was the explanatory variable. We used a stepwise method, including adjustment variables, to confirm whether the certification presence remained in the final multiple regression model. Efficiency was significantly higher in certified hospitals than non-certified hospitals. Certification presence remained in the final multiple regression model (β = .027, CI = -0.004 to 0.057, P = .085). Although not statistically significant, certified hospitals tended to have higher efficiency compared to non-certified hospitals. These findings suggested that hospitals that actively engage in H&PM may have higher efficiency in inpatient health care. However, further research is needed to establish the causal relationship.

Design and development of patient care voice actuated bed in hospital

Manually adjusting hospital beds presents significant challenges for healthcare professionals, which affects their workflow and patient care outcomes. Manual bed modifications consume a significant amount of time, resulting in nurses being less available for other crucial duties. Patient needs can be delayed, and the quality of care delivered overall can be lowered. Manually adjusting the bed to ensure safety and comfort is a risky practice that could result in incorrect placement that can worsen pre-existing medical issues or cause discomfort and pressure sores. In addition, the demand for accurate and frequent bed changes during the day increases the strain on nurses, especially in situations with high patient turnover or complex care needs. The objective of this study is to create a hospital bed that responds to voice commands to improve patient care and monitoring. The bed's voice recognition technology allows patients to adjust their positions and improve comfort and accessibility, particularly for individuals with mobility issues. It includes sensors that continuously measure the patient's heart rate and temperature while they are in bed. These sensors provide real-time data, enabling prompt detection of any irregularities and facilitating immediate intervention in the patient's heartbeat and temperature. The combination of voice control and continuous health monitoring ensures a higher standard of patient care, improves patient autonomy, and reduces the workload on medical staff. The aim of this innovative bed is to create a healthcare environment that is more responsive and efficient, which ultimately leads to better patient outcomes and enhanced overall hospital efficiency.

Technical efficiency in Irish public hospitals: a multi-output distance function SFA approach

Technical efficiency in Irish public hospitals: a multi-output distance function SFA approach

Evaluation of healthcare efficiency in China: a three-stage data envelopment analysis of directional slacks-based measure.

A consensus on the changing pattern of healthcare efficiency in China is current absent. This study tried to identify temporal fluctuations in healthcare efficiency from 2012 to 2021, and conducted a comparative analysis on the performance of 31 regions in China using region-level balanced panel data. Employing three-stage data envelopment analysis (DEA) as the analytical framework, we measured healthcare efficiency and its changes using the directional slacks-based measure and global Malmquist-luenberger (GML) indexes. We also decomposed the sources of healthcare inefficiency and extended our analysis to changes in healthcare efficiency across different primary medical service levels and regional economic development tiers. The average efficiency score of medical institutions (0.956) was slightly higher than that of hospitals (0.930). We found that the average GML indexes of medical institutions in China stood at 0.990, while the average technical change (TC) index was 0.995 and the average efficiency change (EC) index was 0.998 from 2012 to 2021. The GML indexes, TC indexes, and EC indexes of hospitals were 1.002, 1.009, and 0.994, respectively. The healthcare inefficiency for both inputs and desirable outputs in medical institutions was primarily attributed to the redundant numbers of institutions, outpatient visits slacks and inpatient surgery volume slacks, accounting for 50.040, 49.644, and 28.877%, respectively. The undesirable output inefficiency values of medical institutions concerning in-hospital mortality stood at 0.012, while the figure for hospital regarding the average length of stay (LOS) was 0.002. Additionally, healthcare efficiency in both medical institutions and hospitals exhibited an upward trend from 2012 to 2021, corresponding to an increase in the volume of primary medical services, primary medical staff, and the total gross domestic product (GDP). Total factor productivity (TFP) of medical services declined in China from 2012 to 2021. The excessive number of medical institutions and the slack of medical service volumes were the main sources of healthcare inefficiency. Regions prioritizing primary medical services and boasting higher GDP levels exhibited superior healthcare efficiency. These findings are expected to inform policymakers' efforts in building a value-based and efficient health service system in China.

Pursuing the efficient operation of the primary healthcare hospitals in Thailand through efficiency assessment using the data envelopment analysis method.

