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PubMed1986

Mechanical efficiency in rowing.

Five university oarsmen participated in a determination of mechanical efficiency when rowing in a tank. In the tank, water was circulated at 3 m X s-1 by a motor driven pump. The subjects rowed with the stepwise incremental loading, in which the intensity increased by 10% of the maximum force of rowing (maxFc) every 2 min. Power (WO) was calculated from the force applied to the oarlock pin (FC) and its angular displacement (theta H). Oxygen uptake and heart rate were measured every 30 s during rowing. Anaerobic threshold (AT) was determined from expired gas variables by Wasserman's method. AT of oarsmen was 74.6 +/- 6.01% as a percentage of VO2max. As the displacement of the handgrip in the stroke was independent of WO, the increment of WO was caused by the increase of both FC and stroke frequency. Gross efficiency without base-line correction (GE) increased with FC with low intensities of rowing. In the region of 124-182 W of WO GE was almost constant at 17.5%. Efficiency was 19.8 +/- 1.4%, with resting metabolism as base-line correction (net efficiency), and 27.5 +/- 2.9% when using the unloaded rowing as the base-line correction (work efficiency), and 22.8 +/- 2.2% when calculating the work rate as the base-line correction (delta efficiency).

Adult↗

PubMed1998

Managed care and technical efficiency in outpatient substance abuse treatment units.

This article examines (1) the extent to which managed care participation is associated with technical efficiency in outpatient substance abuse treatment (OSAT) organizations and (2) the contributions of specific managed care practices as well as other organizational, financial, and environmental attributes to technical efficiency in these organizations. Data are from a nationally representative sample survey of OSAT organizations conducted in 1995. Technical efficiency is modeled using data envelopment analysis. Overall, there were few significant associations between managed care dimensions and technical efficiency in outpatient treatment organizations. Only one managed care oversight procedure, the imposition of sanctions by managed care firms, was significantly associated with relative efficiency of these provider organizations. However, several organizational factors were associated with the relative level of efficiency including hospital affiliation, mental health center affiliation, JCAHO accreditation, receipt of lump sum revenues, methadone treatment modality, percentage clients unemployed, and percentage clients who abuse multiple drugs.

Ambulatory Care↗

PubMed2005

Relationships between volume, efficiency, and quality in surgery--a delicate balance from managerial perspectives.

Volume, efficiency, and quality in hospital care are often mixed in debate. We analyze how these dimensions are interrelated in surgical hospital management, with particular focus on volume effects: under financial constraints, efficiency is the best form of cost control. External perception of quality is important to attract patients and gain volumes. There are numerous explicit and implicit notions of surgical quality. The relevance of implicit criteria (functionality, reliability, consistency, customaziability, convenience) can change in the time course of hospital competition. Outcome data theoretically are optimal measures of quality, but surgical quality is multifactorially influenced by case mix, surgical technique, indication, process designs, organizational structures, and volume. As quality of surgery is hard to grade, implicit criteria such as customizability currently often overrule functionality (outcome) as the dominant market driver. Activities and volumes are inputs to produce quality. Capability does not translate to ability in a linear function. Adequate process design is important to realize efficiency and quality. Volumes of activities, degree of standardization, specialization, and customer involvement are relevant estimates for process design in services. Flow-orientated management focuses primarily on resource utilization and efficiency, not on surgical quality. The relationship between volume and outcome in surgery is imperfectly understood. Factors involve learning effects both on process efficiency and quality, increased standardization and task specialization, process flow homogeneity, and potential for process integration. Volume is a structural component to develop efficiency and quality. The specific capabilities and process characteristics that contribute to surgical outcome improvement should be defined and exported. Adequate focus should allow even small institutions to benefit from volume-associated effects. All volumes-based learning within standardized processes will finally lead to a plateauing of quality. Only innovations will then further improve quality. Possessing volume can set the optimal ground for continuous process research, subsequent change, innovation, and optimization, while volume itself appears not to be a quality prerequisite.

Efficiency, Organizational↗

PubMed1994

Left ventricular pump efficiency in long-term mitral regurgitation assessed by means of left ventricular-arterial coupling relations.

