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PubMed1997

Efficiency and health.

Efficiency has become of central importance in health care and is seen as wholly laudable. It appears to offer a precise and objective means of evaluating and comparing institutions, practices and individuals, and is a principle that underlies techniques of cost-benefit analysis and other methods of option appraisal. However, there is a need to examine the concept of efficiency and explore the problems of its application within health care. Efficiency is a value laden notion and it cannot be used as a means of making value judgements from purely factual premises. We have to choose the inputs and outputs in our calculations, and what limits to set on their scope. Efficiency calculations may require us to measure what cannot be quantified, and to treat as commensurable what is incommensurable. There are circumstances in which considerations of efficiency are inappropriate or even immoral.

Cost-Benefit Analysis↗

PubMed2004

Frontier efficiency measurement in health care: a review of empirical techniques and selected applications.

Health care institutions worldwide are increasingly the subject of analyses aimed at defining, measuring, and improving organizational efficiency. However, despite the importance of efficiency measurement in health care services, it is only relatively recently that the more advanced econometric and mathematical programming frontier techniques have been applied to hospitals, nursing homes, health management organizations, and physician practices, among others. This article provides a synoptic survey of the comparatively few empirical analyses of frontier efficiency measurement in health care services. Both the measurement of efficiency in a range of health care services and the posited determinants of health care efficiency are examined.

Australia↗

PubMed2004

When to release allocated operating room time to increase operating room efficiency.

UNLABELLED: We studied when allocated, but unfilled, operating room (OR) time of surgical services should be released to maximize OR efficiency. OR time was allocated for two surgical suites based on OR efficiency. Then, we analyzed real OR schedules. We added new hypothetical cases lasting 1, 2, or 3 h into OR time of the service that had the largest difference between allocated and scheduled cases (i.e., the most unfilled OR time) 5 days before the day of surgery. The process was repeated using the updated OR schedule available the day before surgery. The pair-wise difference in resulting overutilized OR time was calculated for n = 754 days of data from each of the two surgical suites. We found that postponing the decision of which service gets the new case until early the day before surgery reduces overutilized OR time by <15 min per OR per day as compared to releasing the allocated OR time 5 days before surgery. These results show that when OR time is released has a negligible effect on OR efficiency. This is especially true for ambulatory surgery centers with brief cases or large surgical suites with specialty-specific OR teams. What matters much more is having the correct OR allocations and, if OR time needs to be released, making that decision based on the scheduled workload. IMPLICATIONS: Provided operating room (OR) time is allocated and cases are scheduled based on maximizing OR efficiency, then whether OR time is released five days or one day before the day of surgery has a negligible effect on OR efficiency.

Ambulatory Surgical Procedures↗

PubMed2005

Ring fencing of elective surgery: does it affect hospital efficiency?

Ring fencing (RF) is defined as separating elective from emergency operations in parallel hospital production lines. This study examines the effects of RF of elective surgery on hospital efficiency. The analysis is performed on two levels. First, an intensive three-month study at the departmental level of three hospitals was performed. Second, a panel data analysis of the organizational population of Norwegian hospitals over the period from 1992 to 2000 was conducted, using a 'fixed effect' regression model to analyse the effect of RF on hospitals' cost and technical efficiency. The intensive study indicates that RF could have positive effects both on cost and technical efficiency under certain conditions of case-mix and the demand for elective surgery, while the panel analyses of the effects of RF in the hospital population do not produce stable results. We cannot conclude that RF has unconditional positive effects on hospitals' efficiency. However, in certain situations of case-mix and demand for services, RF could be a valuable tool for managers to increase hospitals' efficiency.

Efficiency, Organizational↗

PubMed2005

The form of augmented force-feedback fields and the efficiency and satisfaction in computer-aided pointing tasks.