This study aimed to assess the operational efficiency of Sub-District or Tambon Health Promoting Hospitals (THPHs) in Thailand's Eastern Economic Corridor (EEC) and to propose management guidelines for future improvements. The current state of Thailand's public health demonstrates that government policy has prioritized equal access to public health services in all areas. This increases the need for primary public health services, yet resources are limited and cannot be increased to meet the growing demand. The only effective way to address this issue is to develop the efficiency of public health operations. The sample consisted of 104 THPHs in Chachoengsao, a province in Thailand's EEC. Data for five input and seven output variables were collected between September 18 and November 15, 2023. An online survey was conducted to gather the required data for fiscal year 2022. Data envelopment analysis was used to measure the efficiency of THPHs. The average efficiency index of the 104 THPHs was 0.9066, with about 60% having an efficiency index of 1.00. When classified by size, it was found that the efficiency levels of the THPHs grew with size, considering that the average efficiency index of the small, medium, and large THPHs was 0.8642, 0.9140, and 0.9417, respectively. The proportion of efficient THPHs also increased with size, at 58.14%, 60.00%, and 66.67%, respectively. Regarding efficiency improvement targets, small THPHs had the highest output targets (28.40%), followed by medium THPHs (15.31%) and large THPHs (9.91%). For the inefficient THPHs, some management guidelines were made to improve their future performances.

Measuring Technical Efficiency and Productivity of Secondary Maternal and Child Health Hospitals in Hubei, China: Some Evidences from Hubei Province of China 2019 to 2021.

Environmental factors like COVID-19 can have significant impact on technical efficiency (TE) and total factor productivity (TFP) of health services provided. In this study, focusing on Maternal and Child Health (MCH) hospitals in Hubei Province of China in 2019 to 2021, we aimed to measure their TE and TFP, identify some influential environmental factors, and propose some policy recommendations. Altogether 62 secondary MCH hospitals were selected as the study sample. Four input indicators, 3 output indicators, and 4 environmental indicators were selected to analyze the panel data from 2019 to 2021. Three-stage Data Envelopment Analysis (DEA) and Malmquist Productivity Index (MPI) model were employed to estimate the TE and TFP of these hospitals. During 2019 to 2021, the inputs of the sample hospitals had increased, while the outputs had decreased. The inputs redundancy was negatively associated with birth rate, number of residents, and GDP per capita (P < .05). It was positively associated with number of COVID-19 infections (P < .05). The adjusted TE scores in 2019 to 2021 were 0.822, 0.784, and 0.803, respectively. The TFP declined in 2020 and 2021 compared to 2019, with scores being 0.845 and 0.762. The technical efficiency change (TEC) scores from 2019 to 2021 were 0.926 and 1.063. The technological change (TC) scores from 2019 to 2021 were 0.912 and 0.716. During 2019 to 2021, the operation of sample hospitals had been significantly influenced by environmental factors like COVID-19 pandemic, low birth rate, number of residents, and GDP per capita. The inputs had increased but outputs had decreased, leading to an increase in inputs redundancy and a decline in TE. The TFP showed a downward trend, with TC and SEC being the priority directions for improvement. Some recommendations are made for both hospitals and government to continuously improve the TE and TFP.

Research spot analysis of hospital efficiency evaluation based on CiteSpace

Research spot analysis of hospital efficiency evaluation based on CiteSpace

Evaluation and optimization of hospital system in Chinese provinces: does mortality matter?

During the production process of goods and services, sometimes undesirable outputs are difficult to avoid. However, this aspect is often ignored. Hospitals produce patient care, but undesirable outputs do arise. The novelty of this paper is to introduce the mortality as an undesirable output into the derivation of the public hospital efficiency measure. Similar to the production of economic goods and pollution where the latter increase along with the former, our description of mortality in hospital is considered as weakly disposable. Based on an extension model of Kuosmanen [Am. J. Agric. Econ. 87 (2005) 1077–1082], we evaluate the public hospital efficiency with and without incorporating mortality under four scenarios. We apply this model to measure public hospital efficiency in Chinese provinces. The results indicate that no matter whether one considers undesirable outputs within the objective functions, it has a significant impact on benchmarking once the mortality is included to define the production technology.