The left ventricular-arterial coupling relationship was used in patients with long-term mitral regurgitation to test the hypothesis that the low impedance left atrial contribution to left ventricular ejection obscures an impairment in left ventricular-arterial coupling and forward left ventricular pump efficiency. Twenty-two control patients and 26 patients with long-term mitral regurgitation were studied. Micromanometer left ventricular pressures and radionuclide angiograms for left ventricular volumes were acquired over a range of loading conditions. Left ventricular-arterial coupling was assessed by the ratio of left ventricular chamber elastance, E(es), to total arterial elastance, E(a). Forward left ventricular pump efficiency was calculated as the ratio of forward left ventricular stroke work to the corresponding pressure-volume area. There was a progressive decrease in E(es) in the patients with long-term mitral regurgitation (p < 0.001), but there was no significant difference in E(a) in comparison to the control patients. Consequently, E(es)/E(a) demonstrated a progressive decrease (p < 0.001). Although the efficiency of performing total left ventricular stroke work was only reduced when left ventricular contractile function was severely impaired (p < 0.001), there was a progressive reduction in left ventricular pump efficiency for performing forward left ventricular stroke work in the patients with long-term mitral regurgitation (p < 0.001). Further, normalized left ventricular stroke work was reduced for any left ventricular-arterial coupling ratio in the patients with long-term mitral regurgitation compared with the control patients. These data indicate that despite the outward evidence for normal left ventricular ejection in patients with long-term mitral regurgitation, a progressive deterioration in left ventricular contractile state leads to impaired left ventricular-arterial coupling and to an impairment in the efficiency of performing forward left ventricular stroke work. Once the left ventricle begins to dilate in patients with long-term mitral regurgitation, the progressive deterioration in left ventricular-arterial coupling and pump efficiency suggests that an earlier consideration of mitral valve surgery may be warranted to preserve left ventricular contractile function.

Adult↗

PubMed1990

Mechanics and energetics in running with special reference to efficiency.

In running, the muscles exert forces acting internally on the body and externally on the ground to move the body's center of mass forward. The energetics of running can be studied by calculating efficiency: mechanical work done/net energy consumed. Variations in efficiency, however, can be attributed not only to the human machinery but also to methodological differences. Mechanical work has been calculated primarily by two procedures: one is from energy changes taking place on and around the body's center of mass, and the other is from segmental analysis. Using the former and assuming the energy cost to be 1 kcal kg-1 km-1, we have shown that efficiency increases with running speed from 45 to 70%, with elastic energy recoil playing a role (Cavagna and Kaneko, J. Physiol. 268, 467-481, 1977). However, the efficiency value decreases with speed if the oxygen debt is included in the calculation of the energy cost. With the same method we have also shown that the efficiency of distance runners is higher than that of sprinters if the running speed is less than 25 km h-1, and that there is a most economical step rate for maximizing the efficiency at a given constant running speed.

Biomechanical Phenomena↗

PubMed1995

Geographically-decentralized planning and management in health care: some informational issues and their implications for efficiency.

Geographically decentralized planning and management is an emerging theme within the health sector in many OECD countries. Advocates of decentralization argue that providing greater authority to local decision-making bodies can improve both the technical and allocative efficiency with which health care systems operate. Using concepts drawn from organizational theory and the economics of organizations, we examine the potential of centralized and decentralized planning and management structures to be efficient in light of the informational problems that must be overcome to allocate resources efficiently. We focus in particular on the need to integrate information regarding: (1) the effectiveness and efficiency of alternative clinical interventions and of alternative ways organize the delivery of health care; (2) the needs, values, and preferences in the population; and (3) local circumstances that affect delivery of care across regions. Informational concerns suggest that decentralized structures have greater potential to be efficient. We then briefly discuss some principles for the design of decentralized structures to aid in realizing these potential efficiency gains.

Decision Making, Organizational↗

PubMed2004

The ED is an efficient place to treat ED patients.

The purpose of this study was to determine what percentage of ED patients would be more efficiently treated in an offsite clinic. A stratified sample consisting of 650 ED visits were reviewed. Patient care was classified as more efficiently delivered in ED or clinic using prospectively developed criteria. Five hundred fifty-three (85%; 95% confidence interval [CI], 82-88%) visits met the definition of efficient ED utilization. One (0.15%; 95% CI, 0.01-0.99%) met the criteria for efficient clinic utilization. The other 96 (15%; 95% CI, 12-18%) failed to meet the definition of efficient for either site; 92 of these failed 2 or more clinic criteria. Only 25 (3.9%; 95% CI, 2.6-5.7%) were seen for nonacute problems. Few ED patients would be more efficiently seen in a clinic.

Ambulatory Care Facilities↗

PubMed2006

Evaluation of operating room suite efficiency in the Veterans Health Administration system by using data-envelopment analysis.