This study investigates operation efficiency and user satisfaction for spatial and temporal shapes of augmented force-feedback fields to be used with computer pointing devices in target acquisition tasks. In an experiment, three different force-field shapes at two different mean force levels were compared, with an electromechanical force-feedback trackball as control device and with efficiency and user satisfaction as dependent variables. Efficiency was measured by the time required to perform a certain task, and user satisfaction was measured through a subjective rating procedure. Satisfaction results indicate that to a rough approximation, participants can be grouped into those who prefer high and those who prefer low force levels. Members of the former group were most satisfied with force fields with a gradual start and an abrupt ending. This force-field shape also proved to be the most efficient for both groups. When all participants were considered as a single group, none of the effects was found to be statistically significant. A gender effect was also found; in both preference groups women achieved significantly shorter task completion times than men. Actual or potential applications of this research include enabling computer interaction for people prone to repetitive strain injuries and the increment of efficiency and satisfaction in human-computer interaction in general.

Adult↗

PubMed1984

Constant mechanical efficiency of contractile machinery of canine left ventricle under different loading and inotropic conditions.

We have recently proposed that the total mechanical energy generated in each cardiac contraction can be quantified by the systolic pressure-volume area (PVA). PVA is the area in the pressure-volume (P-V) diagram that is circumscribed by the end-systolic and end-diastolic P-V relation curves and the systolic segment of the P-V trajectory. This area has dimensions of energy and comprises the external mechanical work and the elastic potential energy. In the left ventricle of cross-circulated canine hearts, we studied the relation between PVA and oxygen consumption per beat (VO2) above VO2 for mechanically unloaded contraction. We assumed that this excess VO2 is utilized for mechanical contraction by the contractile machinery. The percentage of PVA in the excess VO2, both in the same unit of energy, J, would then represent the efficiency of energy conversion from the excess VO2 to the total mechanical energy in the contractile machinery. We obtained this efficiency in variously loaded contractions in both control and enhanced contractile states with epinephrine and calcium. We found that the efficiency was constant at 30-50 (mean 40) % regardless of the changes in both loading conditions and contractile states. By this constant efficiency and a variable fraction of external work in PVA, we accounted for the load- and contractility-dependent variability of the conventional mechanical efficiency (0-30%) of the heart.

Animals↗

PubMed2006

Systematic review: impact of health information technology on quality, efficiency, and costs of medical care.

BACKGROUND: Experts consider health information technology key to improving efficiency and quality of health care. PURPOSE: To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. DATA SOURCES: The authors systematically searched the English-language literature indexed in MEDLINE (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database. We also added studies identified by experts up to April 2005. STUDY SELECTION: Descriptive and comparative studies and systematic reviews of health information technology. DATA EXTRACTION: Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs. DATA SYNTHESIS: 257 studies met the inclusion criteria. Most studies addressed decision support systems or electronic health records. Approximately 25% of the studies were from 4 academic institutions that implemented internally developed systems; only 9 studies evaluated multifunctional, commercially developed systems. Three major benefits on quality were demonstrated: increased adherence to guideline-based care, enhanced surveillance and monitoring, and decreased medication errors. The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed. Empirical cost data were limited. LIMITATIONS: Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited. CONCLUSIONS: Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear.

Biomedical Technology↗

PubMed1992

Rural hospital closures: an inquiry into efficiency.

The relationship between efficiency and rural hospital closure was examined by comparing the efficiency of nongovernment short-term general rural hospitals that closed in 1988 to that of their counterparts that remained opened. A similar comparison was made between the efficiency of open and closed urban facilities. Although no relationship between efficiency and closure was demonstrated, an examination of the surpluses and shortages in production among inefficient hospitals revealed that inefficient closed hospitals in both rural and urban areas experienced a lack of demand for inpatient services. Furthermore, a threshold value of 21 or 22 inpatient discharges per bed per year was identified as being related to closure regardless of whether a hospital was operating efficiently or not.

Bed Occupancy↗

PubMed1996

Church ownership and hospital efficiency.

