Measuring the productive efficiency and clinical quality of institutional long-term care for the elderly.

The authors consider the association between productive efficiency and clinical quality in institutional long-term care for the elderly. Cross-sectional data were collected from 122 wards in health-centre hospitals and residential homes in Finland in 2001. Productive efficiency was measured in terms of technical efficiency, which was defined as the unit's distance from the (best practice) production frontier. The analysis employed stochastic production frontier estimation, where technical inefficiency in the production function was specified to be a function of ward characteristics and clinical quality of care. Several quality indicators based on the Resident Assessment Instrument, such as prevalence of pressure ulcers and depression with no treatment, were used in the analysis. The results did not reveal systematic association between technical efficiency and clinical quality of care. However, the prevalence of pressure ulcers, indicating poor quality of care was associated with technical efficiency, a fact which highlights the importance of including quality measures in the assessment of efficiency in long-term care.

[1]  George E. Battese,et al.  Functional Forms of Stochastic Frontier Production Functions and Models for Technical Inefficiency Effects: A Comparative Study for Wheat Farmers in Pakistan , 1997 .

[2]  Donna L. Retzlaff-Roberts,et al.  The Trade-off Between Hospital Cost and Quality of Care: An Exploratory Empirical Analysis , 1992, Medical care.

[3]  W. Meeusen,et al.  Efficiency Estimation from Cobb-Douglas Production Functions with Composed Error , 1977 .

[4]  D. Mehr,et al.  Setting Thresholds for MDS Quality Indicators for Nursing Home Quality Improvement Reports , 1997 .

[5]  J. Newhouse Toward a Theory of Nonprofit Institutions: An Economic Model of a Hospital , 1970 .

[6]  P. Kooreman Nursing home care in The Netherlands: a nonparametric efficiency analysis. , 1994, Journal of health economics.

[7]  D. Aigner,et al.  P. Schmidt, 1977,?Formulation and estimation of stochastic frontier production function models,? , 1977 .

[8]  J. Newhouse,et al.  Frontier estimation: how useful a tool for health economics? , 1994, Journal of health economics.

[9]  S. Smith,et al.  Late-onset Rasmussen's syndrome with first seizure during pregnancy. , 1995, European neurology.

[10]  S. Katz,et al.  Designing the national resident assessment instrument for nursing homes. , 1990, The Gerontologist.

[11]  J F Burgess,et al.  On measuring the hospital cost/quality trade-off. , 1999, Health economics.

[12]  Ole Bent Olesen,et al.  Incorporating quality into data envelopment analysis: a stochastic dominance approach , 1995 .

[13]  D. Vitaliano,et al.  Cost and efficiency in nursing homes: a stochastic frontier approach. , 1994, Journal of health economics.

[14]  E. Eggink,et al.  A Quality-Adjusted Cost Function in a Regulated Industry: The Case of Dutch Nursing Homes , 2001, Health care management science.

[15]  L. Cooney,et al.  Resource Utilization Groups: A Patient Classification System for Long-term Care , 1985, Medical care.

[16]  M. Rosko Cost efficiency of US hospitals: a stochastic frontier approach. , 2001, Health economics.

[17]  Franz C. Palm,et al.  Wald Criteria for Jointly Testing Equality and Inequality , 1986 .

[18]  E. Cornelius,et al.  Refining a Case‐Mix Measure for Nursing Homes: Resource Utilization Groups (RUG‐III) , 1994, Medical care.

[19]  D. Zimmerman,et al.  Using Indicators To Structure Quality Improvement Initiatives in Long‐Term Care , 1996, Quality management in health care.

[20]  Abraham Charnes,et al.  Measuring the efficiency of decision making units , 1978 .

[21]  M. Farrell The Measurement of Productive Efficiency , 1957 .

[22]  B E Fries,et al.  Development of the nursing home Resident Assessment Instrument in the USA. , 1997, Age and ageing.

[23]  J. A. N. Eedleman,et al.  Nurse-Staffing Levels and the Quality of Care in Hospitals , 2002 .

[24]  R. Färe,et al.  Productivity and quality changes in Swedish pharmacies , 1995 .

[25]  Andrew Street,et al.  How much confidence should we place in efficiency estimates? , 2003, Health economics.

[26]  G. Battese,et al.  A model for technical inefficiency effects in a stochastic frontier production function for panel data , 1995 .

[27]  J. Morris,et al.  Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS). , 1995, The Gerontologist.

[28]  Brant E. Fries,et al.  Validity and reliability of Resource Utilization Groups (RUG-III) in Finnish long-term care facilities , 1999, Scandinavian journal of public health.

[29]  Miika Linna,et al.  Measuring Efficiency of Long-Term Care Units in Finland , 2001, Health care management science.

[30]  M. Linna,et al.  Measuring hospital cost efficiency with panel data models. , 1998, Health economics.

[31]  D. Reifschneider,et al.  SYSTEMATIC DEPARTURES FROM THE FRONTIER: A FRAMEWORK FOR THE ANALYSIS OF FIRM INEFFICIENCY* , 1991 .

[32]  J S Zinn,et al.  The Effects of Ownership, Operating Environment, and Strategic Choices on Nursing Home Efficiency , 1995, Medical care.

[33]  S. Kumbhakar,et al.  A Generalized Production Frontier Approach for Estimating Determinants of Inefficiency in U.S. Dairy Farms , 1991 .