Measurement and Interpretation of Productivity (1979) / Chapter Skim
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Measuring Outputs in Hospitals
Measuring Outputs in Hospitals
Pages 255-275
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From page 255... ...
Since outputs are produced by firms or organizations, when there are difficulties in conceptualizing and measuring outputs, it seems sensible to seek clarity at the firm level. While several approaches to the study of outputs in hospitals will be described, I will discuss in greater detail in the final section of the paper some of the work my colleagues and I have carried out at the Stanford Center for Health Care Research.
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From page 256... ...
Labor costs in hospitals have also risen faster than those of the rest of the economy during the period under review, an average annual increase of 9 percent. Labor inputs can also be decomposed into price and volume increases: labor costs have increased both because of higher wage rates and because of increases in the number of employees per patient day.
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From page 257... ...
The largest changes observed were the increased number of MDS employed by hospitals and increases in the number of residents and interns per patient load (Stanford Center for Health Care Research 1977, p.
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From page 258... ...
Unfortunately, what is learned may not be consistent, as will be discussed below. PROCESS MEASURES OF HOSPITAL CARE Process measures focus on the functioning of the hospital as indicated by the number and type of services performed for patients.
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From page 259... ...
OUTCOME MEASURES OF HOSPITAL CARE Outcome measures focus attention on the characteristics of' lllatelials Ol' objects on which the organization performs. As opposed to process measures, which assess el'l'ort or activities, outcome indicators Incus on what el'l'ects have actually been achieved.
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From page 260... ...
The second is a problem which plagues both process and outcome measures, as already noted. Let us see how health care researchers have dealt with these two problems.
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From page 261... ...
Nevertheless, with all their problems, outcome measures focus attention on effects as opposed to efforts and hence are more likely to avoid the fallacy of using measures of inputs as surrogates for outputs. ADJUSTING PROCESS AND OUTCOME MEASURES FOR DIFFERENCES IN PATIENT MIX It has been asserted that hospital output, whether measured in terms of services or outcomes, varies over time and across hospitals.
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From page 262... ...
In the final section of this paper, a more elaborate attempt to adjust service and outcome measures for patient differences will be described. PROCESS VERSUS OUTCOME MEASURES OF QUALITY OF CARE Process measures of care quality are much more widely employed than outcome measures.
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From page 263... ...
a careful attempt is made to adjust both services and outcomes for differences among patients, (2) direct measures of several types of diagnostic and therapeutic services are developed, and 2This research was carried out by the Stanford Center for Health Care Research under contract HRA 230-75-0169 with the National Center for Health Services Research, Health Resources Administration, U.S.
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From page 264... ...
DATA AND METHODOLOGY The data used in this study involve over 600,000 patients treated during the 4-year period 1970-1973 in 17 acute care hospitals in the United States. These hospitals had all participated in a prospective study of organizational factors affecting quality of surgical care carried out by the Stanford Center for Health Care Research (19741.
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From page 265... ...
The first composite measure, service intensity, was based on the mix of specific diagnostic and therapeutic services received during the hospitalization including the use of special care units. The second composite measure, service duration, was based upon the length of stay in days and reflects the amount of basic nursing and hotel services provided during the hospitalization.
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From page 267... ...
Details of' this procedure and technique for standardization have been described elsewhere Stanford Center idol Health Care Research 19771. After obtaining the estimates of' the services expected, a comparison is made with the services actually received.
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From page 268... ...
Almost all of the individual measures making up the component exhibited an increase over the 4-year period: the largest single increase was recorded for the use of special care units, which showed a 3.3-percent annual increase. Service duration measured by length of stay decreased on the average by 0.38 days, from 8.61 days in 1970 to 8.29 days in 1973.
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From page 269... ...
The coefficient of variation for differences in service intensity among hospitals was 7 percent; for service duration it was 14 percent; and the coefficient for the overall composite measure was 8 percent. Substantial variation was also found among hospitals in adjusted death rates.
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From page 271... ...
In contrast, longer service duration was associated with an increased death rate (0.64~. Not surprisingly, given the relationship of the composite measure of overall services to its two components, specific services and routine services, the overall services paralleled the finding for service duration but was not as strong (0.45~.
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From page 272... ...
Consistent with the effect reported in Table 2 and in the margins of Figure 1, the effect of standardized duration was stronger than that for service intensity. That is, the hospitals ranked fourth, sixth, seventh, and eleventh best in terms of their standardized outcomes were in the cell with shorter service duration and lower service intensity, while the hospitals ranked ninth, tenth, and twelfth best were in the cell with longer service duration and higher service intensity.
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From page 273... ...
, several alternative outcome measures were examined including morbidity at seven days postsurgery, return to function at 40 days, and mortalityincluding death outside of the hospital at 40 days. As described elsewhere (Scott et al.
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From page 274... ...
(1974) Evaluating the quality of hospital care through severity-adjusted death rates: some pitfalls.
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From page 275... ...
Springfield, Va.: National Technical Information Service. Stanford Center for Health Care Research (1976)
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