Using a sample of California hospitals, the effect of church ownership was examined as it relates to nonprofit hospital efficiency. Efficiency scores were computed using a nonparametric method called data envelopment analysis (DEA). Controlling for hospital size, location, system membership, and type of church ownership, church-owned hospitals were found to be more frequently in the efficient category than their secular nonprofit counterparts. The outcomes have policy implications for reducing healthcare expenditures by focusing on increasing outputs or decreasing inputs, as appropriate, and bolstering the case for church-sponsored hospitals to retain the tax-exempt status due to their ability to manage their resources as efficiently as (or more efficiently than) secular hospitals.

California↗

PubMed2000

Measuring hospital efficiency: a comparison of two approaches.

OBJECTIVE: To compare the results of scoring hospital efficiency by means of two new types of frontier models, Data Envelopment Analysis (DEA) and stochastic frontier regression (SFR). STUDY SETTING: Financial records of Florida acute care hospitals in continuous operation over the period 1982-1993. STUDY DESIGN: Comparable DEA and SFR models are specified, and these models are then estimated to obtain the efficiency indexes yielded by each. The empirical results are subsequently examined to ascertain the extent to which they serve the needs of hospital policymakers. DATA COLLECTION: A longitudinal or panel data set is assembled, and a common set of output, input, and cost indicators is constructed to support the estimation of comparable DEA and SFR models. PRINCIPAL FINDINGS: DEA and SFR models yield convergent evidence about hospital efficiency at the industry level, but divergent portraits of the individual characteristics of the most and least efficient facilities. CONCLUSIONS: Hospital policymakers should not be indifferent to the choice of the frontier model used to score efficiency relationships. They may be well advised to wait until additional research clarifies reasons why DEA and SFR models yield divergent results before they introduce these methods into the policy process.

Bed Occupancy↗

PubMed1992

Ownership and organizational performance. A comparison of technical efficiency across hospital types.

Using a national data base of urban hospitals, the effect of ownership (government, nonprofit, and for-profit) on the technical efficiency of hospitals was examined. Efficiency scores were computed using a method called data envelopment analysis. Controlling for environmental and hospital characteristics, for-profit hospitals were found somewhat less frequently and government hospitals consistently more frequently in the efficient category. When examining highly inefficient hospitals as a percentage of those receiving inefficient scores, for-profit hospitals appeared to be highly inefficient relative to the other ownership forms. Government and nonprofit hospitals were somewhat indistinguishable from one another regarding their percentages of highly inefficient scores. For-profit hospitals also tended to use supply and capital asset (hospital size) inputs less efficiently, and service and labor inputs more efficiently than hospitals in the other ownership categories.

Efficiency↗

PubMed2004

The association of debt financing with not-for-profit hospitals' operational and capital-investment efficiency.

Increased debt in companies can motivate both operational and capital-investment efficiency. This positive influence of debt is attributed to creditors' oversight of corporate behavior and the need to generate cash flows to service debt. Our study investigates whether debt has a similar relationship with efficiency in not-for-profit hospitals. Using statistical analysis of a database of audited financial statements of not-for-profit hospitals, we test whether debt is associated with six distinct measures of operational and capital-investment efficiency. We find that debt either has no association with efficiency or predicts decreased efficiency. Possible explanations are that creditors' oversight is less tight in the not-for-profit setting and that debt may at times motivate excessive capital investment because of a legal requirement to tie tax-exempt debt with a capital-investment project.

Capital Expenditures↗

PubMed1989

[Occlusal pattern factors influencing masticatory efficiency].