BACKGROUND: Operating room (OR) activity transcends single ratios such as cases/room, but weighting multiple inputs and outputs may be arbitrary. Data-envelopment analysis (DEA) is a novel technique by which each facility is analyzed by the weightings that optimize its score. METHODS: We performed DEA analysis of 23 Veterans Health Administration annual OR activity; 87,180 cases were performed, 24 publications generated, and 560 trainee-years of education delivered, in 168 ORs over 166,377 hours by 1,384 full-time equivalents of surgical and anesthesia providers and 523 nonproviders. RESULTS: Varying analyzed parameters produced similar efficiency rankings, with individual differences suggesting possible inefficiencies. We characterized returns to scale for efficient sites, suggesting whether patient flow might be efficiently further increased through these sites. We matched inefficient sites to similar efficient sites for comparison and suggested resource alterations to increase efficiency. CONCLUSIONS: Broader DEA application might characterize OR efficiency more informatively than conventional single-ratio rank ordering.

Anesthesiology↗

PubMed2005

Comparing hospital cost efficiency between Norway and Finland.

In this study, cost efficiency in Finnish and Norwegian hospitals was compared using national discharge data and identical definitions for cost and output measures. Cross-sectional data on 47 Finnish and 51 Norwegian public hospitals in 1999 were used. Private, military and psychiatric hospitals were excluded. Data were collected from the National Discharge Registries. These were supplemented with cost information collected from hospitals' year-end accounts. The output data included admissions grouped according to diagnosis related groups (DRGs), outpatient visits, day care and inpatient days. Net hospital operating costs excluding capital costs were used as input. Nonparametric data envelopment analysis (DEA) was used in the calculation of cost efficiency. The results revealed marked differences in efficiency, in both within country and across country comparisons. According to preliminary results there was more variation in cost efficiency among Finnish hospitals, and the average level of cost efficiency was 17-25% lower in Norwegian hospitals. Although these preliminary results must be taken with caution, this study demonstrates the importance and potential benefits of integrating cost efficiency analysis into international comparisons of health care expenditure.

Cross-Sectional Studies↗

PubMed2005

Does chain affiliation make a difference in efficiency of dialysis providers in the USA.

There has been an accelerated movement in the USA dialysis market towards affiliation with chain organizations. But little is known about the impact of this strategy of consolidation on provider performance of efficiency. This paper examines whether affiliation with multi-center dialysis chains creates a difference in technical efficiency. Data were obtained from 1994 to 2000 Independent Renal Facility Cost Report Data files of the Centers for Medicare and Medicaid Studies. Using multiple time series design with a comparison group, technical efficiency was examined through an intertemporal data envelopment analysis. The results showed that mean efficiency scores of chain-affiliated facilities in both pre- and post-affiliation periods are slightly higher than those of their independent counterparts, but the difference was not statistically significant. Members of the first and second largest chains did not appear to gain benefit from affiliation. In conclusion, greater technical efficiency of affiliated facilities is not the result of system engagement but rather the result of organizational maturation, or organizational learning. Engagement with the two largest systems does not provide members with its theoretical premises to achieve technically efficient production of dialysis treatments in multiple product markets.

Commerce↗

PubMed1996

Measurement of the cutting efficiency of endodontic instruments: a new concept.

The cutting efficiency of endodontic instruments was measured using an original experimental technique that incorporates new concepts to simulate clinical conditions. Five designs of #ISO 030 endodontic instruments, K-reamer (Maillefer), Flexofile (Maillefer), Helifile (Micro-mega), K-flex (Kerr), and Unifile (De Trey), were chosen and their cutting efficiency assessed at their full working length of 16 mm on two Plexiglas parallelepipeds tilted to follow the 2% conicity of the instruments. For each instrument, four series of 25 cuts were carried out and each cut made on a new flat, smooth Plexiglas surface with an even hardness of 33 VHN. Instruments were tested under a simulated clinical condition of a quarter clockwise turn ROTARY MOTION followed by a PULL ACTION at 16 mm/s rate, with a fixed load on the instrument of 325 g. Water irrigation at a rate of 85 ml/s was supplied before each procedure. Cutting efficiency was evaluated in terms of mass of Plexiglas cut (using a Mettler analytic balance with accuracy of 3 x 10(-5) g) per unit of energy used by the instrument, i.e. mg/J. Unifile was found to have the best cutting efficiency of 0.80 +/- 0.01 (Mean +/- SD) and lowest cutting efficiency loss followed by Flexofile 0.70 +/- 0.03 then Helifile 0.36 +/- 0.01 then K-flex 0.51 +/- 0.07. K-reamer was found to have the lowest cutting efficiency of 0.16 +/- 0.05.

