National Health System Hospitals Research Articles

Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals.

Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010–2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010–2012 according to their ownership structure—public hospitals, private hospitals and public–private partnership (PPP)—data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.

Characterization of dengue cases confirmed using the database linkage technique: assessment of virus circulation in Belo Horizonte, Brazil, 2009-2014.

to describe dengue virus circulation in Belo Horizonte, Brazil, from 2009 to 2014. this is a series study of cases of dengue infected by different virus serotypes, identified by virus isolation or RT-PCR; database linkage was performed between the Notifiable Health Conditions Information System (SINAN), the Brazilian National Health System Hospital Information System (SIH/SUS) and the Laboratory Environment Manager (GAL). 91.1% of the records were linked (n=775); among the cases (n=851), 60.4% (n=514) were confirmed as DENV-1, 22.1% (n=188) DENV-4, 9.8% (n=83) as DENV-2, and 7.7% (n=66) as DENV-3; DENV-2 accounted for a higher percentage of severe cases (4.5%). DENV-1 prevailed and circulated in all evaluated years.

Adolescent intentional self-harm notifications and hospitalizations in Brazil, 2007-2016.

to describe the profile of case notifications and hospitalizations of intentional self-harm involving adolescents in Brazil. this was a descriptive study with data from the Notifiable Health Conditions Information System (SINAN) (2011-2014) and the Brazilian National Health System Hospital Information System (SIH/SUS) (2007-2016) about intentional self-harm. there were 15,702 notifications, with predominance of the 15-19 years age group (76.4%), females (71.6%) and White race/skin color (58.3%); the home was the most frequent place of occurrence (88.5% among those 10-14 years old and 89.9% among those 15-19 years old); poisoning/intoxication was the most used method (76.6% and 78% in the 10-14 and 15-19 age groups, respectively); there were 12,060 hospitalizations, with a predominance of females (58.1%) and greater occurrence in Southeast Region (2.7 and 7.0 notifications/100,000 inhabitants in the 10-14 and 15-19 age groups, respectively). the results reinforce the need for health services to be sensitive to recording cases and providing care to these adolescents.

Murine typhus. How does it affect us in the 21st century? The epidemiology of inpatients in Spain (1997–2015)

ObjectiveThe aim of this study was to analyze the epidemiological impact of murine typhus in patients who required hospitalization in the National Health System (SNS) in Spain between 1997 and 2015. BackgroundMurine typhus (MT) is a zoonosis caused by Rickettsia typhi. MT is transmitted from rats, cats, dogs, and opossums to humans by their fleas. The clinical picture is characterized by headache, fever, rash, and liver function alteration. The prevalence of MT is considered underestimated since most cases are mild and self-limited. However, up to 10% of patients develop serious complications such as pneumonia or acute kidney injury and may even need admission to intensive care units. MethodsThis was a retrospective longitudinal descriptive study of inpatients diagnosed with Rickettsia typhi infection (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM], 081.0) in Spanish public hospitals between January 1, 1997, and December 31, 2015. Data were obtained from the Minimum Basic Data Set (MBDS, CMBD in Spanish), which includes information about inpatients admitted to the National Health System (NHS) hospitals provided by the Health Information Institute of the Ministry of Health and Equality. ResultsNinety-nine inpatients were included. The incidence rate of MT was 0.12 (95% CI, 0.09-0.14) cases per one million person-years. Cases were irregularly distributed throughout the period of study, with a slight upward trend between 2013 and 2015. The Canary Islands had the highest incidence rate: 2.17 (95% CI, 1.69–2.64) cases per one million person-years (80 cases). Most patients were men (63.6%). The mean age (±SD) was 46.4 years (±19). Five patients were under 15 years old. Approximately 85.9% of cases required urgent hospital admissions. The average hospital stay was 11 days (±9.9). Only 1 patient died. ConclusionsAlthough considered uncommon, the incidence of MT seems to be increasing slowly. Most cases occurred in middle-aged men between late summer and early autumn in Spain. The Canary Islands and Andalusia registered the highest number of cases. The MBDS is an appropriate approach to study MT hospital management.

