Modeling Efficiency at the Process Level: An Examination of the Care Planning Process in Nursing Homes

Abstract

Objective. To examine the efficiency of the care planning process in nursing homes. Methods: We collected detailed primary data about the care planning process for a stratified random sample of 107 nursing homes from Kansas and Missouri. We used these data to calculate the average direct cost per care plan and used data on selected deficiencies from the Online Survey Certification and Reporting System to measure the quality of care planning. We then analyzed the efficiency of the assessment process using corrected ordinary least squares (COLS) and data envelopment analysis (DEA). Results: Both approaches suggested that there was considerable inefficiency in the care planning process. The average COLS score was 0.43; the average DEA score was 0.48. The correlation between the two sets of scores was quite high, and there was no indication that lower costs resulted in lower quality. For-profit facilities were significantly more efficient than not-for-profit facilities. Conclusions. Multiple studies of nursing homes have found evidence of inefficiency, but virtually all have had measurement problems that raise questions about the results. This analysis, which focuses on a process with much simpler measurement issues, finds evidence of inefficiency that is largely consistent with earlier studies. Making nursing homes more efficient merits closer attention as a strategy for improving care. Increasing efficiency by adopting well-designed, reliable processes can simultaneously reduce costs and improve quality.

Using nonparametric conditional approach to integrate quality into efficiency analysis: empirical evidence from cardiology departments

“…The common element of the one-stage approach and the congestion analysis is that quality is used to augment the production set. In contrast to these two approaches, other studies advocated using quality as an external variable, which is not part of the production process, but is helpful in explaining the differences in efficiency across health care providers [19][20][21][22][23][24][25]. These studies applied the two-stage approach by estimating the values of provider efficiency in the first stage without considering quality and then regressing the obtained efficiency estimates on quality in the second stage of analysis.…”

Efficiency and quality of care in nursing homes: an Italian case study

“…This kind of measure has been employed both in DEA and non-DEA studies about efficiency and quality of care in nursing homes, moreover in those situations where data about outcome were not available or enough reliable (e.g. Lee et al [3], Zhang et al [4], Cheesteen et al [10]). …”

“…Despite that, even a cursory review would identify that several studies have already investigated the various factors, such as size, ownership, staffing, reimbursement system and other policy interventions, may influence the efficiency and quality of care in nursing homes. These studies have applied different approaches to investigate the capability of nursing homes to deliver high quality and efficient care to residents, like as the Data Envelopment Analysis [2][3][4], the Stochastic Frontier Analysis [5][6][7], and the Bayesian Networks [1]. Contributions have also discussed how the structure of the health and social care system may affect efficiency and quality of care in nursing homes, with particular emphasis on the role of competition [8,9].…”

Suicide among elders: a Durkheimian proposal

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