Hospital Performance Measures Research Articles

Evaluating private hospital performance before and during COVID-19 in China.

The coronavirus disease 2019 (COVID-19) pandemic had a tremendous impact on the global medical system. The development of private hospitals is an important measure to deepen the reform of China's medical and health system, and an important driving force to improve the effective supply of medical services. This study aims to compare the performance of China's private hospitals before and during COVID-19 and determine the factors that affect hospital profitability between the 2 periods. Data are collected from 10 private listed hospitals from 2017 to 2022, and ratio analysis is used to measure hospital performance in 5 aspects, namely profitability, liquidity, leverage, activity (efficiency), and cost coverage. Multiple regression analysis is used to determine the influencing factors of hospital profitability. The results show a negative impact of COVID-19 on private hospital performance. Specifically, regardless of region, hospital profitability, liquidity, and cost coverage were reduced due to COVID-19, while hospital leverage was increased. COVID-19 had also an impact on hospital efficiency. In addition, before COVID-19, current ratio and cost coverage ratio were the determinants of hospital profitability, while only cost coverage ratio affected hospital profitability during the COVID-19 outbreak. We provide evidence that COVID-19 had an impact on China private hospitals, and the findings will aid private hospitals in improving their performance in the post-COVID-19 era.

Hospital performance evaluation indicators: a scoping review.

Hospitals are the biggest consumers of health system budgets and hence measuring hospital performance by quantitative or qualitative accessible and reliable indicators is crucial. This review aimed to categorize and present a set of indicators for evaluating overall hospital performance. We conducted a literature search across three databases, i.e., PubMed, Scopus, and Web of Science, using possible keyword combinations. We included studies that explored hospital performance evaluation indicators from different dimensions. We included 91 English language studies published in the past 10 years. In total, 1161 indicators were extracted from the included studies. We classified the extracted indicators into 3 categories, 14 subcategories, 21 performance dimensions, and 110 main indicators. Finally, we presented a comprehensive set of indicators with regard to different performance dimensions and classified them based on what they indicate in the production process, i.e., input, process, output, outcome and impact. The findings provide a comprehensive set of indicators at different levels that can be used for hospital performance evaluation. Future studies can be conducted to validate and apply these indicators in different contexts. It seems that, depending on the specific conditions of each country, an appropriate set of indicators can be selected from this comprehensive list of indicators for use in the performance evaluation of hospitals in different settings.

When Antimicrobial Treatment and Surgical Prophylaxis Collide: A Stewardship Opportunity

Background: In 2002, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Centers for Disease Control and Prevention (CDC) established the Surgical Infection Prevention (SIP) project for the purposes of developing and standardizing quality improvement measures known to reduce the rates of post-operative surgical site infections (SSIs). Four years later the Surgical Care Improvement Project (SCIP), an expansion of SIP, was published in governmental Specifications Manual for National Inpatient Quality Measures and provided several additional initiatives applicable to the perioperative period. Central to both projects are the assurance of the timeliness, selection, and duration of peri-operative surgical prophylactic antibiotics. In support of this objective, various medical associations, such as the American Society of Health-System Pharmacists (ASHP) and the Infectious Diseases Society of America (IDSA), have developed the Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. To ensure compliance with quality measures, hospitals are required to report data to the Physicians Quality Reporting System, which is then reviewed by CMS for reimbursement purposes and to measure hospital performance. To maintain optimal standards of care and satisfy all core measures, it is expected that patients undergoing most categories of surgical procedures receive prophylactic antibiotics. We recognized that patients already being administered antimicrobial therapy as treatment for the condition requiring the surgery not uncommonly also were prescribed unwarranted and redundant pre-operative antibiotics. Our study was meant to quantify such antibiotic redundancy, which only risks the development of antimicrobial resistance and adverse events, to bolster our and other hospitals antimicrobial stewardship programs. Methods: A retrospective analysis of computerized hospital records over a one-month period of time (November 2022) was conducted focusing on hospital admissions that involved surgical operative procedures. Only those patients who had received a pre-operative surgical prophylactic antibiotic were included in the analysis. Results: Of the 92 surgeries that fulfilled the inclusion criteria, 38 (41.3%) were performed on patients who were already receiving therapeutic antibiotics for more than 24 hours targeted to treat the infection for which they were undergoing surgery. These included laparoscopic cholecystectomy (24), appendectomy (12), wound debridement (12), and soft tissue incision and drainage procedures (9), comprising nearly 50% of each type of these operations performed during the study time period. Conclusion: These findings demonstrate a clear opportunity to strengthen both our, and presumably other, hospitals antimicrobial stewardship programs. Together with physician education, granting the pharmacy the ability to cancel unnecessary and redundant surgical prophylactic antibiotics would conceivably be of great benefit.

