A New Approach of Measuring Hospital Performance for Low- and Middle-income Countries.

Efficiency of the hospitals affects the price of health services. Health care payments have equity implications. Evidence on hospital performance can support to design the policy; however, the recent literature on hospital efficiency produced conflicting results. Consequently, policy decisions are uncertain. Even the most of evidence were produced by using data from high income countries. Conflicting results were produced particularly due to differences in methods of measuring performance. Recently a management approach has been developed to measure the hospital performance. This approach to measure the hospital performance is very useful from policy perspective to improve health system from cost-effective way in low and middle income countries. Measuring hospital performance through management approach has some basic characteristics such as scoring management practices through double blind survey, measuring hospital outputs using various indicators, estimating the relationship between management practices and outputs of the hospitals. This approach has been successfully applied to developed countries; however, some revisions are required without violating the fundamental principle of this approach to replicate in low- and middle-income countries. The process has been clearly defined and applied to Nepal. As the results of this, the approach produced expected results. The paper contributes to improve the approach to measure hospital performance.

Classifying and comparing fundraising performance for nonprofit hospitals.

Charitable contributions are becoming increasingly important to nonprofit hospitals, yet fundraising can sometimes be one of the more troublesome aspects of management for nonprofit organizations. This study utilizes an organizational effectiveness and performance framework to identify groups of nonprofit organizations as a method of classifying organizations for performance evaluation and benchmarking that may be more informative than commonly used characteristics such as organizational age and size. Cluster analysis, ANOVA and chi-square analysis are used to study 401 organizations, which includes hospital foundations as well as nonprofit hospitals directly engaged in fundraising. Three distinct clusters of organizations are identified based on performance measures of productivity, efficiency, and complexity. A general profile is developed for each cluster based upon the cluster analysis variables and subsequent analysis of variance on measures of structure, maturity, and legitimacy as well as selected institutional characteristics. This is one of only a few studies to examine fundraising performance in hospitals and hospital foundations, and is the first to utilize data from an industry survey conducted by the leading general professional association for healthcare philanthropy. It has methodological implications for the study of fundraising as well as practical implications for the strategic management of fundraising for nonprofit hospital and hospital foundations.

Rating healthy organizational performance.

Across the spectrum of philanthropy, donors are asking what evidence exists that an organization is actually creating positive, meaningful and sustainable change. Just as patient outcomes were adopted to demonstrate the efficacy of treatment, so too should organizational outcomes be adopted by health care facilities and the development organizations that support them to demonstrate the tangible and lasting benefits to the communities they serve.

[Research Ranking of Spanish Public Universities (2019)].

Research Ranking of Spanish Public Universities (2019). BACKGROUND: The changes produced in the Spanish university system due to the Bologna process require periodically updated evaluation reports of research activity. The objective of this study is to update the last available ranking of Spanish public universities, based on data from 2013-2018. METHOD: The production and productivity of each university were assessed based on seven specific indicators and a global score: articles in journals indexed in the JCR (Journal Citation Reports), research periods, R+D projects, doctoral theses, FPU (training of university professors) grants, FPI (training of personal researchers) grants, and patents. RESULTS: Globally, the universities Complutense of Madrid, Barcelona, and Granada hold the first positions in terms of production, while the first positions in terms of productivity are held by the universities Pompeu Fabra, Autonomous of Madrid, and Autonomous of Barcelona. CONCLUSIONS: The universities that hold the top positions in this ranking remain relatively steady over time and are also the Spanish universities that stand out in international classifications.

Stochastic frontier analysis of hospital inefficiency: a review of empirical issues and an assessment of robustness.

Twenty stochastic frontier analysis (SFA) studies of hospital inefficiency in the United States were analyzed. Results from best-practice methods were compared against previously used methods in hospital studies to ascertain the robustness of SFA in estimating cost inefficiency. To compare past studies and analyze new data, SFA methods were varied by (a) the assumptions of the structure of costs and distribution of the error term, (b) inclusion of quality and product descriptor measures, and (c) use of simultaneous and two-stage estimation techniques. SFA results were relatively insensitive to several model variations.

