125915 20240731103333.0 doi 10.3390/ijerph20043389 sideral 133426 ART-2023-133426 eng Gorgemans, S. Universidad de Zaragoza (orcid)0000-0002-1847-3442 Comparing hospital efficiency: An illustrative study of knee and hip replacement surgeries in Spain 2023 Access copy available to the general public Unrestricted WHO’s Health Systems Performance Assessment framework suggests monitoring a set of dimensions. This study aims to jointly assess productivity and quality using a treatment-based approach, specifically analyzing knee and hip replacement, two prevalent surgical procedures performed with consolidated technology and run in most acute-care hospitals. Focusing on the analysis of these procedures sets out a novel approach providing clues for hospital management improvements, covering an existing gap in the literature. The Malmquist index under the metafrontier context was used to estimate the productivity in both procedures and its decomposition in terms of efficiency, technical and quality change. A multilevel logistic regression was specified to obtain the in-hospital mortality as a quality factor. All Spanish public acute-care hospitals were classified according to their average severity attended, dividing them into three groups. Our study revealed a decrease in productivity mainly due to a decrease in the technological change. Quality change remained constant during the period with highest variations observed between one period to the next according to the hospital classification. The improvement in the technological gap between different levels was due to an improvement in quality. These results provide new insights of operational efficiency after incorporating the quality dimension, specifically highlighting a decreasing operational performance, confirming that the technological heterogeneity is a critical question when measuring hospital performance. info:eu-repo/grantAgreement/ES/ISCIII-RICAPPS/RD21-0016-0023 info:eu-repo/semantics/openAccess by http://creativecommons.org/licenses/by/3.0/es/ 0.808 2023 Health, Toxicology and Mutagenesis 2023 Q2 Public Health, Environmental and Occupational Health 2023 Q2 Pollution 2023 Q2 7.3 2023 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Comendeiro-Maaløe, M. Ridao-López, M. Bernal-Delgado, E. (orcid)0000-0002-0961-3298 4012 650 Universidad de Zaragoza Dpto. Direcc.Organiza.Empresas Área Organización de Empresas 20, 4 (2023), 3389 [12 pp.] Int. j. environ. res. public health International journal of environmental research and public health 1661-7827 844378 http://zaguan.unizar.es/record/125915/files/texto_completo.pdf Versión publicada 2800723 http://zaguan.unizar.es/record/125915/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:125915 articulos driver 2024-07-31-09:47:08 ARTICLE