000074963 001__ 74963
000074963 005__ 20200117221650.0
000074963 0247_ $$2doi$$a10.1371/journal.pone.0201466
000074963 0248_ $$2sideral$$a107597
000074963 037__ $$aART-2018-107597
000074963 041__ $$aeng
000074963 100__ $$0(orcid)0000-0002-1847-3442$$aGorgemans, S.$$uUniversidad de Zaragoza
000074963 245__ $$aQuality and technical efficiency do not evolve hand in hand in Spanish hospitals: Observational study with administrative data
000074963 260__ $$c2018
000074963 5060_ $$aAccess copy available to the general public$$fUnrestricted
000074963 5203_ $$aObjective Recent evidence on the Spanish National Health System (SNHS) reveals a considerable margin for hospital efficiency and quality improvement. However, those studies do not consider both dimensions together. This study aims at jointly studying both technical efficiency (TE) and quality, classifying the public SNHS hospitals according to their joint performance. Methods Stochastic frontier analysis is used to estimate TE and multilevel logistic regressions to build a low-quality composite measure (LQ), which considers in-hospital mortality and safety events. All hospitalizations discharged in Spain in 2003 and 2013, in 179 acute-care general hospitals, were studied. Four scenarios of resulting performance were built setting yearly medians as thresholds for the overall sample, and according to hospital-complexity strata. Results Overall, since 2003, median TE improved and LQ reduced -from TE2003:0.89 to TE2013:0.93 and, from LQ2003:42.6 to LQ2013:27.7 per 1, 000 treated patients. The time estimated coefficient showed technical progress over the period. TE across hospitals showed scarce variability (CV2003:0.08 vs. CV2013:0.07), not so the rates of LQ (CV2003:0.64 vs. CV2013:0.76). No correlation was found between TE values and LQ rates. When jointly considering technical efficiency and quality, hospitals dealing with the highest clinical complexity showed the highest chance to be placed in optimal scenarios, also showing lesser variability between hospitals. Conclusions Efficiency and quality have improved in Spanish public hospitals. Not all hospitals experiencing improvements in efficiency equally improved their quality. The joint analysis of both dimensions allowed identifying those optimal hospitals according to this trade-off.
000074963 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII/RD16-0007-0001$$9info:eu-repo/grantAgreement/ES/MINEIC/ECO2017-83771-C3-2-R
000074963 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000074963 590__ $$a2.776$$b2018
000074963 591__ $$aMULTIDISCIPLINARY SCIENCES$$b23 / 69 = 0.333$$c2018$$dQ2$$eT2
000074963 592__ $$a1.1$$b2018
000074963 593__ $$aAgricultural and Biological Sciences (miscellaneous)$$c2018$$dQ1
000074963 593__ $$aMedicine (miscellaneous)$$c2018$$dQ1
000074963 593__ $$aBiochemistry, Genetics and Molecular Biology (miscellaneous)$$c2018$$dQ1
000074963 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000074963 700__ $$aComendeiro-Maaløe, M.
000074963 700__ $$aRidao-López, M.
000074963 700__ $$0(orcid)0000-0002-0961-3298$$aBernal-Delgado, E.
000074963 7102_ $$14012$$2650$$aUniversidad de Zaragoza$$bDpto. Direcc.Organiza.Empresas$$cÁrea Organización de Empresas
000074963 773__ $$g13, 8 (2018), e0201466[12 pp]$$pPLoS One$$tPloS one$$x1932-6203
000074963 8564_ $$s515666$$uhttps://zaguan.unizar.es/record/74963/files/texto_completo.pdf$$yVersión publicada
000074963 8564_ $$s101450$$uhttps://zaguan.unizar.es/record/74963/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000074963 909CO $$ooai:zaguan.unizar.es:74963$$particulos$$pdriver
000074963 951__ $$a2020-01-17-22:08:44
000074963 980__ $$aARTICLE