Productivity in Pediatric Palliative Care: Measuring and Monitoring an Elusive Metric.

CONTEXT: Workforce productivity is poorly defined in health care. Particularly in the field of pediatric palliative care (PPC), the absence of consensus metrics impedes aggregation and analysis of data to track workforce efficiency and effectiveness. Lack of uniformly measured data also compromises the development of innovative strategies to improve productivity and hinders investigation of the link between productivity and quality of care, which are interrelated but not interchangeable. OBJECTIVES: To review the literature regarding the definition and measurement of productivity in PPC; to identify barriers to productivity within traditional PPC models; and to recommend novel metrics to study productivity as a component of quality care in PPC. METHODS: PubMed® and Cochrane Database of Systematic Reviews searches for scholarly literature were performed using key words (pediatric palliative care, palliative care, team, workforce, workflow, productivity, algorithm, quality care, quality improvement, quality metric, inpatient, hospital, consultation, model) for articles published between 2000 and 2016. Organizational searches of Center to Advance Palliative Care, National Hospice and Palliative Care Organization, National Association for Home Care & Hospice, American Academy of Hospice and Palliative Medicine, Hospice and Palliative Nurses Association, National Quality Forum, and National Consensus Project for Quality Palliative Care were also performed. Additional semistructured interviews were conducted with directors from seven prominent PPC programs across the U.S. to review standard operating procedures for PPC team workflow and productivity. RESULTS: Little consensus exists in the PPC field regarding optimal ways to define, measure, and analyze provider and program productivity. Barriers to accurate monitoring of productivity include difficulties with identification, measurement, and interpretation of metrics applicable to an interdisciplinary care paradigm. In the context of inefficiencies inherent to traditional consultation models, novel productivity metrics are proposed. CONCLUSIONS: Further research is needed to determine optimal metrics for monitoring productivity within PPC teams. Innovative approaches should be studied with the goal of improving efficiency of care without compromising value.

Impact of HMO penetration and other environmental factors on hospital X-inefficiency.

This study examined the impact of health maintenance organization (HMO) market penetration and other internal and external environmental factors on hospital X-inefficiency in a national sample (N = 1,966) of urban U.S. hospitals in 1997. Stochastic frontier analysis, a frontier regression technique, was used to measure X-inefficiency and estimate parameters of the correlates of X-inefficiency. Log-likelihood restriction tests were used to test a variety of assumptions about the empirical model that guided its selection. Average estimated X-inefficiency in study hospitals was 12.96 percent. Increases in managed care penetration, dependence on Medicare and Medicaid, membership in a multihospital system, and location in areas where competitive pressures and the pool of uncompensated care are greater were associated with less X-inefficiency. Not-for-profit ownership was associated with increased X-inefficiency.

Economic profiling of primary care physicians: consistency among risk-adjusted measures.

OBJECTIVE: To investigate whether different risk-adjustment methodologies and economic profiling or "practice efficiency" metrics produce differences in practice efficiency rankings for a set of primary care physicians (PCPs). DATA SOURCE: Twelve months of claims records (inpatient, outpatient, professional, and pharmacy) for an independent practice association HMO. STUDY DESIGN: Patient risk scores obtained with six profiling risk-adjustment methodologies were used in conjunction with claims cost tabulations to measure practice efficiency of all primary care physicians who managed 25 or more members of an HMO. DATA COLLECTION: For each of the risk-adjustment methodologies, two measures of "efficiency" were constructed: the standardized cost difference between total observed (standardized actual) and total expected costs for patients managed by each PCP, and the ratio of the PCP's total observed to total expected costs (O/E ratio). Primary care physicians were ranked from most to least efficient according to each risk-adjusted measure, and level of agreement among measures was tested using weighted kappa. Separate rankings were constructed for pediatricians and for other primary care physicians. FINDINGS: Moderate to high levels of agreement were observed among the six risk-adjusted measures of practice efficiency. Agreement was greater among pediatrician rankings than among adult primary care physician rankings, and, with the standardized difference measure, greater for identifying the least efficient than the most efficient physicians. The O/E ratio was shown to be a biased measure of physician practice efficiency, disproportionately targeting smaller sized panels as outliers. CONCLUSIONS: Although we observed moderate consistency among different risk-adjusted PCP rankings, consistency of measures does not prove that practice efficiency rankings are valid, and health plans should be careful in how they use practice efficiency information. Indicators of practice efficiency should be based on the standardized cost difference, which controls for number of patients in a panel, instead of O/E ratio, which does not.