The Application of SLAM in Life and Scientific Research

This article mainly focuses on the application of SLAM in technology and provides a literature review on the following aspects: 1) The application of SLAM in automatic parking of automobiles. This includes using AVP-SLAM for high-precision automatic parking in outdoor parking lots using convolutional neural networks, and using MOFISLM for high-precision automatic parking when indoor GPS signals are poor. 2) The application of SLAM in robotics. It includes three aspects. The first is using the GMapping algorithm to construct and locate maps with high accuracy, low computational complexity, and high robustness, enabling robots to plan the shortest path in unknown environments. The second is to use ORB-SLAM2, which can handle more complex situations, to navigate medical institution robots to improve hospital efficiency and reduce disease transmission rates. The third is for robots that perform tasks in complex and unknown terrains. The improved version of LAMP1.0, LAMP2.0, which is suitable for complex underground environments, can achieve multi robot collaborative cooperation with high accuracy and robustness. 3) Application of SLAM in the field of unmanned aerial vehicles. This article mainly elaborates on four aspects. The first is to use visual SLAM to achieve collaborative work between ground robots and drones, and to utilize the high camera advantage of drones to quickly build maps for ground robots, improve accuracy, and save time. The second is to utilize the application of VSLAM on unmanned aerial vehicles to contribute to agriculture. The third is ORB-SLAM3 to provide rapid and high-precision landing on deck for unmanned aerial vehicles in maritime missions. The fourth is using SLAM to assist unmanned aerial vehicles in landing in emergency or position situations (such, when GPS signals are lost).

Impact of potassium test sample rejections on routine laboratory service, South Africa.

Accurate potassium measurements are necessary for effective clinical management of hyperkalaemia. Pre-analytical factors may affect laboratory measurements, leading to erroneous results and inappropriate patient management and negatively impact the efficiency and finances of laboratories and hospitals. This study evaluated the impact of rejected potassium test requests on laboratory service. We conducted a retrospective descriptive study to assess potassium test data at a public laboratory in Pretoria, Gauteng, South Africa, using samples collected from an academic hospital, peripheral hospitals, and outpatient clinics between January 2018 to December 2018. We assessed the relationship between reasons for rejection and health facility type, as well as financial implications for the laboratory. The potassium result rejection rate was 15.1% (29 806 samples), out of the 197 405 requests received. The most common reasons for rejection were old sample (> 1 day old) (41.4%; 12 348 rejections) and haemolysis (38.2%; 11 398 rejections). The most frequent reason for rejections at the central, academic hospital was haemolysis (42.0%), while old sample was the most common reason for rejection at peripheral hospitals (43.4%; 4119/9493 requests) and outpatient health facilities (57.2%; 7208/12 605 requests) (p = 0.022). The total cost of potassium sample rejection over the study period was substantial, given the resource constraints in this setting. Peripheral hospitals and outpatient departments accounted for the majority of rejected potassium testing results, possibly resulting from delays in transportation; causing substantial financial impact on the laboratory. Improved sample collection, handling, and expedited transportation are recommended. This study highlights the importance of appropriate sample collection and handling and the undesirable consequences of non-adherence to these pre-analytical considerations.

A Decision Tree Model-based Study on the Grouping of Hospitalization Expenses of Type 2 Diabetes Patients in a Traditional Chinese Medicine Hospital

Objective To discover the case-mix approach for TCM treatment of dominant disease type 2 diabetes patients and to analyze the hospitalization expense standards for different combinations of patients to provide theoretical references for better participation of TCM hospitals in the DRG payment method as well as reasonable regulation of hospitalization expenses for TCM type 2 diabetes patients in the future. Methods Case data were collected from 1,171 patients discharged with a principal diagnosis of type 2 diabetes from September 2021 to April 2023 from a tertiary care Chinese medicine hospital in Tianjin. Univariate and multivariate stepwise regression analyses determined categorical node variables. The decision tree model was used to perform case combinations and to analyze the expense standards and weights of different groups of disease types. Results The number of days of hospitalization, conditions in admission, and whether complicated cardiovascular and cerebrovascular diseases are the main factors affecting the hospitalization expense of type 2 diabetes patients in Chinese medicine hospitals, and the decision tree model was used to group the patients to form nine groups of patient case combinations. The standard of hospitalization expense for each combination was set reasonably. Conclusion The grouping results are more satisfactory, and the grouping scheme and hospitalization expense standards can provide a scientific basis for DRG grouping, adopting differentiated expense management, and improving the medical resource efficiency in TCM hospitals.

Efficiency effects of public hospital closures in the context of public hospital reform: a multistep efficiency analysis.