Solid organ transplantation in Brazil: a descriptive study of distribution and access inequalities across the Brazilian territory, 2001-2017.

to describe the distribution of solid organ transplants in Brazil, as well as information about the waiting list (demand) and origin of transplant patients by organ type and Federative Unit, from 2001 to 2017. this was a descriptive study using data from State Transplantation Centers, the Brazilian Organ Transplant Association, and the Brazilian National Health System Hospital Information System (SIH/SUS). 153 transplant units were identified in 2017, with only 11.8% located in the Northern and Midwest regions; within the study period, 99,805 transplants were performed, ranging from 3,520 (2001) to 8,669 (2017); the highest number of transplants was concentrated in the Southern and Southeastern regions. there are inequalities in transplantation access, possibly due to lack of uniformity in service distribution.

Incidence and geographical distribution of patients hospitalised with fascioliasis in Spain

IntroductionThe epidemiology of human fascioliasis is related to the geographical and environmental characteristics of the area where transmission occurs. There are gaps in the current knowledge of the distribution of fascioliasis in Spain. The objective of the study was to determine the incidence and geographic distribution of patients with fascioliasis who required hospitalization in Spain. MethodAn observational study of the hospitalised population (166 patients) with a diagnosis of fascioliasis, according to the minimum basic data set (MBDS) for hospital discharge, between 1997 and 2014 was carried out. Most of the hospitals were Spanish National Health System hospitals. ResultsThe incidence of hospitalised patients with fascioliasis was 2.1 (99% CI, 2.03–2.13) cases/10,000,000 inhabitants per year. The annual incidence was reduced during the 18 years of the study. The relative risk of men was 1.136 (99% CI, 0.299–0.993) with respect to women. A focal geographic aggregation of cases was observed in areas especially in northern and central Spain. The greatest incidents were found in the provinces of Segovia and Lugo. Intrahospital death occurred in 3 patients. ConclusionThe incidence of hospitalisations with fascioliasis in Spain is low, has been reduced and has predominated in the provinces of Segovia and Lugo.

Coronary artery bypass grafting in Spain. Influence of procedural volume on outcomes.

To analyze the association between volume and outcomes in coronary artery bypass grafting (CABG) in the Spanish National Health System. We analyzed CABG episodes from 2013 to 2015. The selected outcome variables were in-hospital mortality in the index episode, 30-day cardiac-related readmissions, and mortality during readmission. Risk-adjusted rates of in-hospital mortality (RAMR) and 30-day readmissions (RARR) were calculated using multilevel logistic regression. High- and low-volume hospitals for CABG were identified by a nonconditioned analysis (k-means) and by compliance with the volume recommendation of clinical practice guidelines. A total of 17 335 CABG index episodes were included, with a crude in-hospital mortality rate of 5.0%. Episodes attended in low-volume centers for CABG (< 155 CABG per year) showed 17% higher RAMR (5.81%±2.07% vs 4.96%±1.76%; P <.001) and a negative linear correlation between volume and RARR (r=-0.318; P=.029), as well as a higher percentage of complications during the episode. The same association between volume and more favorable outcomes was found in isolated CABG. The mean CABG volume is low in Spanish National Health System hospitals. Higher volume was associated with better outcomes in CABG, both total and isolated. The findings of this study indicate the need for a higher concentration of CABG programs, as well as the publication of risk-adjusted outcomes of coronary intervention.

Cirugía de revascularización aortocoronaria en España. Influencia del volumen de procedimientos en los resultados