Performance Management and the Specificities of Public Hospitals

The aim of this article is to describe the specific features of public hospitals that hamper performance measurement. We conducted a literature review of several theses and articles, which enabled us to describe the specificities of public hospitals and their impact on hospital performance measurement and management systems.

Implementation of the New Medicare-Mandated Patient-Reported Outcomes After Joint Arthroplasty Performance Measure

A new mandatory hospital-level, risk-standardized performance measure for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on patient-reported outcomes (THA/TKA PRO-PM) has been implemented by the Centers for Medicare & Medicaid Services (CMS). All THA and TKA in Medicare fee-for-service beneficiaries at inpatient facilities are included. The THA/TKA PRO-PM is the proportion of risk-standardized THA or TKA patients meeting or exceeding the substantial clinical benefit threshold between preoperative and postoperative outcomes measures (Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Knee injury and Osteoarthritis Outcome Score for Joint Replacement). This binary outcome (yes/no) is then divided by all eligible patients creating a percentage of patients reaching substantial clinical benefit. The percentile score among hospitals will be reported. Following 2 voluntary reporting periods, mandatory reporting will begin in 2025. The CMS requires 50% reporting rates; failure leads to annual payment reduction in fiscal year 2028. The CMS intends the THA/TKA PRO-PM to be a patient-centered, meaningful, and relatable measure of hospital performance reported to the public. For surgeons, this is an opportunity to collaborate with hospitals for developing and implementing a THA/TKA data collection system to avoid penalties for the hospital. Further implementation for outpatient surgery and in ambulatory surgery centers has been announced by CMS. Major resources will be needed to succeed in the expected capture rates.

Development of a Hospital-Stakeholder Collaboration Tool Using Mixed Methods to Assess Stakeholder Perspectives for Hospital Service Improvement.

The purpose of this study was to develop the Hospital-Stakeholder Collaboration (HSC) Tool and Hospital Performance Factor (HPF) Tool to explore stakeholder perception and value for hospital service improvement. This exploratory mixed-method study involved three steps: initial tool development (Step 1), validity testing (Step 2), and module development (Step 3). In Step 1, qualitative data collection through literature reviews, focus group discussions, and interviews with hospital management experts led to the creation of the preliminary tools. Step 2 involved qualitative analysis by α 5-member expert panel, followed by quantitative analysis with 36 respondents for validity (Pearson correlation, α = 0.05) and reliability (Cronbach's Alpha, α = 0.6) tests. Step 3 encompassed the final module development. The HSC tool contains 6 domains and the HPF tool contains 4 perspectives. The 6 HSC domains were: 1) stakeholder identification, 2) interactive dialogue, 3) commitment, 4) planning, 5) implementation, 6) change in action and behavior. The 4 HPF perspectives were: 1) stakeholder perspective, 2) financial perspective, 3) internal business process, and 4) staff and organizational capacity. The values of the HSC tool validity and reliability tests were around 0,0046 and around 0,995, respectively. Additionally, the values of the HPF tool validity and reliability tests were around 0,0062 and around 0,995, respectively. This study offers a practical tool for needs assessment for the improvement of service by analyzing direct feedback from hospital stakeholders and measuring hospital performance factors.

