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Profiling resource use: do different outcomes affect assessments of provider efficiency?
Amy K Rosen1, Carter C Rakovski, Susan A Loveland
1Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Medical Center, Bedford, MA 01730, USA. akrosen@bu.edu
The American Journal of Managed Care
|December 26, 2002
Summary
Provider efficiency assessments varied significantly based on the outcome measure used. Different metrics identified distinct networks as efficient, highlighting the impact of measurement choice on healthcare network evaluations.
Area of Science:
- Health Services Research
- Healthcare Management
- Performance Measurement
Background:
- Evaluating healthcare network efficiency is crucial for resource allocation and quality improvement.
- Standardized methods are needed to ensure equitable comparisons across different service providers.
- The Department of Veterans Affairs (VA) healthcare system presents a complex environment for efficiency assessment.
Purpose of the Study:
- To determine if two distinct outcome measures yield different efficiency assessments for 22 VA service networks.
- To analyze the impact of case-mix adjustment on network efficiency evaluations.
- To understand how the choice of outcome measure influences the identification of efficient healthcare providers.
Main Methods:
- Retrospective analysis of VA inpatient and outpatient administrative data from fiscal year 1997.
- Development and validation of weighted concurrent case-mix models using adjusted clinical groups.
- Calculation of unadjusted and adjusted efficiency indices based on 'days of care' and 'average accounting costs' for each network.
Main Results:
- Case-mix adjustment altered individual network efficiency assessments, though approximately half remained efficient overall.
- Significant discrepancies were observed between the two outcome measures; for instance, networks efficient by 'days of care' were sometimes inefficient by 'average accounting costs'.
- The choice of outcome measure directly impacted which networks were classified as efficient.
Conclusions:
- Healthcare provider efficiency assessments are contingent upon the specific outcome measure employed.
- Recognizing the variability in efficiency assessments based on outcome measures is vital for developing more accurate and fair comparisons among providers.
- This study underscores the need for careful consideration of measurement selection in healthcare performance evaluation.