Comparison of apparent efficiency of haemodialysis satellite units in England and Wales using data envelopment analysis.
OBJECTIVE
To expand care for chronic haemodialysis (HD) patients throughout England and Wales by studying two aspects of service delivery that are important: to identify relative performance of haemodialysis satellite units (HDSUs), and understand the factors that influence the performance. As a first step toward these aspects, this work reports a study of apparent comparative efficiency in the delivery of HDSUs and demonstrates the potential of data envelopment analysis (DEA).


METHODS
DEA was applied to data obtained from a national survey of the organizational structures and processes of delivering care at HDSUs in England and Wales.


RESULTS
DEA was found to be a judicious approach for performance assessment of HDSUs, although valid results depend on appropriate model specification and quality of data available. The available data were not of sufficient comprehensiveness or quality to produce definitive results but suggested that overall efficiency could improve; these data suggested by as much as 10% overall (mean efficiency score 90%) and variably within the sample (46 [65%] that HDSUs were potentially inefficient, the lowest unit scoring 38%).


CONCLUSIONS
Addressing questions raised by comparative inefficiency could help plans to improve capacity to deal with the growing demand for HD delivered in HDSUs. The application was an important start and needs to be followed by further research to establish model validity and obtain authoritative results.
Gerard
Karen
K
University of Oxford, UK. kareng@soton.ac.uk
Roderick
Paul
P
D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D004739:England; D006291:Health Policy; D006302:Health Services Research / Q000379:methods; D006801:Humans; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D014852:Wales