Analysis of east java mata masyarakat hospital based on malcolm baldrige performance criteria

A hospital is a health service institution that provides complete individual health services, providing inpatient, outpatient and emergency services. Quality of Service is one form of effort made by each Hospital in carrying out actions that make patients feel comfortable, safe, fast and precise in getting their needs. This research aims to explain performance analysis using the Malcolm Baldrige criteria in hospitals Mata Masyarakat of East Java. This research is a cross-sectional study where data is collected at a certain time to describe the situation at that time. Employees selected as respondents will fill out a questionnaire that has been prepared with a number of questions based on Malcolm Baldrige's criteria. The data that will be taken in the research is the characteristics of employees at the hospital Mata Masyarakat and performance measurement based on hospital employee perceptions. The population in this study were hospital employees Mata Masyarakat are 40 employees consisting of management staff and unit heads. In this study, the samples used were managers and unit heads in hospitals Mata Masyarakat are 30 people. The research results show that the criteria with the highest percentage scores are Customer Focus, Process Management and Results with each score (85%) while the lowest is Leadership with a score of (79%). total score obtained by hospital Mata Masyarakat's score for all Malcolm Baldrige Criteria based on the questionnaire results is 837.6 or 83.69% of the maximum score of 1000 which is in the very good category.

Electronic Clinical Quality Measures of Health Information Technology and Hospital Performance: Evidence of U.S. Hospitals

Electronic Clinical Quality Measures of Health Information Technology and Hospital Performance: Evidence of U.S. Hospitals

The Mediated Impact of Health Care Insurance Inclusion Between Hospital Management and Operation Efficiency in Saudi Arabia

The healthcare scene in Saudi Arabia has been experiencing notable changes, characterised by an increasing focus on enhancing the quality and availability of medical services. Given the significant role that hospitals play in the provision of healthcare services, it is essential to comprehend the interplay between management strategies and operational efficiency. In a country without fixed and implanted national health care insurance program, like KSA, it is a challenge to modify the weak existed program to a big project of national health care insurance program. This inclusion despite making high beneficial for health care of the human but making high challenge for health care management and could affect the Management Efficiency which was almost affected by different variables like Management Staff Satisfaction. Facilities Availability, Management Cost Reduction and Patient Safety Improvement Plan Healthcare providers had to have compensatory shift that healthcare administrator had to provide after healthcare insurance changes. This study will benefits hospital management practises on operational efficiency results, using well-established theories of organisational management and healthcare economics. Furthermore, the research investigates the degree to which the existence of health care insurance coverage acts as a mediator in this association. The presence of health care insurance plays a pivotal role in shaping patients' ability to get medical services and has the potential to influence the efficacy of hospital management approaches. In order to accomplish these aims, quantitative research have been used. Quantitative data is collected by means of surveys and archive hospital performance measures, derived from interviews and focus group discussions conducted with important players within the healthcare sector of Saudi Arabia.

Measurement of Hospital Performance in the Border Region of Timor Leste through Customer Satisfaction Aspects

Kefamenanu Regional General Hospital is the only government hospital in North Central Timor Regency (TTU) as a provider of health services in Kefamenanu City which is a border area. The current presence of the Leona Private Hospital in the district directly forces the Kefamenanu Hospital to improve services so as not to lose credibility in the community. Kefamenanu General Hospital must strive to provide quality health services for the community by formulating a vision, mission, goals, objectives and indicators of success as outlined in a strategic plan. In this article the discussion focuses on aspects of customer satisfaction. The results of the study show that from the perspective of customer satisfaction, it is in the "Satisfied" interval so that the performance of Kefamenanu Hospital can be said to be "Good".

Effects of Hospital-Acquired Conditions on Readmission Risk: The Mediating Role of Length of Stay

Problem definition: Hospital-acquired conditions (HACs) represent undesirable complications that occur during a hospital stay. HACs can compromise patient safety and care outcomes and result in unnecessary socio-economic costs. Although hospitals are expected to reduce the incidence of HACs, few studies have examined the implications of HACs on other clinical outcomes and measures of hospital performance. This study contributes to the literature by exploring the relationship between exposure to a set of target HACs, length of stay (LOS) performance, and 30-day readmission risk. Methodology/results: To estimate the effects of HACs, we conduct econometric analyses using patient-visit-level data for heart attack, heart failure, and pneumonia patients hospitalized in the U.S. state of Florida during 2010–2014. We define LOS performance as the deviation of LOS from the Geometric Mean LOS (GMLOS), a standard LOS set by the Centers for Medicare and Medicaid Services. First, we find that exposure to HACs leads to a 37% increase in the odds of readmission and a 79% increase in LOS. Second, an increase in LOS is associated with a decrease in readmission risk, and this decrease is stronger for patients exposed to HACs. Third, LOS performance mediates the HACs-readmission risk relationship, such that the increase in the readmission risk of a HAC patient can be fully suppressed by the patient’s LOS. Fourth, we find that for patients exposed to HACs, the benefits of a longer LOS are almost entirely capitalized when the LOS becomes 65% longer than the GMLOS. Managerial implications: We demonstrate that, when addressing the consequences of HACs, clinicians also face indirectly a trade-off between reducing readmissions and controlling costs. We proffer LOS as a potential mechanism under hospitals’ control for mitigating the adverse effects of HACs on readmission risk. Thus, this study offers guidance to clinicians having to decide when to discharge patients with exposure to HACs. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0088 .

