74963 20200117221650.0 doi 10.1371/journal.pone.0201466 sideral 107597 ART-2018-107597 eng (orcid)0000-0002-1847-3442 Gorgemans, S. Universidad de Zaragoza Quality and technical efficiency do not evolve hand in hand in Spanish hospitals: Observational study with administrative data 2018 Access copy available to the general public Unrestricted Objective 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. info:eu-repo/grantAgreement/ES/ISCIII/RD16-0007-0001 info:eu-repo/grantAgreement/ES/MINEIC/ECO2017-83771-C3-2-R info:eu-repo/semantics/openAccess by http://creativecommons.org/licenses/by/3.0/es/ 2.776 2018 MULTIDISCIPLINARY SCIENCES 23 / 69 = 0.333 2018 Q2 T2 1.1 2018 Agricultural and Biological Sciences (miscellaneous) 2018 Q1 Medicine (miscellaneous) 2018 Q1 Biochemistry, Genetics and Molecular Biology (miscellaneous) 2018 Q1 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Comendeiro-Maaløe, M. Ridao-López, M. (orcid)0000-0002-0961-3298 Bernal-Delgado, E. 4012 650 Universidad de Zaragoza Dpto. Direcc.Organiza.Empresas Área Organización de Empresas 13, 8 (2018), e0201466[12 pp] PLoS One PloS one 1932-6203 515666 http://zaguan.unizar.es/record/74963/files/texto_completo.pdf Versión publicada 101450 http://zaguan.unizar.es/record/74963/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:74963 articulos driver 2020-01-17-22:08:44 ARTICLE