Introduction and objectivesTo analyze the association between volume and outcomes in coronary artery bypass grafting (CABG) in the Spanish National Health System. MethodsWe analyzed CABG episodes from 2013 to 2015. The selected outcome variables were in-hospital mortality in the index episode, 30-day cardiac-related readmissions, and mortality during readmission. Risk-adjusted rates of in-hospital mortality (RAMER) and 30-day readmissions (RARER) were calculated using multilevel logistic regression. High- and low-volume hospitals for CABG were identified by a nonconditioned analysis (k-means) and by compliance with the volume recommendation of clinical practice guidelines. ResultsA total of 17 335 CABG index episodes were included, with a crude in-hospital mortality rate of 5.0%. Episodes attended in low-volume centers for CABG (< 155 CABG per year) showed 17% higher RAMR (5.81%±2.07 vs 4.96±1.76; P <.001) and a negative linear correlation between volume and RARR (r=−0.318; P=.029), as well as a higher percentage of complications during the episode. The same association between volume and more favorable outcomes was found in isolated CABG. ConclusionsThe mean CABG volume is low in Spanish National Health System hospitals. Higher volume was associated with better outcomes in CABG, both total and isolated. The findings of this study indicate the need for a higher concentration of CABG programs, as well as the publication of risk-adjusted outcomes of coronary intervention.Full English text available from: www.revespcardiol.org/en

Incidencia y distribución geográfica de pacientes hospitalizados con fascioliasis en España

IntroductionThe epidemiology of human fascioliasis is related to the geographical and environmental characteristics of the area where transmission occurs. There are gaps in the current knowledge of the distribution of fascioliasis in Spain. The objective of the study was to determine the incidence and geographic distribution of patients with fascioliasis who required hospitalisation in Spain. MethodAn observational study of the hospitalised population (166 patients) with a diagnosis of fascioliasis, according to the minimum basic data set (MBDS) for hospital discharge, between 1997 and 2014 was carried out. Most of the hospitals were Spanish National Health System hospitals. ResultsThe incidence of hospitalised patients with fascioliasis was 2.1 (99% CI, 2.03-2.13) cases/10,000,000 inhabitants per year. The annual incidence was reduced during the 18 years of the study. The relative risk of men was 1.136 (99% CI, 0.299-0.993) with respect to women. A focal geographic aggregation of cases was observed in areas especially in northern and central Spain. The greatest incidents were found in the provinces of Segovia and Lugo. Intrahospital death occurred in 3 patients. ConclusionThe incidence of hospitalisations with fascioliasis in Spain is low, has been reduced and has predominated in the provinces of Segovia and Lugo.

Changing Trends in the Epidemiology and Risk Factors of Pneumocystis Pneumonia in Spain.

Objective: The information about the epidemiology of Pneumocystis pneumonia (PcP) in Europe is scarce, and in Spain there are only data nationwide on patients with HIV infection. This study has been carried out with the aim of knowing in our country the current epidemiological spectrum and the risk factors of PcP.Methods: Observational, descriptive transversal study that included all patients admitted in Spain with diagnosis upon discharge of PcP registered in the National Health System's Hospital Discharge Records Database of Spain, between 2008 and 2012.Results: Four thousand five hundred and fifty four cases of PcP were reported, 1,204 (26.4%) in HIV-negative patients. During the study period, mean annual incidence (cases per million) was 19.4, remaining globally stable, increasing from 4.4 to 6.3 in HIV-negative patients and decreasing from 15.5 to 13.4 among HIV-infected patients. Risk factors were identified in 85.5% of HIV-negative cases, the most frequent being hematological neoplams (29%), chronic lung diseases (15.9%), and non-hematological cancers (14.9%). Mean mortality and hospitalization cost were high (25.5% and 12,000 euros, respectively).Conclusions: The results of this first nationwide study in Spain allow a change in the misconception that, after the AIDS epidemic, PcP is an infrequent disease, showing that today it is an emerging problem in patients without HIV infection. These findings underlines the need for increased efforts toward a better characterization of risk groups to improve prophylactic strategies and reduce the burden of disease.

Comparison of the Uptake of Screening Colonoscopy between Physicians and the General Population in Greece

