First among (UN) equals: assessing hospital performance using data envelopment analysis

This article explores the use of Data Envelopment Analysis (DEA) as a comparative analytic tool to assess the relative effectiveness of competing hospitals. Building on previous research with DEA in hospital efficiency analysis, the authors extend the earlier technical efficiency-based DEA models to include qualitative outcome measures. Data from hospitals in a regional competitive health care market in South Florida are assessed using this new DEA model.     

A Bayesian spatio-temporal analysis of neighborhood pediatric asthma emergency department visit disparities

Asthma disparities have complex, neighborhood-level drivers that are not well understood. Consequently, identifying particular contextual factors that contribute to disparities is a public health goal. We study pediatric asthma emergency department (ED) visit disparities and neighborhood factors associated with them in South Carolina (SC) census tracts from 1999 to 2015. Leveraging a Bayesian framework, we identify risk clusters, spatially-varying relationships, and risk percentile-specific associations. Clusters of high risk occur in both rural and urban census tracts with high probability, with neighborhood-specific associations suggesting unique risk factors for each locale. Bayesian methods can help clarify the neighborhood drivers of health disparities.     

Using routine accident and emergency department data to describe local injury epidemiology

All 17330 Accident and Emergency Department (A and E) attendances following injury (67% of all A and E attendances by residents of the EH54 postcode (the town of Livingston) at St John's Hospital during 1995 and 1996 were examined to study local accident epidemiology. The overall annual injury attendance rate for males (245.7/1000) and females (148.0/1000) and sex and age group analyses show recognised patterns reflecting occupation and domestic circumstances. Higher attendance rates were associated with greater deprivation and living close to the hospital. The unique injury coding system used by the hospital offers the potential to highlight particular injury types occurring within population sub-groups. When linked with primary care and out-of-hours centre data, this could be useful in targeting preventive activities; this will be facilitated in this hospital, which will become part of a 'combined' acute and primary care trust from April 1999.     

A modified three-stage data envelopment analysis

In The Netherlands the care for the disabled accounts for 10% of total health care costs, or almost 1% of GNP. About half of these costs are devoted to the residential care for the mentally disabled. This study studied the amount of cost inefficiency in a sample of homes operating in 1998. We first apply a data envelopment analysis to our sample and then apply another stage-evaluating the nonradial slack of each input and the effects external factors have on them. After "correcting" for the external effects we find that technical and scale inefficiency disappears and cost efficiency increases by 6%. We attribute these findings with the strict regulation under which Dutch homes operate. Further, this approach can be applied to any service or market that faces governmental regulation.     

Assessment of tobacco smoke exposure in the pediatric emergency department

ObjectiveTobacco smoke exposure causes significant childhood morbidity and is associated with a multitude of conditions. National organizations recommend tobacco smoke exposure screening at all pediatric clinical encounters. Data regarding tobacco smoke exposure screening in the pediatric emergency department is sparse, although children with tobacco smoke exposure-associated conditions commonly present to this setting. We aimed to determine the frequency and outcome of tobacco smoke exposure screening in the pediatric emergency department, and assess associated sociodemographic/clinical characteristics.MethodsThis retrospective review included pediatric patients presenting to a large pediatric emergency department in Cincinnati, Ohio between 2012 and 2013. Variables extracted included: age, sex, race/ethnicity, insurance, child's tobacco smoke exposure status, triage acuity, diagnosis, and disposition. Regression analyses examined predictors of tobacco smoke exposure screening and tobacco smoke exposure status.ResultsA total of 116,084 children were included in the analysis. Mean child age was 6.20 years (SD ± 5.6); 52% were male. Nearly half of the children in the study did not undergo tobacco smoke screening; only 60% of children with tobacco smoke exposure-related illnesses were screened. Predictors of tobacco smoke exposure screening were: younger age, male, African American, non-commercial insurance, high acuity, tobacco smoke exposure-related diagnoses and non-intensive care admission. Of children screened for tobacco smoke exposure, 28% were positive. Children more likely to screen positive were non-Hispanic, had non-commercial insurance, and had tobacco smoke exposure-related diagnoses. NonAfrican American children triaged as low acuity were more likely to have tobacco smoke exposure, yet were less likely to be screened.ConclusionDespite national recommendations, current tobacco smoke exposure screening rates are low and fail to identify at-risk children. Pediatric emergency department visits for tobacco smoke exposure-associated conditions are common, thus further research is needed to develop and assess standardized tobacco smoke exposure screening tools/interventions in this setting.     

Visits to the emergency department as transactional data

Patients arrive at the hospital emergency department for treatment on a random basis. The amount of time required for treatment is a function of the triage level, the patient diagnosis, and the congestion that exists in the emergency department (ED) at the time of patient arrival. The implementation of electronic medical records in the ED permits the accurate tracking and examination of time to allow for improved scheduling of personnel and for the development of protocols for diagnoses that occur on a daily basis in the ED. The SAS Institute in Cary, North Carolina, has developed a method called High Performance Forecasting System that allows for the prediction of time series with random time points. The target variable is the amount of time needed to treat individual patients from the time they enter the system through triage to the time they are discharged. Variability in treatment time by ED personnel can also be examined. Results indicate that there is a "cut point" during the day when the time needed to treat each patient increases. In addition, some specific diagnoses can be anticipated on a regular basis, and the amount of time needed on a daily basis can be predicted by using the forecasting system. Personnel can be scheduled in accordance with the peak treatment time.     