Dental Instruments↗

PubMed2003

Technical and cost efficiency of oral health care provision in Finnish health centres.

In this study we measured the productive efficiency of public dental health provision across Finland. The analysis was based on data envelopment analysis (DEA) using linear programming. In addition, we investigated various factors explaining the technical and cost efficiency of public dental care using a parametric Tobit model. These analyses revealed substantial variation in productive efficiency between health centres in different municipalities. The level of cost inefficiency was generally between 20% and 30%. Good dental health of the population, high rates of unemployment and high per capita expenditure on primary care in the municipality were associated with technical and cost inefficiency. According to the results, cost efficiency would not be improved by shifting input allocation towards more auxiliary manpower in health centres. Individual efficiency scores were clearly sensitive to the choice of output specification. Changing the unit of output measurement from visit- to patient-based measures affected markedly the ranking of dental health centres. However, the set of exogenous correlates associated to inefficiency was strikingly similar for both types of output specification. More resources are needed if the coverage of public dental care is extended to all age groups. The health centre specific efficiency scores obtained in this study can be used locally to evaluate, design and implement structural changes in the production processes.

Adolescent↗

PubMed2001

Mechanical efficiency and user power requirement with a pushrim activated power assisted wheelchair.

The objective of this study was to quantify the difference in mechanical efficiency and user power generation between traditional manual wheelchairs and a pushrim activated power assisted wheelchair (PAPAW). Ten manual wheelchair users were evaluated in a repeated measures design trial with and without the PAPAW for propulsion efficiency. Subjects propelled a Quickie GP equipped with the PAPAW and their own chair on a computer controlled wheelchair dynamometer at five different resistance levels. Power output, user power with the PAPAW hubs, subjects' oxygen consumption per minute and mechanical efficiency were analyzed. Metabolic energy and user power were significantly lower (p<0.05), and mechanical efficiency significantly higher with the PAPAW than with subjects' own chairs. Subjects needed to generate on average 3.65 times more power when propelling their own wheelchairs as compared to PAPAW. Mean mechanical efficiency over all trials was 80.33% higher with the power assisted hubs. PAPAW provides on average 73% of the total power when subjects propel with power assistance. Significantly increased efficiency and reduced requirement of user power is achieved using the PAPAW. With use, the PAPAW may contribute to delaying secondary injuries of manual wheelchair users. In addition, it may be suitable for people who have (or at risk for) upper extremity joint degeneration, reduced exercise capacity, low strength or endurance who currently use electric powered wheelchairs.

Adult↗

PubMed2000

Regional variation in physician practice pattern: an examination of technical and cost efficiency for treating sinusitis.

OBJECTIVE: An examination of the physician efficiency and resulting cost patterns by region. DATA SOURCES: Virginia Medicaid sinusitis related claims for 1993 were aggregated to physician level (n = 178), and Area Resources File for 1993 was used to identify regions for evaluation. STUDY DESIGN: The best practice performance in the usage of five resources (i.e., primary care physician visits, referral services, emergency room visits, prescriptions, laboratory tests) was identified using Data Envelopment Analysis (DEA). Five regions in Virginia were identified according to regional planning to evaluate the variation in efficiency across these regions. PRINCIPAL FINDINGS: Inefficient physicians consumed significantly more resources and were 48% more costly than efficient physicians. Substantial regional variation was found and mainly attributed to the differences in use of prescriptions and laboratory procedures. Urban-rural discrepancy may explain part of the variation. CONCLUSIONS: As this study reveals the existence of substantial variation in physician efficiency, actions should be taken to minimize the variation that is more affected by personal and structural factors. For example, information on efficient use of resources and corresponding patient outcomes can be disseminated to the attending physicians. Educational workshops can be conducted to allow sharing of experience between efficient and inefficient physicians. Efforts should also be directed to help inefficient physicians to adhere to practice guidelines.

Benchmarking↗

PubMed2001

System validation and work practice efficiency gains of a new localization method for stereotactic radiotherapy.