HOSPITAL LENGTH OF STAY PREDICTION WITH ENSEMBLE LEARNING METHODE

The hospital length of stay (LoS) is the number of days an inpatient will stay in the hospital. LoS is used as a measure of hospital performance so they can improve the quality of service to patients better. However, making an accurate estimate of LoS can be difficult due to the many factors that influence it. The research conducted aims to predict LoS for treated patients (ICU and non-ICU) with cases of brain vessel injuries by using the ensemble learning method. The Random Forest algorithm is one of the ensembles learning methods used to predict LoS in this study. The dataset used in this study is primary data at PHC Surabaya Hospital. From the results of the simulations performed, the random forest algorithm is able to predict LoS in a dataset of treated patients (ICU and non-ICU) with cases of brain vessel injuries. And the simulation results show a type II error value of 0.10 while the value of type I error is 0.16.

Achieving Equity in Hospital Performance Assessments Using Composite Race-Specific Measures of Risk-Standardized Readmission and Mortality Rates for Heart Failure.

The contemporary measures of hospital performance for heart failure hospitalization and 30-day risk-standardized readmission rate (RSRR) and risk-standardized mortality rate (RSMR) are estimated using the same risk adjustment model and overall event rate for all patients. Thus, these measures are mainly driven by the care quality and outcomes for the majority racial and ethnic group, and may not adequately represent the hospital performance for patients of Black and other races. Fee-for-service Medicare beneficiaries from January 2014 to December 2019 hospitalized with heart failure were identified. Hospital-level 30-day RSRR and RSMR were estimated using the traditional race-agnostic models and the race-specific approach. The composite race-specific performance metric was calculated as the average of the RSRR/RMSR measures derived separately for each race and ethnicity group. Correlation and concordance in hospital performance for all patients and patients of Black and other races were assessed using the composite race-specific and race-agnostic metrics. The study included 1 903 232 patients (75.7% White [n=1 439 958]; 14.5% Black [n=276 684]; and 9.8% other races [n=186 590]) with heart failure from 1860 hospitals. There was a modest correlation between hospital-level 30-day performance metrics for patients of White versus Black race (Pearson correlation coefficient: RSRR=0.42; RSMR=0.26). Compared with the race-agnostic RSRR and RSMR, composite race-specific metrics for all patients demonstrated stronger correlation with RSRR (correlation coefficient: 0.60 versus 0.74) and RSMR (correlation coefficient: 0.44 versus 0.51) for Black patients. Concordance in hospital performance for all patients and patients of Black race was also higher with race-specific (versus race-agnostic) metrics (RSRR=64% versus 53% concordantly high-performing; 61% versus 51% concordantly low-performing). Race-specific RSRR and RSMR metrics (versus race-agnostic) led to reclassification in performance ranking of 35.8% and 39.2% of hospitals, respectively, with better 30-day and 1-year outcomes for patients of all race groups at hospitals reclassified as high-performing. Among patients hospitalized with heart failure, race-specific 30-day RSMR and RSRR are more equitable in representing hospital performance for patients of Black and other races.

