title: Dynamic network data envelopment analysis for university hospitals evaluation.
abstract: OBJECTIVE
  To develop an assessment tool to evaluate the efficiency of federal university general hospitals.
  
  
  METHODS
  Data envelopment analysis, a linear programming technique, creates a best practice frontier by comparing observed production given the amount of resources used. The model is output-oriented and considers variable returns to scale. Network data envelopment analysis considers link variables belonging to more than one dimension (in the model, medical residents, adjusted admissions, and research projects). Dynamic network data envelopment analysis uses carry-over variables (in the model, financing budget) to analyze frontier shift in subsequent years. Data were gathered from the information system of the Brazilian Ministry of Education (MEC), 2010-2013.
  
  
  RESULTS
  The mean scores for health care, teaching and research over the period were 58.0%, 86.0%, and 61.0%, respectively. In 2012, the best performance year, for all units to reach the frontier it would be necessary to have a mean increase of 65.0% in outpatient visits; 34.0% in admissions; 12.0% in undergraduate students; 13.0% in multi-professional residents; 48.0% in graduate students; 7.0% in research projects; besides a decrease of 9.0% in medical residents. In the same year, an increase of 0.9% in financing budget would be necessary to improve the care output frontier. In the dynamic evaluation, there was progress in teaching efficiency, oscillation in medical care and no variation in research.
  
  
  CONCLUSIONS
  The proposed model generates public health planning and programming parameters by estimating efficiency scores and making projections to reach the best practice frontier.
authors.affiliation: Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Maria Stella de Castro
authors.initials: MS
authors.lastname: Lobo
authors.affiliation: Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Henrique de Castro
authors.initials: Hde C
authors.lastname: Rodrigues
authors.affiliation: Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Edgard Caires Gazzola
authors.initials: EC
authors.lastname: André
authors.affiliation: Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Jônatas Almeida
authors.initials: JA
authors.lastname: de Azeredo
authors.affiliation: Departamento de Engenharia de Produção, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Marcos Pereira Estellita
authors.initials: MP
authors.lastname: Lins
mesh_terms: D003695:Delivery of Health Care; D017598:Efficiency, Organizational; D006785:Hospitals, University / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D011382:Programming, Linear