The purpose of this study was to investigate the relationship between occlusal pattern factors and masticatory efficiency. 50 subjects with normal dentition were tested to obtain the occlusal pattern standard. The simplified particle counting method, which was previously reported by Imaoka et al., was used to determine the masticatory efficiency. Measurements included 5 factors of the occlusal pattern of the habitual chewing side, including the canine of each subject: the number of occlusal contact areas, the size of each area, the number of occlusal facets of the projected area, the size of the factors of the projected area and the inclination of the occlusal facets. The correlation between the 5 factors of the occlusal pattern and the masticatory efficiency were analyzed to obtain a standard for the restoration of occlusal patterns. The results were as follows: 1. The number of occlusal contacts and the number and inclination of occlusal facet were the main factors which to influenced the masticatory efficiency. 2. The standard number of occlusal contacts and occlusal facets were 15 and 25 respectively. 3. Although the inclination of the occlusal facets of premolars was slightly bigger than those of molars, the standard inclination of the occlusal facets was 25-30 degrees. 4. There was no significant correlation between the masticatory efficiency and the projected area of the occlusal contacts and facets. 5. The classification of occlusal facets should be considered, because of the inclination of the occlusal facets which appear at the same areas of the cusp point, the fossa and the marginal ridge was 10-15 degrees, and the inclination of the other areas of occlusal pattern was bigger.

Dental Occlusion↗

PubMed1989

Oxygen uptake and efficiency related to external work rate during loaded walking.

The work load for the treadmill test is generally controlled by changing the slope of the treadmill (vertical method). Recently a new loading method was devised in which the subject pulls a weight horizontal from behind on the treadmill (horizontal method). The present study was conducted to compare the oxygen uptake (VO2 between the vertical and horizontal methods. The VO2 was 8 to 15% higher with the horizontal than with the vertical method on the same load levels. The difference was significant for 700 kpm/min (p less than 0.05). When unloaded, the frequency of steps was 109 +/- 9.3 steps/min. The frequency of steps was substantially unchanged with increasing external work rate in both methods. There was no difference in the frequency of steps between the two methods. The present paper discusses the significance of the VO2 difference resulting from the difference ways of loading, but the effect of frequency of steps was regarded as insignificant. The present study discussed the assumptions in calculating delta efficiency, delta efficiency per one step and net efficiency, and proposed the necessary conditions for the calculations. Although the efficiency from the three calculation ways was scattered, after selecting the efficiency under the necessary conditions, its value was almost the same and showed about 23%.

Adult↗

PubMedDate not supplied

[Evaluation of the efficiency of primary care centers. Application of data analysis].

BACKGROUND: One of the major difficulties in evaluating the efficiency of Primary Medical Centres is that of integrating quantitative and qualitative data. METHODS: This study applies the Involved Data Analysis (DEA) for the purpose of evaluating the efficiency of Primary Medial Centres located in the Province of Zaragoza (Spain). DEA is a lineal programming technique that provides information on the relative efficiency of each unit, as compared to all other units. Output such as doctors and nursing services as well as variables relating to the quality of service, and input (personnel and pharmaceutical expenses) referring to 1994, were obtained from Area Management. RESULTS: Without taking qualitative variables into account, only 13 Primary Medical Centres reached maximum efficiency level 1. with a range of 0.53 to 1. Taking quality variables into account, 24 units reached optimum efficiency, with a range of 0.61 to 1. CONCLUSIONS: DEA is a useful tool for both qualitative and quantitative overall evaluation of input and output and identifies units that are inefficient as compared to others. Despite the difficulties involved, the method appears to be beneficial for management as a complementary aid to currently used techniques.

Data Interpretation, Statistical↗

PubMed1997

Automated five-part white blood cell differential counts. Efficiency of software-generated white blood cell suspect flags of the hematology analyzers Sysmex SE-9000, Sysmex NE-8000, and Coulter STKS.