Assessing performance of Taiwan hospitals using data envelopment analysis: In view of ownership

With rapid economic development in Taiwan, people have greater awareness of health care and are paying more attention to it. From the perspective of hospital management, the scale of hospitals and efficiency improvement are of concern to hospital managers. However, the extent of efficiency will differ between public and private hospitals due to their different ownership and goals. The study aims to evaluate the efficiency of public and private hospitals and to investigate the influence of ownership on efficiency of hospitals. The differences between hospitals can be understood by analyzing the features of the organization of hospitals and their geographic environment. In this way, hospitals with relatively low efficiency will be able to make improvements based on concrete evidence. By means of the two‐stage method, the efficiency scores of 182 hospitals in Taiwan are compared. In the first stage, the data envelopment analysis is applied to obtain the efficiency scores of hospitals. The results show that private hospitals are more efficient than public hospitals. In the second stage, Tobit regression is used to investigate the factors influencing efficiency obtained by the data envelopment analysis. The results indicate that there are differences between ownership in market competition and the average length of stay.     

Investigating health system performance: An application of data envelopment analysis to Zambian hospitals

Background  

Zambia has recently articulated an ambitious national health program designed to meeting health-related MDGs. Public expectations are high and Zambia continues to receive significant resources from global and bilateral donors to support its health agenda. Although the lack of adequate resources presents the most important constraint, the efficiency with which available resources are being utilised is another challenge that cannot be overlooked. Inefficiency in producing health care undermines the service coverage potential of the health system. This paper estimates the technical efficiency of a sample of hospitals in Zambia.     

Using data envelopment analysis and the bootstrap method to evaluate organ transplantation efficiency in Brazil

Health Care Management Science - Brazil has the most extensive public program for organ transplantation in the world, and the Brazilian National Health System (SUS) provides full coverage of all...     

A data flow sheet for managing unstable patients in the emergency department

The one-page data flow sheet for emergency care can facilitate rapid review of ongoing care and transfer of information for the next care givers.     

Confined space emergency response: assessing employer and fire department practices

An emergency response plan for industrial permit-required confined space entry is essential for employee safety and is legally required. Maintaining a trained confined space rescue team, however, is costly and technically challenging. Some employers turn to public fire departments to meet their emergency response requirements. The confined space emergency response practices of employers and fire departments have not been previously assessed. We present (1) federal data on the U.S. occurrence between 1992 and 2005 of confined space fatal incidents involving toxic and/or oxygen-deficient atmospheres; (2) survey data from 21 large companies on permit-required confined space emergency response practices; (3) data on fire department arrival times; and (4) estimates by 10 senior fire officers of fire department rescue times for confined space incidents. Between 1992 and 2005, 431 confined space incidents that met the case definition claimed 530 lives, or about 0.63% of the 84,446 all-cause U.S. occupational fatal injuries that occurred during this period. Eighty-seven (20%) incidents resulted in multiple fatalities. Twelve (57%) of 21 surveyed companies reported that they relied on the fire department for permit-required confined space emergency response. Median fire department arrival times were about 5 min for engines and 7 min for technical rescue units. Fire department confined space rescue time estimates ranged from 48 to 123 min and increased to 70 and 173 min when hazardous materials were present. The study illustrates that (1) confined space incidents represent a small but continuing source of fatal occupational injuries in the United States; (2) a sizeable portion of employers may be relying on public fire departments for permit-required confined space emergency response; and (3) in the event of a life-threatening emergency, fire departments usually are not able to effect a confined space rescue in a timely manner. We propose that the appropriate role for the fire department is to support a properly trained and equipped on-site rescue team and to provide advanced life support intervention following extrication and during ambulance transportation.     

Postexposure prophylaxis for victims of sexual assault: treatments and attitudes of emergency department physicians

Background

Emergency departments (EDs) are the primary source of care for victims of sexual assault (SA). Provision of emergency contraception (EC) to these women has previously been noted to be sporadic. Completeness of care for victims of SA and the barriers to complete care are further investigated in this study.

Study Design

All ED attending physicians in Maryland, Virginia and the District of Columbia were identified and contacted for participation; 35% completed the survey. Practice patterns were analyzed for the 67% of physicians who do not refer SA victims to other hospitals.

Results

We found that 83% of physicians “always” or “usually” offer EC, but only half prescribe EC more than 48 h postassault. While most (89%) typically offer prophylaxis for STDs other than HIV, only 45% offer or counsel on HIV prophylaxis. Physician attitudes and hospital protocols were significant modifiers.

