Performance measurement of nonhomogeneous Hong Kong hospitals using directional distance functions.

Cook et al. (Oper Res 61(3):666-676, 2013) propose a DEA-based model for the performance evaluation of non-homogeneous decision making units (DMUs) based on constant returns to scale (CRS), extended by Li et al. (Health Care Manag Sci 22(2):215-228, 2019) to variable returns to scale (VRS). This paper locates these models into more general DDF models to deal with nonhomogeneous DMUs and applies these to Hong Kong hospitals. The production process of each hospital is divided into subunits which have the same inputs and outputs and hospital performance is measured using the subunits. The paper provides CRS and VRS versions of DDF models and compares them with Cook et al. (Oper Res 61(3):666-676, 2013) and Li et al. (Health Care Manag Sci 22(2):215-228, 2019). A kernel-based method is used to estimate the distributions as well as a DEA-based efficiency analysis adapted by Simar and Zelenyuk to test the distributions. Both DDF CRS and VRS versions produce results similar to Cook et al. (Oper Res 61(3):666-676, 2013) and Li et al. (Health Care Manag Sci 22(2):215-228, 2019) respectively. However, the statistical tests find differences for the different technologies assumed as would be expected. For hospital managers, the more generalised DDF models expand their range of options in terms of directional improvements and priorities as well as dealing with non-homogeneity.

Effect of apparent temperature on hospitalization from a spectrum of cardiovascular diseases in rural residents in Fujian, China.

Cardiovascular disease (CVD) is a leading threat to global public health. Although associations between temperature and CVD hospitalization have been suggested for developed countries, limited evidence is available for developing countries or rural residents. Moreover, the effect of apparent temperature (AT) on the spectrum of cause-specific CVDs remains unknown. Based on 2,024,147 CVD hospitalizations for rural residents from eight regions in Fujian Province, China, during 2010-2016, a quasi-Poisson regression with distributed lag non-linear model was fitted to estimate the AT effect on daily CVD hospitalization for each region, and then pooled in a meta-regression that included regional indicators related to rural residents. Stratified analyses were performed according to the cause of hospitalization, sex and age groups. Finally, we calculated the fraction of CVD hospitalizations attributable to AT, as a reflection of the burden associated with AT. The heat effect appeared at lag 0-1 days, with 19% (95% CI, 11-26%) increased risk of CVD hospitalization, which was worse for ischemic heart disease, heart failure, arrhythmias and ischemic stroke. The decreased AT was associated with increase of hemorrhagic stroke at lag 0-28 days. People aged 65 and above suffered more from the heat effect on cardiovascular and cerebrovascular diseases. Regions with a lower gross value of agricultural production, rural residents' per capita net income, number of air conditioners and water heaters were more susceptible. A large number of hospitalizations were attributable to heat for most subcategories. High AT level increased CVD hospitalization, and the subcategories had different susceptibilities. The effects were modified by individual and regional characteristics. These findings have important implications for the development of targeted interventions and for hospital service planning.