A review of health-related workplace productivity loss instruments.

The objective of this review was to identify health-related workplace productivity loss survey instruments, with particular emphasis on those that capture a metric suitable for direct translation into a monetary figure. A literature search using Medline, HealthSTAR, PsycINFO and Econlit databases between 1966 and 2002, and a telephone-administered survey of business leaders and researchers, were conducted to identify health-related workplace productivity measurement survey instruments. This review was conducted from the societal perspective. Each identified instrument was reviewed for the following: (i). reliability; (ii). content validity; (iii). construct validity; (iv). criterion validity; (v). productivity metric(s); (vi). instrument scoring technique; (vii). suitability for direct translation into a monetary figure; (viii). number of items; (ix). mode(s) of administration; and (x). disease state(s) in which it had been tested. Reliability and validity testing have been performed for 8 of the 11 identified surveys. Of the 11 instruments identified, six captured metrics that are suitable for direct translation into a monetary figure. Of those six, one instrument measured absenteeism, while the other five measured both absenteeism and presenteeism. All of the identified instruments except for one were available as paper, self-administered questionnaires and many were available in languages other than English. This review provides a comprehensive overview of the published, peer-reviewed survey instruments available to measure health-related workplace productivity loss. As the field of productivity measurement matures, tools may be developed that will allow researchers to accurately calculate lost productivity costs when performing cost-effectiveness and cost-benefit analyses. Using data captured by these instruments, society and healthcare decision makers will be able to make better informed decisions concerning the value of the medications, disease management and health promotion programmes that individuals receive.

Profiling resource use: do different outcomes affect assessments of provider efficiency?

OBJECTIVES: To examine whether 2 outcome measures result in different assessments of efficiency across 22 service networks within the Department of Veterans Affairs (VA). STUDY DESIGN: A retrospective analysis using VA inpatient and outpatient administrative databases. METHODS: A 60% random sample of veterans who used healthcare services during fiscal year 1997 was split into a 40% sample (n = 1,046,803) for development and a 20% sample (n = 524,461) for validation. Weighted concurrent case-mix models using adjusted clinical groups were developed to explain variation in 2 outcomes: "days of care"--the sum of a patient's inpatient and outpatient annual visit days, and "average accounting costs"--the sum of the average service costs multiplied by the units of service for each patient. Two profiling indicators were calculated for each outcome: an unadjusted efficiency index and an adjusted efficiency index. These indices were compared to examine network efficiency. RESULTS: Although about half the networks were identified as "efficient" before and after case-mix adjustment, assessments of individual network efficiency were affected by the adjustment. The 2 outcomes differed on which networks were efficient. For example, 4 networks that appeared as efficient based on days of care appeared as inefficient based on average costs. CONCLUSIONS: Assessments of provider efficiency across the 22 networks depended on the outcome measure used. Knowledge about the extent to which assessments of provider efficiency depend on the outcome measure used is an important step toward improved and more equitable comparisons across providers.

The causes of variations in unit labour costs: a preliminary study.

This paper reports a study of eight National Health Service Trusts, using data drawn from the Unit Labour Costs database and supplementary data collected for the purposes of the study, which set out to begin to explain the large variations in unit labour cost that exist. On the basis of extensive discussions within and between units, it was found that major causes of variations in productivity related to length of stay and bed utilization, which were in turn a result of variations in case mix. Staff utilization was a further major factor. Another observation was that the quality of data, particularly the integration of financial, activity and manpower data, was often poor.

Efficiency. Measured response.