Developing A Sustainable Balanced Scorecard (SBSC) Model by Integrating EESG (Economic, Environmental, Social, and Governance) Performance Indicators for Private Hospitals in Egypt

This study constructs a model for Sustainable Balanced Scorecard (SBSC) by identifying the critical indicators from eight perspectives (Finance, Internal Business Process, Customer/Patient, Learning and Growth, Economic, Environmental, Social, and Governance). Moreover, in this study, a structural evaluation approach is presented to link the important SBSC indicators to a strategy map for private hospitals in Egypt. The most important metrics for measuring hospital performance are compiled from relevant literature and evaluated by a panel of experts in accordance with the eight SBSC perspectives. Then, using the DEMATEL (Decision-Making Trial and Evaluation Laboratory) approach, a tool to analyze multiple criteria, the study ascertains the causal connections among the indicators, pinpoints the crucial core and deciding factors, and creates a visual strategy map with logical connections to boost hospital performance. To assess sustainable performance of private hospitals, 49 metrics were chosen based on the perspectives of the SBSC. Also, the study reveals that ‘‘Governance Control Activities’’, ‘‘Governance Financial Activities’’, ‘‘Non-compliance with laws and regulations’’, “Return on Investment”, “% of Revenue from repeat business “, “Net Promoter Score (NPS)”, and “Patient Complaints”, are the most essential evaluation indicators for private hospitals’ performance. The strategy map results demonstrate a clear road map to assist hospital leaders in ranking performance metrics and focusing on strategy-related actions for the essential indicators, where they could more effectively direct their limited resources toward areas that need the most improvement.

Using Potentially Preventable Severe Maternal Morbidity to Monitor Hospital Performance.

The Centers for Disease Control and Prevention (CDC) measure of severe maternal morbidity (SMM) quantifies the burden of SMM but is not restricted to potentially preventable SMM. The authors adapted the CDC SMM measure for this purpose and evaluated it for use as a hospital performance measure. Guidelines for defining performance SMM (pSMM) were (1) exclusion of preexisting conditions from outcome; (2) exclusion of inconsistently documented outcomes; and (3) risk adjustment for conditions that preceded hospitalization. California maternal hospital discharge data from 2016 to 2017 were used for model development, and 2018 data were used for model testing and evaluation of hospital performance. Separate models were developed for hospital types (Community, Teaching, Integrated Delivery System [IDS], and IDS Teaching), generating model-based expected pSMM values. Observed-to-expected (O/E) ratios were calculated for hospitals and used to categorize them as overperforming, average performing, or underperforming using 95% confidence intervals. Performance categories were compared for pSMM vs. CDC SMM (excluding blood transfusion). The overall 2016-2018 pSMM rate was 0.44%. All hospital types had over- and underperformers, and the proportions of Community, Teaching, IDS, and IDS Teaching hospitals whose performance differed from their performance on the CDC SMM measure were 12.1%, 25.0%, 38.9%, and 66.7%, respectively. The rate of potentially preventable SMM as defined by pSMM (0.44%) was less than half the previously published rate of CDC SMM (1.03%). pSMM identified differences in performance across hospitals, and pSMM and CDC SMM classified hospitals' performances differently. pSMM may be suitable for hospital comparisons because it identifies potentially preventable, hospital-acquired SMM that should be responsive to quality improvement activities.

Pentingnya Akreditasi Rumah Sakit Bagi Pelayanan Kesehatan: Hospital Application Study

Hospitals in guaranteeing good service quality and patient safety must be proven through accreditation. Accreditation is carried out by submitting an application to the Hospital Accreditation Commission (KARS). Hospital Accreditation is a way of monitoring the implementation of measuring hospital performance indicators. The purpose of writing this scientific article is to find out the importance of improving the quality of hospitals, especially for hospital structures and health workers. The method in this scientific article is to compare cases from several hospital studies that apply the accreditation process and the literature collected at the editing (re-examination) stage. The data is then processed and analyzed and conclusions drawn. The findings from the study of the application of hospitals in the importance of holding accreditation are to improve the quality of hospital services, improve hospital patient safety, increase protection for patients, the public, human resources for hospitals and hospitals as institutions and support government programs in the health sector. It can be concluded that the importance of hospitals carrying out accreditation is to ensure good service quality and patient safety must be proven through accreditation. Accreditation is carried out by submitting an application to the Hospital Accreditation Commission (KARS). Suggestions made for hospital agencies, namely hospitals that have obtained national accreditation status are required to make strategic improvement plans in accordance with the surveyor's recommendations to meet hospital service standards that have not been achieved.

Comparing Hospital Efficiency: An Illustrative Study of Knee and Hip Replacement Surgeries in Spain.

