Department of Business Management and Organization, School of Engineering and Architecture, University of Zaragoza, 50009 Zaragoza, Spain.
Institute for Health Sciences in Aragon (IACS), 50009 Zaragoza, Spain.
Int J Environ Res Public Health. 2023 Feb 15;20(4):3389. doi: 10.3390/ijerph20043389.
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.
世界卫生组织的卫生系统绩效评估框架建议监测一系列维度。本研究旨在采用基于治疗的方法联合评估生产力和质量，具体分析膝关节和髋关节置换术，这两种常见的手术采用综合技术进行，并在大多数急性护理医院中开展。关注这些手术的分析为医院管理的改进提供了一种新颖的方法，填补了文献中的一个空白。在超前沿背景下使用 Metafrontier 指数来估计这两种手术的生产力及其在效率、技术和质量变化方面的分解。指定了一个多层次逻辑回归来获得作为质量因素的住院死亡率。根据平均就诊严重程度对所有西班牙公立急性护理医院进行了分类，将它们分为三组。我们的研究表明，生产力下降主要是由于技术变化下降所致。质量变化在整个期间保持不变，根据医院分类，相邻期间的变化最大。不同水平之间技术差距的改善是由于质量的提高。这些结果在纳入质量维度后提供了运营效率的新见解，特别是突出了运营绩效的下降，证实了技术异质性在衡量医院绩效时是一个关键问题。