An analysis of the activity of 75 acute hospitals over the period 1991-96 using data envelopment analysis shows that, while overall productivity increased, the efficiency of individual hospitals did not. A small decrease in the efficiency of individual hospitals was found in the last four years studied. An analysis of quality of care over the same period suggests that gains in volume of services may have been at the expense of quality of care. The results suggest that incentives for increasing hospital efficiency have a one-off impact rather than a sustained effect.

Ranking 2019 de investigación de las universidades públicas españolas / Research Ranking of Spanish Public Universities (2019)

ANTECEDENTES: los cambios producidos en el sistema universitario español con el proceso Bolonia hacen necesaria la realización periódica de informes de evaluación de la actividad investigadora. El objetivo de este estudio es actualizar el último ranking disponible de investigación de las universidades públicas españolas con los datos de 2013-2018. MÉTODO: se evaluó la producción y productividad de cada universidad, atendiendo a siete indicadores específicos y a una puntuación global: artículos en revistas indexadas en el JCR (Journal Citation Reports), tramos de investigación, proyectos I+D, tesis doctorales, ayudas FPU (formación de profesorado universitario), ayudas FPI (formación de personal investigador) y patentes. RESULTADOS: a nivel global, las universidades Complutense de Madrid, Barcelona y Granada se sitúan en las primeras posiciones en producción, mientras que las primeras posiciones en productividad son ocupadas por las universidades Pompeu Fabra, Autónoma de Madrid y Autónoma de Barcelona. CONCLUSIONES: las universidades que ocupan las primeras posiciones en este ranking se mantienen relativamente estables a lo largo del tiempo y son también las que destacan en clasificaciones internacionales

BACKGROUND: The changes produced in the Spanish university system due to the Bologna process require periodically updated evaluation reports of research activity. The objective of this study is to update the last available ranking of Spanish public universities, based on data from 2013-2018. METHOD: The production and productivity of each university were assessed based on seven specific indicators and a global score: articles in journals indexed in the JCR (Journal Citation Reports), research periods, R+D projects, doctoral theses, FPU (training of university professors) grants, FPI (training of personal researchers) grants, and patents. RESULTS: Globally, the universities Complutense of Madrid, Barcelona, and Granada hold the first positions in terms of production, while the first positions in terms of productivity are held by the universities Pompeu Fabra, Autonomous of Madrid, and Autonomous of Barcelona. CONCLUSIONS: The universities that hold the top positions in this ranking remain relatively steady over time and are also the Spanish universities that stand out in international classifications

Comprehensive review of the limitations of relative value unit measurements of productivity in academic departments.

Measuring radiologist, especially sonologist, productivity has never been of greater interest than now, as radiology has moved from its historical status as a cost center to the largest revenue generator in most institutions. With more local institutional and federal oversight and regulation into the reimbursement and valuation of imaging procedures, including emphasis on outsourcing, overvalued procedures, and bundling, the ability to measure productivity and to draw meaningful conclusions from the data becomes increasingly imperative if we as radiologists and sonologists expect to contribute meaningfully to the process. This article presents a history of the "relative value unit" and discusses the valuation of radiologist/sonologist productivity in this era of ubiquitous high-technology implementation.

A New Approach of Measuring Hospital Performance for Lowand Middle-income Countries

Efficiency of the hospitals affects the price of health services. Health care payments have equity implications. Evidence on hospital performance can support to design the policy; however, the recent literature on hospital efficiency produced conflicting results. Consequently, policy decisions are uncertain. Even the most of evidence were produced by using data from high income countries. Conflicting results were produced particularly due to differences in methods of measuring performance. Recently a management approach has been developed to measure the hospital performance. This approach to measure the hospital performance is very useful from policy perspective to improve health system from cost-effective way in low and middle income countries. Measuring hospital performance through management approach has some basic characteristics such as scoring management practices through double blind survey, measuring hospital outputs using various indicators, estimating the relationship between management practices and outputs of the hospitals. This approach has been successfully applied to developed countries; however, some revisions are required without violating the fundamental principle of this approach to replicate in low- and middle-income countries. The process has been clearly defined and applied to Nepal. As the results of this, the approach produced expected results. The paper contributes to improve the approach to measure hospital performance.