Aim: To evaluate the uptake of screening colonoscopy among physicians as compared to the general population. Methods: Asymptomatic physicians, aged 45–67 years, at average risk for colorectal cancer (CRC), working in the participating National Health System hospitals were asked to complete a questionnaire regarding the uptake of screening colonoscopy. The results were compared to those in a background healthy population, aged 50–75 years, inhabitants of a Greek county, who were offered a free access to a screening colonoscopy program for CRC. High-risk adenomas were those ≥10 mm in diameter or any adenoma, regardless of size, with villous histology or high-grade dysplasia. Results: Overall, 267 of 782 physicians and 402 of 6,534 nonphysicians underwent a screening colonoscopy (uptake rates 34.2 and 6.2% respectively, p = 0.00001). Screening colonoscopy has yielded 4 adenocarcinomas (1.6%), 14 high-risk adenomas (5.5%), and 61 low-risk adenomas (25.7%) in the physicians’ group. Corresponding figures in the nonphysician arm were 4 (1), 26 (6.5), and 107 (26.6%), respectively. The main reason among physicians for nonadherence was indifference/negligence (n = 213). Conclusion: The proportion of physicians undergoing screening colonoscopy for CRC is significantly higher compared to the general population; however, it does remain suboptimal.

Hospitalization for ambulatory care-sensitive conditions in the state of Rondônia, Brazil: a descriptive study of the period 2012-2016.

to describe the frequency and reasons for hospitalizations for ambulatory care-sensitive conditions (HACSC) in Rondônia, Brazil, between 2012 and 2016, and to analyze their relationship with the evolution of the coverage of the family health strategy (FHS) in the same period. this was a descriptive study of secondary data from the Brazilian National Health System's Hospital Information System. during the period of the study 133,958 HACSC were authorized, corresponding to a rate of 75 hospitalizations/1,000 inhab.; there was a parallel annual increase in FHS coverage and a slightly decreasing trend of authorized HACSC, although this was not statistically significant; in 2012, HACSC frequency was 20.7% in relation to all hospitalizations that occurred in the state, while in 2016 this indicator declined to 16.7%. HACSC frequency in Rondônia was high between 2012 and 2016; although there was an increase in FHS coverage in the same period, this increase was not accompanied by a significant change in the frequency of HACSC registered in the state.

Neurological Disorders in Central Spain, Second Survey: Feasibility Pilot Observational Study.

BackgroundThe Neurological Disorders in Central Spain, second survey (NEDICES-2) is a population-based, closed-cohort study that will include over 8000 subjects aged ≥55 years. It will also include a biobank.ObjectiveThe objective of this study was to evaluate all major aspects of the NEDICES-2 (methods, database, screening instruments, and questionnaires, as well as interexpert rating of the neurological diagnoses) in each one of the planned areas (all of them in central Spain) and to test the possibility of obtaining biological samples from each participant.MethodsA selection of patients and participants of the planned NEDICES-2 underwent face-to-face interviews including a comprehensive questionnaire on demographics, current medications, medical conditions, and lifestyle habits. Biological samples (blood, saliva, urine, and hair) were also obtained. Furthermore, every participant was examined by a neurologist.ResultsIn this pilot study, 567 study participants were enrolled (196 from hospitals and 371 from primary care physician lists). Of these 567, 310 completed all study procedures (questionnaires and the neurological evaluation). The study was time-consuming for several primary care physicians. Hence, a few primary care physicians from some areas refused to participate, which led to a reconfiguration of study areas. In addition, the central biobank needed to be supplemented by the biobanks of local Spanish National Health System hospitals.ConclusionsPopulation-based epidemiological surveys, such as the NEDICES-2, require a pilot study to evaluate the feasibility of all aspects of a future field study (population selection, methods and instruments to be used, neurological diagnosis agreement, and data collection).

A multi-centre quality improvement project to reduce the incidence of obstetric anal sphincter injury (OASI): study protocol