OBJECTIVE: The present study evaluates the efficiency of software-generated white blood cell (WBC) "suspect flags" of the hematology analyzers Sysmex SE-9000, Sysmex NE-8000, and Coulter STKS. DESIGN: Automated WBC differential counts were considered positive if they contained any suspect WBC flag indicating the presence of blasts, myeloid precursor cells, or abnormal lymphocytes. Reference differential counts were performed by microscopic examination of 400 WBCs per sample. After comparison to the reference method, automated differential counts were classified as true-positive, true-negative, false-positive, and false-negative. The flagging efficiency of analyzers was expressed as a percentage of subjects correctly classified. SPECIMENS: Four hundred sixty-seven blood samples were randomly chosen for comparison analysis from various inpatient and outpatient departments of the Vienna university hospital, Austria. RESULTS: The efficiency rates of flagging for the presence of > or = 1% abnormal WBCs were 78% (SE-9000), 77% (NE-8000), and 72% (Coulter STKS). The flagging efficiencies were best for samples with normal WBC counts. With regard to the specific suspect flags, the flagging of blast cells was most efficient on all analyzers. CONCLUSIONS: Our results demonstrate the comparable overall performance of three analyzers, SE-9000, NE-8000, and Coulter STKS. They further underscore the importance of critical interpretation of automated differential counts, because at a detection limit of > or = 1% abnormal WBCs > 20% of samples were not correctly flagged by either analyzer.

Austria↗

PubMed1998

Efficiency of sunlight utilization: tubular versus flat photobioreactors

The light saturation effect imposes a serious limitation on the efficiency with which solar energy can be utilized in outdoor algal cultures. One solution proposed to reduce the intensity of incident solar radiation and overcome the light saturation effect is "spatial dilution of light" (i.e., distribution of the impinging photon flux on a greater photosynthetic surface area), but consistent experimental data supporting a significant positive influence of spatial light dilution on the productivity and the photosynthetic efficiency of outdoor algal cultures have never been reported. We used a coiled tubular reactor and compared a near-horizontal straight tubular reactor and a near-horizontal flat panel in outdoor cultivation of the cyanobacterium Arthrospira (Spirulina) platensis under defined operating conditions for optimum productivity. The photosynthetic efficiency achieved in the tubular systems was significantly higher because their curved surface "diluted" the impinging solar radiation and thus reduced the light saturation effect. This interpretation was supported by the results of experiments carried out in the laboratory under continuous artificial illumination using both a flat and a curved chamber reactor. The study also showed that, when the effect of light saturation is eliminated or reduced, productivity and solar irradiance are linearly correlated even at very high diurnal irradiance values, and supported findings that outdoor algal cultures are light-limited even during bright summer days. It was also observed that, besides improving the photosynthetic efficiency of the culture, spatial dilution of light also leads to higher growth rates and lowers the cellular content of accessory pigments; that is, it reduces mutual shading in the culture. The inadequacy of using volumetric productivity as the sole criterion for comparing reactors of different surface-to-volume ratio and of the areal productivity for evaluating the performance of elevated photobioreactors operated outdoors is stressed; it is furthermore suggested that the photosynthetic efficiency achieved by the culture also be calculated to provide a suitable parameter for comparison of different algal cultivation systems operated under similar climatic conditions. Copyright 1998 John Wiley & Sons, Inc.

Journal Article↗

PubMedDate not supplied

The efficiency of adiabatic inversion for perfusion imaging by arterial spin labeling.

Velocity-driven adiabatic inversion is an attractive method for labeling arterial blood spins for quantitative perfusion imaging. To quantify perfusion and to optimize experimental parameters, an accurate estimate of labeling efficiency is required. We present theoretical and numerical methods to calculate the labeling efficiency over a wide range of experimental and physiologic parameters. The results are compared to experimental measurements in vivo. Inversion efficiency was found to be higher than previously assumed and relatively insensitive to flow velocity and the amplitude of the RF irradiation used for inversion. Assuming laminar flow, labeling efficiencies of greater than 90% are easily obtainable over a broad range of flow velocities. For applications where RF power deposition is a limiting factor such as at high field strengths, labeling efficiency can be maintained by reducing the labeling gradient. These results further illustrate the capability of adiabatic inversion to effectively label flowing blood.

Adult↗