Carla Amado

On comparing the performance of primary care providers

Abstract In the past few years primary health care has been characterised as central to the development of the National Health Service in the United Kingdom. Furthermore, performance assessment is seen as a way of achieving care of high standards. Performance indicators and targets are being developed to assess primary care providers, and to develop financial incentives. However, the number of studies that have compared the performance of primary care providers is limited and the existing approaches to evaluation are open to improvement. In this paper, we provide a critical review of the studies that have focused on the evaluation of primary health care providers, with particular reference to the use of the non-parametric technique Data Envelopment Analysis. We conclude that most studies focus on structure and outputs, without consideration of outcomes – the ultimate measure of performance – and tend to be of a summative rather than formative nature.

Challenges for performance assessment and improvement in primary health care: the case of the Portuguese health centres.

Primary care is currently at the heart of health service policy, both in Portugal and internationally. At the same time, interest in the measurement of efficiency of health care delivery has increased considerably. However, very few studies have focused specifically on performance assessment in primary health care provision. In this paper we aim to contribute to a discussion regarding appropriate ways to compare the performance of primary health care providers. Following a review of the literature, a conceptual framework for performance assessment of health centres is developed and tested using the Portuguese case. Our empirical analysis uses data from 2004 and 2005 for all the Portuguese health centres and compares the geographical equity of access to services, technical efficiency and quality of services across district health authorities. Data envelopment analysis is the technique used to measure technical efficiency. From our empirical analysis, we conclude that there is evidence of large variation in equity of access to services, in technical efficiency and quality of services across district health authorities. Our findings suggest that a better use of resources could lead to more and improved services. Whilst formative evaluation could contribute to this, the challenge is to engage health care professionals in the evaluation exercise.

Exploring the use of DEA for formative evaluation in primary diabetes care: an application to compare English practices

Primary care is currently at the heart of the UK National Health Service policy. Primary care trusts have the crucial role of improving the efficiency and equity in primary care delivery. However, few studies have focused on performance assessment in primary care provision. In this paper, we examine the role of data envelopment analysis (DEA) in helping decision makers to understand and improve the performance of primary care practices. We discuss the results from a study of 14 practices in England in terms of their delivery of diabetes services. In order to take into account the multiple values that underlie public services provision, we have considered several different perspectives for evaluation. These were: technical, allocative and cost efficiency, clinical and patient-focused effectiveness, and equity. The approach adopted involved a deep engagement with the practices. The purpose was to understand the structures and processes supporting effective practice using DEA in a formative role rather than the more usual summative role with a large data set. This approach is in the tradition of the developmental engagement approach of operational research.

Using Data Envelopment Analysis to support the design of process improvement interventions in electricity distribution

A significant number of studies have documented the use of Data Envelopment Analysis (DEA) for efficiency measurement in the context of electricity distribution, particularly at the level of the distribution utilities. However, their aim has been predominantly descriptive and classificatory, without any attempt to ‘open’ the black box of the transformation process. In contrast, our aim is to explore the potential of DEA to contribute to the design of effective process improvement interventions within a distribution utility.

Formative Evaluation of Electricity Distribution Utilities Using Data Envelopment Analysis

The use of Data Envelopment Analysis (DEA) in the electricity distribution sector has been prolific in the number of papers published in research journals. However, while numerous studies have been documented, they have mostly been summative. Their aim has been predominantly descriptive and classificatory. This paper argues that evaluations of a formative nature are more effective than summative studies in promoting a better understanding of the structures and processes of electricity distribution utilities and, consequently, are more appropriate to contribute to performance improvement. To illustrate the use of DEA for formative evaluation, and highlight some of the difficulties of using DEA in practice, this paper compares the cost-efficiency of the Portuguese electricity distribution companies from 2002 to 2006. A dynamic analysis using Malmquist Indices is also conducted in order to evaluate the changes in productivity over this period. Our analysis shows that the application of DEA for formative purposes meets some difficulties. In particular it shows that while the modelling of productivity/efficiency scores using DEA is relatively straightforward, it is comparatively more difficult to develop models that are economically valid and that produce results with face validity. On the basis of the insights derived from this analysis, the paper provides some recommendations regarding the successful application of DEA for performance improvement.

Measuring active ageing: A Data Envelopment Analysis approach

The ‘Active Ageing Index’ was created with the purpose of helping policy makers implement and monitor active ageing policies both at European and national levels. However, this index has not fully achieved this purpose. In this article we propose a methodological approach based on Data Envelopment Analysis to enhance the measurement of active ageing in the European Union countries. We use a model with 22 indicators grouped into four domains. By introducing different types of virtual weight restrictions, we combine normative judgements with an optimisation procedure, showing each country in the best possible light. Furthermore, we undertake a sensitivity analysis regarding the effect of varying the limits of the relative contribution of each domain.