BackgroundThird and fourth degree perineal tears, or obstetric anal sphincter injuries (OASI), sustained during childbirth can result in anal incontinence and psychosocial problems which require ongoing treatment. Within the English National Health System (NHS) reported rates of OASI have gradually increased. In response, a care bundle was developed incorporating four elements: 1) antenatal information to women, 2) manual perineal protection during all vaginal births, 3) episiotomy to be performed with a 60° mediolateral angle at crowning (when clinically indicated) and 4) perineal examination (including per rectum) after childbirth. Implementation of the OASI Care Bundle is aided by a skills development module and an awareness campaign. The project is a collaboration between two national professional bodies, an NHS hospital trust and an academic institution.MethodsImplementation of the OASI Care Bundle will be evaluated using a stepped-wedge design. From January 2017 sixteen maternity units across England, Wales and Scotland will participate in the study over a 15-month period, with sequential roll-out of the intervention in four blocks (regions) of four units. The primary clinical outcome is OASI rate. Regression analysis will adjust for differences in organisational characteristics and obstetric risk factors in women who gave birth before and after implementation of the care bundle. Focus group discussions and in-depth interviews with clinicians will evaluate the feasibility of integrating the care bundle into routine practice. Interviews with women will explore the acceptability of the intervention.DiscussionThis protocol outlines the evaluation of our quality improvement project which aims to prevent OASI using a bundle of evidence-based interventions that are each widely used in practice. The OASI project aims to 1) standardise practice to prevent OASI in a way that is acceptable to clinicians and women and 2) identify the barriers and enablers associated with upscaling interventions within maternity units. If found to be effective, feasible and acceptable, the OASI Care Bundle will be shared with a range of audiences using the communication channels available to the professional bodies.Trial registrationThe OASI Project was retrospectively registered on the ISCTRN12143325 database date assigned 03/10/2017.

Psychometric Properties of the Revised Death Attitude Profile in a Greek Sample of Nurses.

This study aimed to examine the psychometric properties of the Revised Death Attitude Profile (DAP-R) in a sample of Greek nurses and nursing students. A convenience sample (n = 934) was used from six National Health System hospitals, and two University Schools of Nursing in central and northern Greece completed the Greek version of the DAP-R (Gr-DAP-R). Principal component analysis with varimax rotation revealed a six-factor solution, including approach acceptance, death avoidance, escape acceptance, neutral acceptance, fear of death, and after death concerns. The internal consistency for each of the subscales ranged from 0.64 to 0.88. Intercorrelations between the Gr-DAP-R subscales supported the relative independence of death attitudes dimensions. The Gr-DAP-R can be used as a research and clinical tool in assessing death attitudes among Greek nurses.

Distúrbios cognitivos adversos no pós‐operatório: uma pesquisa nacional de anestesiologistas portugueses

Background and objectivesPostoperative delirium and postoperative cognitive dysfunction are some of the most common complications in older surgical patients and are associated with adverse outcomes. The aim of this study was to evaluate portuguese anesthesiologists’ perspectives and knowledge about adverse postoperative cognitive disorders, and routine clinical practice when caring for older surgical patients. MethodsWe used a prospective online survey with questions using a Likert scale from 1 to 5 (completely disagree to completely agree), or yes/no/don’t know answer types. Potential participants were portuguese anesthesiologists working in hospitals affiliated with the portuguese national health system and private hospitals. ResultsWe analyzed 234 surveys (17.7% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (78.6%). When caring for an agitated and confused patient postoperatively, 62.4% would first administer an analgesic and 11.1% an anxiolytic. Protocols to screen and manage postoperative cognitive disorders are rarely used. Nearly all respondents believe that postoperative delirium and postoperative cognitive dysfunction are neglected areas in anesthesiology. ConclusionsOverall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anesthesia are aware of the main risk factors for their development but may lack information on prevention and management of postoperative delirium. The majority of hospitals do not have protocols regarding preoperative cognitive assessment, diagnosis, management or follow‐up of patients with delirium and postoperative cognitive dysfunction.

Adverse postoperative cognitive disorders: a national survey of portuguese anesthesiologists

Background and objectivesPostoperative delirium and postoperative cognitive dysfunction are some of the most common complications in older surgical patients and are associated with adverse outcomes. The aim of this study was to evaluate portuguese anesthesiologists’ perspectives and knowledge about adverse postoperative cognitive disorders, and routine clinical practice when caring for older surgical patients. MethodsWe used a prospective online survey with questions using a Likert scale from 1 to 5 (completely disagree to completely agree), or yes/no/don’t know answer types. Potential participants were portuguese anesthesiologists working in hospitals affiliated with the portuguese national health system and private hospitals. ResultsWe analyzed 234 surveys (17.7% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (78.6%). When caring for an agitated and confused patient postoperatively, 62.4% would first administer an analgesic and 11.1% an anxiolytic. Protocols to screen and manage postoperative cognitive disorders are rarely used. Nearly all respondents believe that postoperative delirium and postoperative cognitive dysfunction are neglected areas in anesthesiology. ConclusionsOverall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anesthesia are aware of the main risk factors for their development but may lack information on prevention and management of postoperative delirium. The majority of hospitals do not have protocols regarding preoperative cognitive assessment, diagnosis, management or follow-up of patients with delirium and postoperative cognitive dysfunction.