WHO's Health Systems Performance Assessment framework suggests monitoring a set of dimensions. This study aims to jointly assess productivity and quality using a treatment-based approach, specifically analyzing knee and hip replacement, two prevalent surgical procedures performed with consolidated technology and run in most acute-care hospitals. Focusing on the analysis of these procedures sets out a novel approach providing clues for hospital management improvements, covering an existing gap in the literature. The Malmquist index under the metafrontier context was used to estimate the productivity in both procedures and its decomposition in terms of efficiency, technical and quality change. A multilevel logistic regression was specified to obtain the in-hospital mortality as a quality factor. All Spanish public acute-care hospitals were classified according to their average severity attended, dividing them into three groups. Our study revealed a decrease in productivity mainly due to a decrease in the technological change. Quality change remained constant during the period with highest variations observed between one period to the next according to the hospital classification. The improvement in the technological gap between different levels was due to an improvement in quality. These results provide new insights of operational efficiency after incorporating the quality dimension, specifically highlighting a decreasing operational performance, confirming that the technological heterogeneity is a critical question when measuring hospital performance.

Accounting for heterogeneity in the measurement of hospital performance

ABSTRACT As the Corona pandemic of 2020 has shown, disposing of sufficient hospital capacity is of great importance. Ideally, this capacity should be provided by efficient units, calling for measurement of their performance. However, the standard cost frontier model yields biased efficiency scores because it ignores (often unobserved) heterogeneity between hospitals. In this paper, efficiency scores are derived from a cost function with both random intercept and random slope parameters which overcomes the problem of unobserved heterogeneity in stochastic frontier analysis. Based on an unbalanced panel covering the years 2004 to 2007 and comprising at least 100 Swiss hospitals per year, Bayesian inference points to significant heterogeneity suggesting rejection of the standard cost frontier model. When unobserved heterogeneity is fully accounted for, average estimated inefficiency decreases to 5%, below the 14% (21%, respectively) value reported for a number of European and Middle-Eastern countries (Hollingsworth, 2008; Alawi et al. 2019). Moreover, hospitals rated below 85% efficiency according to the standard model gain up to 12% points. They can provide much needed capacity that otherwise would be discarded on the grounds that they are not sufficiently efficient providers.

Does competition improve hospital performance: a DEA based evaluation from the Netherlands

Many countries have introduced competition among hospitals aiming to improve their performance. We evaluate the introduction of competition among hospitals in the Netherlands over the years 2008–2015. The analysis is based on a unique longitudinal data set covering all Dutch hospitals and health insurers, as well as demographic and geographic data. We measure hospital performance using Data Envelopment Analysis and distinguish three components of competition: the fraction of freely negotiated services, market power of hospitals, and insurer bargaining power. We present new methods to define variables for each of these components which are more accurate than previously developed measures. In a multivariate regression analysis, the variables explain more than half of the variance in hospital efficiency. The results indicate that competition between hospitals and the relative fraction of freely negotiable health services are positively related to hospital efficiency. At the same time, the policy measure to steadily increase the fraction of health services contracted in competition may well have resulted in a decrease in hospital efficiency. The models show no significant association between insurer bargaining power and hospital efficiency. Altogether, the results offer little evidence that the introduction of competition for hospital care in the Netherlands has been effective.

Predicting acute myocardial infarction (AMI) 30-days mortality: Using standardised mortality ratio (SMR) as the hospital performance measure

BackgroundA standardised mortality ratio (SMR) is the hospital observed mortality divided by its predicted mortality and has been used as an indicator to monitor hospital performance. ObjectivesThis study developed a model that predicted 30-day mortality for acute myocardial infarction (AMI) and compared the SMR among 41 Malaysian public hospitals using statistical process control charts. Methods & resultsData from referral centres and specialist hospitals with cardiology services were analysed. Both referral centres and specialist hospitals had comparable mortality, except for Hospitals A and B, which the study considered outliers. Two-thirds of the remaining hospitals had an SMR of above one (SMR 1.05–1.51), but the indices were still within the expected variations. ConclusionThe SMR coupled with a funnel plot and variable life adjusted display (VLAD) can identify hospitals with potentially higher than expected mortality rates.