Conclusion

Sexual assault victims are often not offered comprehensive care including prophylaxis against pregnancy and all STDs including HIV. Additional research is warranted to determine why physicians do not routinely offer HIV prophylaxis after SA.     

主成分分析和数据包络分析的联合应用

目的 联合应用主成分分析和数据包络分析以综合评价某医院各临床科室的相对效率,提出改善建议.方法 根据医院情况,选择财务、工作量和病人满意度等各方面有代表性的12个指标,计算出16个临床科室的主成分得分和相对效率值,将2者分别排序并综合于二维象限,直观地评价和判断各科室相对效率.并得出非有效科室的松弛量,指出需调整的投入产出量,以达到相对有效.结果 二维象限显示各科室2种方法间排序一致,差异无统计学意义（P〉0.05）.位于第一象限的普外科、神经内科、肿瘤内科相对效率高（最优解θ=1）、综合情况较好 （PCA得分〉1）;而第四象限的小儿外科、眼科等相对效率高（最优解θ=1）,但主成分得分低（PCA得分〈-1.5）,规模偏小综合实力较差,应考虑予以发展;第二、三象限的感染病科、血液内科和口腔科则效率较差,为达到科室相对有效,在产出不变时,实际占用总床日数、职工人数、工资和福利、固定资产、材料及一次性消耗等投入应根据松弛量进行调整.结论 主成分分析和数据包络分析能互相补充,既体现评价单元的综合差异,又可比较相对效率,联合应用可以更全面地评价各决策单元.使用二维象限能更直观的判断较多评价单元的相对效率和综合情况,可以考虑在医院管理决策中予以推广.     

数据包络分析法在国家自然科学基金项目结题评估中的应用

目的 尝试运用数据包络分析对国家自然科学基金项目的结题绩效进行评估.方法以北京大学人民医院某一年度结题的国家自然科学基金项目为对象,建立结题绩效评估指标体系,并应用数据包络分析输出模型进行计算和分析.结果 基于所应用的方法,得到了各个项目的绩效评估结果和产出不足量、投入冗余量.结论 数据包络分析法在项目结题绩效中的运用是可行的,通过数据包络法可以对项目进行有效的结题绩效评估,为项目负责人的项目实施和管理部门的策略制定提供依据.     

Parental attitudes in the pediatric emergency department about the COVID-19 vaccine

BackgroundCOVID-19 vaccinations are now recommended in the United States (U.S.) for children ≥ 6 months old. However, pediatric vaccination rates remain low, particularly in the Hispanic/Latinx population.ObjectiveUsing the 4C vaccine hesitancy framework (calculation, complacency, confidence, convenience), we examined parental attitudes in the emergency department (ED) towards COVID-19 vaccination, identified dimensions of parental vaccine hesitancy, and assessed parental willingness to have their child receive the COVID-19 vaccine.MethodsAs part of a larger multi-methods study examining influenza vaccine hesitancy, we conducted interviews that included questions about COVID-19 vaccine authorization for children. We used directed content analysis to extract qualitative themes from 3 groups of parents in the ED: Hispanic/Latinx Spanish speaking (HS), Hispanic/Latinx English speaking (HE), non-Hispanic/non-Latinx White English speaking (WE). Themes were triangulated with the Parent Attitudes about Childhood Vaccines (PACV) survey, where higher scores indicate increased vaccine hesitancy.ResultsFactors influencing vaccine hesitancy were mapped to the 4C framework from 58 sets of interviews and PACVs. HE and HS parents, compared to WE parents, had less knowledge about COVID-19 and its vaccine, and more beliefs in COVID-19 vaccine myths. However, both HS and HE parent groups were more inclined to endorse COVID-19 vaccine effectiveness as a reason to have their children vaccinated. HS parents felt that COVID-19 increased their fear of illnesses in general and were worried about confusing COVID-19 with other infections. Median PACV scores of HS (Mdn = 20) and HE (Mdn = 20) parent groups were higher than of WE parents (Mdn = 10), but parental willingness to have their child receive COVID-19 vaccination was similar across groups.ConclusionsHigher COVID-19 vaccine hesitancy among HS and HE parents compared to WE parents may be attributed to insufficient knowledge about COVID-19, its vaccine, along with COVID-19 vaccine myths. Efforts to provide targeted vaccine education to different populations is warranted.     

Patterns in the offering of hepatitis B prophylaxis by US emergency department physicians.

US emergency department physicians surveyed were more likely to offer hepatitis B prophylaxis to patients after unknown hepatitis B status needlestick injuries than sexual exposures, especially consensual sex. There was no difference in willingness to offer prophylaxis with respect to patient occupation or age or with respect to ED physicians' demographic and professional characteristics.     

Using data envelopment analysis to measure the extent of technical efficiency of public health centres in Ghana

Background  

Data Envelopment Analysis (DEA) has been used to analyze the efficiency of the health sector in the developed world for sometime now. However, in developing economies and particularly in Africa only a few studies have applied DEA in measuring the efficiency of their health care systems.