The first report of a 5-year period cancer registry in Greece (2009-2013): a pathology-based cancer registry.

Cancer registries are essential in health care, since they allow more accurate planning of necessary health services and evaluation of programs for cancer prevention and control. The Hellenic Society of Pathology (HSP) having recognized the lack of such information in Greece has undertaken the task of a 5-year pathology-based cancer registry in Greece (2009-2013). In this study, > 95% of all pathology laboratories in the national health system hospitals and 100% of pathology laboratories in private hospitals, as well as > 80% of private pathology laboratories have contributed their data. The most common cancer types overall were as follows: breast cancer (18.26%), colorectal cancer (15.49%), prostate cancer (13.49%), and lung cancer (10.24% of all registered cancers). In men, the most common neoplasms were as follows: prostate cancer, colorectal cancer, lung cancer, and gastric cancer. In women, the most common neoplasms were as follows: breast cancer, colorectal cancer, thyroid cancer, and lung cancer. The data on cancer burden in Greece, presented herein, fill the void of cancer information in Greece that affects health care not only nationally but Europe-wise.

Geolocation of hospitalizations registered on the Brazilian National Health System's Hospital Information System: a solution based on the R Statistical Software.

to describe a solution enabling geolocation of hospital admissions (AIH), processed on the Brazilian National Health System's Hospital Information System. in order to spatialize AIHs an R language script was written, based on the microdatasus and CepR packages; the script was applied to identify all AIHs in Goiás state in the year 2015; after downloading and pre-processing the data, the procedure for AIH spatialization was detailed. of the 361,213 AIHs processed, we were able to retrieve 24,220 different ZIP codes (CEPs); from this set of ZIP codes, 23,910 (98.7%) were geolocated; these geolocated ZIP codes enabled spatialization of 97.7% of AIHs processed for the state of Goiás. it is possible to spatialize AIHs with a high success rate; the method detailed in this paper opens a new range of possibilities for the design of evaluation studies, formulation of policies and planning of health care actions.

Efficiency and Productivity of County-level Public Hospitals Based on the Data Envelopment Analysis Model and Malmquist Index in Anhui, China.

Background:China began to implement the national medical and health system and public hospital reforms in 2009 and 2012, respectively. Anhui Province is one of the four pilot provinces, and the medical reform measures received wide attention nationwide. The effectiveness of the above reform needs to get attention. This study aimed to master the efficiency and productivity of county-level public hospitals based on the data envelopment analysis (DEA) model and Malmquist index in Anhui, China, and then provide improvement measures for the future hospital development.Methods:We chose 12 country-level hospitals based on geographical distribution and the economic development level in Anhui Province. Relevant data that were collected in the field and then sorted were provided by the administrative departments of the hospitals. DEA models were used to calculate the dynamic efficiency and Malmquist index factors for the 12 institutions.Results:During 2010–2015, the overall average relative service efficiency of 12 county-level public hospitals was 0.926, and the number of hospitals achieved an effective DEA for each year from 2010 to 2015 was 4, 6, 7, 7, 6, and 8, respectively, as measured using DEA. During this same period, the average overall production efficiency was 0.983, and the total productivity factor had declined. The overall production efficiency of five hospitals was >1, and the rest are <1 between 2010 and 2015.Conclusions:In 2010–2015, the relative service efficiency of 12 county-level public hospitals in Anhui Province showed a decreasing trend, and the service efficiency of each hospital changed. In the past 6 years, although some hospitals have been effective, the efficiency of the county-level public hospitals in Anhui Province has not improved significantly, and the total factor productivity has not been effectively improved. County-level public hospitals need to combine their own reality to find their own deficiencies.