The increased procedural demands of stereotactic localization techniques when compared with conventional treatment practices reduces machine efficiency, an outcome likely to be greatly magnified by the introduction of fractionation to stereotactic techniques. Currently in Australia and New Zealand there are no guidelines for the definition of efficiency. We sought to devise a system to simultaneously validate the accuracy and efficiency of the technique. The frameless relocation methods employed in the Medtronic Sofamor Danek (MSD) stereotactic radiotherapy (SRT) system were studied in the clinical setting. Accuracy has been determined according to the accumulation of errors throughout the planning and treatment process. The clinical demands of the system (staffing and resources) were analysed relative to conventional treatment approaches. Timing studies indicate a mean time of 19.7 min for treatment of a daily SRT fraction (4-5 arcs, single isocentre). Cost and staffing requirements are similar to those for conventional radiotherapy. It is concluded that with the system used, SRT is efficient for routine clinical implementation, with the level of efficiency increasing with increasing patient numbers. It is recommended that a common acceptance standard be developed to allow cross-institutional comparison of the clinical efficiency of new treatment techniques.

Brain Neoplasms↗

PubMed1994

Factors affecting the labor efficiency of hospital-based blood bank laboratories.

BACKGROUND: A variety of financing mechanisms and managerial innovations have been developed in the past decade to control hospital costs. Some evidence suggests that those changes have not produced substantial improvements in labor efficiency among employees in the hospital's technical level, such as in the blood bank laboratories. STUDY DESIGN AND METHODS: This study measured labor efficiency in 40 hospital-based blood bank laboratories in Southern California during the year from July 1989 to June 1990 and explored the impact of financial, managerial, and operational factors on labor efficiency. RESULTS: With standardized output measures used in all blood bank laboratories, a wide variation of labor efficiency was found. Multivariate analyses indicate that the labor efficiency of blood bank employees was not influenced by organizational financial incentives, but was affected by the managerial styles of blood bank managers. CONCLUSION: Interpretation of the findings suggests that labor efficiency is affected by operational designs intended to improve responses to variable workloads and reduce slack time.

Blood Banks↗

PubMed2001

On the relationship between the efficiency and the quality of the consultation. A validity study.

OBJECTIVES: The aim of this study was to determine how the medical performance of physicians during consultations is related to doctor-patient communication and satisfaction of patients, taking into account the actual length of the consultations. In addition, we studied the validity of the 'efficiency-per-time score' as a measure of competence. METHODS: General practice trainees participated in a test situation in which they were confronted with six consultations with standardized (simulated) patients (SPs). All consultations were videotaped and evaluated by multiple observers, using national guidelines on medical content and on communication. The SPs scored satisfaction with the consultation using a satisfaction checklist. Forty GP-trainees were invited, of whom 34 participated. The main outcome measures were the number of obligatory actions undertaken by the GP-trainees, total number of actions undertaken, consultation time, efficiency-per-time score, patient satisfaction and quality of communication score, and the Pearson correlations between these measures. RESULTS: There was a negative correlation between the 'efficiency-per-time score' of the GP-trainees and the satisfaction of the SPs in five of the six consultations [Pearson r from -0.29 (P < 0.05) to -0.58 (P < 0.001)] and between the 'efficiency-per-time score' and the quality of the communication in three of the six consultations [Pearson r from -0.34 (P <.05) to -0.51 (P < 0.001)]. CONCLUSIONS: Short consultations with high technical medical efficiency seem to be related to bad communication and dissatisfied patients, thus questioning the validity of the 'efficiency-per-time score' as a measure of competence.

Belgium↗

PubMedDate not supplied

The efficiency of Scottish acute hospitals: an application of data envelopment analysis.

Measurement of the efficiency of health services would aid the promotion of a better allocation of health care resources. Economic analysis suggests a number of ways of defining and measuring efficiency. However, this rarely informs measures used in health service management. This paper looks at the potential for the use in the United Kingdom's National Health Service of the linear programming based method of data envelopment analysis (DEA). DEA is applied to data from 75 UK acute hospitals. The results demonstrate the capacity of DEA to produce a user-friendly array of results, based on sound theoretical underpinnings. These range from the measurement of relative efficiencies to quantified suggestions as to how hospitals may improve efficiency, by examining both their own efficiency and that of comparable units. Information is provided both about individual hospitals and the sample as a whole. DEA is also able to distinguish between hospitals demonstrating differing returns to scale. Our findings suggest that, although still very much under development, DEA is usable and, given the weakness of current means of measuring efficiency in the National Health Service, that DEA has a strong claim for further consideration.

Data Interpretation, Statistical↗