In the wake of hospital reforms introduced in 2011 in Turkey, public hospitals were grouped into associations with joint management and some shared operational and administrative functions, similar in some ways to hospital trusts in the English National Health Service. Reorganization of public hospitals effect hospital and market area characteristics and existence of hospitals. The objective of this study is to examine the effect of closure on competitive hospital performances. Using administrative data from Turkish Public Hospital Statistical Yearbooks for the years 2005 to 2007 and 2014 to 2017, we conducted a three-step efficiency analysis by incorporating data envelopment analysis (DEA) and propensity score matching techniques, followed by a difference-in-differences (DiD) regression. First, we used bootstrapped DEA to calculate the efficiency scores of hospitals that were located near hospitals that had been closed. Second, we used nearest neighbour propensity score matching to form control groups and ensure that any differences between these and the intervention groups could be attributed to being near a hospital that had closed rather than differences in hospital and market area characteristics. Lastly, we employed DiD regression analysis to explore whether being near a closed hospital had an impact on the efficiency of the surviving hospitals while considering the effect of the 2011 hospital reform policies. To shed light on a potential time lag between hospital closure and changes in efficiency, we used various periods for comparison. Our results suggest that the efficiency of public hospitals in Turkey increased in hospitals that were located near hospitals that closed in Turkey from 2011. Hospital closure improves the efficiency of competitive hospitals under hospital market reforms. Future studies may wish to examine the efficiency effects of government and private sector collaboration on competition in the hospital market.

Country-level effects of diagnosis-related groups: evidence from Germany’s comprehensive reform of hospital payments

Hospitals account for about 40% of all healthcare expenditure in high-income countries and play a central role in healthcare provision. The ways in which they are paid, therefore, has major implications for the care they provide. However, our knowledge about reforms that have been made to the various payment schemes and their country-level effects is surprisingly thin. This study examined the uniquely comprehensive introduction of diagnosis-related groups (DRGs) in Germany, where DRGs function as the sole pricing, billing, and budgeting system for hospitals and almost exclusively determine hospital revenue. The introduction of DRGs, therefore, completely overhauled the previous system based on per diem rates, offering a unique opportunity for analysis. Using aggregate data from the Organisation for Economic Co-operation and Development and recent advances in econometrics, we analyzed how hospital activity and efficiency changed in response to the reform. We found that DRGs in Germany significantly increased hospital activity by around 20%. In contrast to earlier studies, we found that DRGs have not necessarily shortened the average length of stay.

OP157 Evaluating The Clinical And Economic Impact Of Adopting A Closed Peripheral Intravenous Catheter System In A Japanese Hospital

IntroductionUp to 90 percent of inpatients require an intravenous catheter during their hospitalization. A closed, integrated peripheral intravenous catheter (PIVC) system has been shown to protect veins for longer and reduce the risk of complications and unnecessary restarts when compared with an open system. This study evaluated the annual clinical and economic outcomes of adopting a closed, integrated PIVC system, instead of an open system, for inpatients in a Japanese hospital.MethodsA budget impact analysis was developed to estimate the clinical and economic impact for a 500-bed hospital with an 85 percent occupancy rate and a 96-hour catheter replacement protocol. For the analysis, the average length of stay for patients was 12 days and 90 percent of inpatients required a PIVC. Inputs such as catheter failure rate, complication rate, consumables costs, and complication management costs were informed by global and local data sources. The outcomes evaluated included consumables utilization, complication events, nurse time, and overall cost impact.ResultsThe analysis estimated that 12,604 patients required PIVCs. Moving from an open to a closed, integrated PIVC system resulted in a 68 percent reduction in consumables (3,786 fewer catheters and 36,315 fewer connecting accessories). Complications (occlusion, extravasation, phlebitis, and bending) were reduced by 62 percent (3,682 fewer episodes). Blood exposure was reduced by 98 percent (3,565 fewer episodes), and nurse time decreased by 17 percent (786 fewer hours). This resulted in a potential overall cost saving of JPY3,955,140 (USD28,756) annually, after offsetting the acquisition cost of JPY888,247 (USD6,458) associated with the closed system.ConclusionsPIVC is the most common vascular access device used in hospitals, and insertion and maintenance are often performed by nurses. Fewer complications can be expected with a closed system, leading to better patient outcomes. In addition, nurses spend less time managing complications and replacing PIVCs, and consumables utilization is reduced. This results in improved operational efficiency and potential cost savings for hospitals.

RWD91 Hospital Efficiency Impact of Spectral CT Versus Conventional CT in Diagnosis of Patients Suspected of Occult Cancer in the UK

RWD91 Hospital Efficiency Impact of Spectral CT Versus Conventional CT in Diagnosis of Patients Suspected of Occult Cancer in the UK