Assessing the efficiency of mother-to-child HIV prevention in low-and middle-income countries using data envelopment analysis

AIDS is one of the most significant health care problems worldwide. Due to the difficulty and costs involved in treating HIV, preventing infection is of paramount importance in controlling the AIDS epidemic. The main purpose of this paper is to explore the potential of using Data Envelopment Analysis (DEA) to establish international comparisons on the efficiency of implementation of HIV prevention programmes. To do this we use data from 52 low- and middle-income countries regarding the prevention of mother-to-child transmission of HIV. Our results indicate that there is a remarkable variation in the efficiency of prevention services across nations, suggesting that a better use of resources could lead to more and improved services, and ultimately, prevent the infection of thousands of children. These results also demonstrate the potential strategic role of DEA for the efficient and effective planning of scarce resources to fight the epidemic.

On studying ageism in long-term care: a systematic review of the literature.

BACKGROUND Ageism in long-term care is pervasive, but it is not easy to define, to identify and to fight it in practice. These difficulties could be overcome if we develop research capable to conceptualize, detect, measure, and understand the multidimensionality and complexity of ageism. Nevertheless, to achieve this, it is fundamental to know how ageism in long-term care has been previously studied. METHODS This paper systematically reviews studies on ageism in long-term care services published before October 2015 and indexed in Web of Science, PubMed, and Social Care Online electronic databases. Electronic searches were complemented with visual scanning of reference lists and hand searching of leading journals in the field of gerontology. Four specific review questions were addressed: Which analytical angles (aetiology, prevalence, manifestations, consequences, and interventions) have been explored? Which theories and concepts have been used? Which methods have been employed? Which variants of ageism have been covered? RESULTS Studies have focused mainly on the manifestations, etiology, and prevalence of ageism, neglecting its consequences and the interventions to tackle it; a significant number of studies used scales of ageism which, despite being appropriate considering the aims of the research, present important limitations; most studies have focused on residential services, neglecting non-residential services; some of the variants of ageism have been well covered, while implicit and self-ageism have been under-explored. CONCLUSIONS Research on ageism in long-term care services is scarce but important. Much has been done but much remains to be done. An agenda for future research is presented.

Ageism in Health Care: A Systematic Review of Operational Definitions and Inductive Conceptualizations

PURPOSE International and national bodies have identified tackling ageism in health care as an urgent goal. However, health professionals, researchers, and policy makers recognize that it is not easy to identity and fight ageism in practice, as the identification of multiple manifestations of ageism is dependent on the way it is defined and operationalized. This article reports on a systematic review of the operational definitions and inductive conceptualizations of ageism in the context of health care. DESIGN AND METHODS We reviewed scientific articles published from January 1995 to June 2015 and indexed in the electronic databases Web of Science, PubMed, and Cochrane. Electronic searches were complemented with visual scanning of reference lists and hand searching of leading journals in the field of ageing and social gerontology. RESULTS The review reveals that the predominant forms of operationalization and inductive conceptualization of ageism in the context of health care have neglected some components of ageism, namely the self-directed and implicit components. Furthermore, the instruments used to measure ageism in health care have as targets older people in general, not older patients in particular. IMPLICATIONS The results have important implications for the advancement of research on this topic, as well as for the development of interventions to fight ageism in practice. There is a need to take into account underexplored forms of operationalization and inductive conceptualizations of ageism, such as self-directed ageism and implicit ageism. In addition, ageism in health care should be measured by using context-specific instruments.

Using data envelopment analysis for formative evaluation of radiotherapy services: An exploratory study

Radiotherapy is an important element in cancer treatment, both for cure and for palliation. Whilst performance measurement and performance improvement are major concerns of most radiotherapy departments, measuring and managing the performance of these departments is particularly challenging. This article critically explores the use of Data Envelopment Analysis (DEA) for formative evaluation of radiotherapy services. Following a review of the literature, a conceptual framework for performance assessment of radiotherapy departments is developed and its use illustrated. Our empirical analysis uses mostly data from 2007 and compares the fairness of access to services, technical efficiency, and clinical effectiveness across the English strategic health authorities. The analysis shows that whilst the application of DEA in this context meets some difficulties, it also has great potential by providing valuable information to improve services, especially if used in a formative mode.