Appendix G: Characteristics of Health Care Efficiency Measures Published in Peer-Reviewed Literature [1982-2006]

Health Care Efficiency Measures: Identification, Categorization, and Evaluation

Contents
United States Only - Unit of Observation: Hospital
Unit of Observation: Hospital (Continued)
United States Only - Unit of Observation: Physician
United States Only - Unit of Observation: Health Plans
United States Only - Unit of Observation: Nurses
United States Only - Unit of Observation: Other

United States Only - Unit of Observation: Hospital N=93

Author, year	Type of paper	Unit of observation	Sample size	Data source	Time frame	Years	Inputs	Outputs	PR	AC	PT	CM	Method	Data on reliability, sensitivity analysis, validity reported?
Kessler DP et al., 2002¹	Research	Hospital	1,661,674 Patients	Secondary data	Longitudinal	1985-1996	Total costs Financial	Episode of care Health services	X	X	X	X	Other regression-based approach	No /Yes/No
							Episode of care Physical	Health outcome Health outcomes	X	X	X	X	Other regression-based approach	No /Yes/No
Carey K, 2003²	Research	Hospital	1,209 Hospitals	Secondary data	Cross-sectional	1998	Other labor costs(f), Beds (counts)(p), Total costs(f) Physical Financial	Hosp discharge(s), Health outcome(o), Hosp days(s) Health services Health outcomes	X	X		X	SFA	No /No /No
Nunamaker TR, 1983³	Research	Hospital	17 Hospitals	Secondary data	Longitudinal	1978-1979	Total costs Financial	Hosp days Health services					Ratios, DEA	No /Yes/No
Maindiratta A, 1990⁴	Research	Hospital	55 Hospitals	Not specified	Cross-sectional	Yrs N/R	Nurse labor costs, Administrative staff labor costs, Ancillary cost Financial	Hosp days Health services					DEA	No /No /No
Alexander JA et al., 1994⁵	Research	Hospital	333 Hospitals	Secondary data	Cross-sectional	1981	Other labor costs Financial	Hosp days Health services	X	X			Ratios	No /Yes/No
							Operating cost Financial	Hosp days Health services	X	X			Ratios	No /Yes/No
Chirikos TN et al., 1994⁶	Research	Hospital	189 Hospitals	Secondary data	Cross-sectional	1989	Other labor costs, Operating cost Financial	Hosp days Health services	X	X		X	DEA	No /No /No
Bradford WD et al., 1996⁷	Research	Hospital	379 Hospitals	Secondary data	Cross-sectional	1986	Other labor costs, Other capital costs Financial	Hosp days Health services	X	X			Other regression-based approach	No /No /No
Rosko MD et al., 1999⁸	Research	Hospital	195 Hospitals	Secondary data	Cross-sectional	1989	Other labor costs, Other capital costs, Total costs Financial	Physician visit, Hosp discharge Health services	X	X		X	SFA	No /Yes/No
Morey RC et al., 2000⁹	Descriptive	Hospital	27 Hospitals	Secondary data	Cross-sectional	1987-1988	Total costs Financial	Hosp discharge Health services	X	X		X	DEA	No /No /No
Chirikos TN et al., 2000¹⁰	Research	Hospital	186 Hospitals	Secondary data	Longitudinal	1982-1993	Administrative staff labor costs, Other labor costs, Equipment capital costs, Other capital costs, Other costs Financial	Outpatient procedure, Hosp discharge, Hosp days Health services	X			X	DEA, SFA	No /Yes/No
Rosko MD, 2001¹¹	Research	Hospital	1,631 Hospitals	Secondary data	Longitudinal	1990-1996	Other labor costs, Other capital costs, Total expenses minus physician expenses Financial	Physician visit, Hosp discharge Health services	X	X		X	SFA	No /Yes/No
Cleverley WO, 2002¹²	Descriptive, Develop methodology	Hospital	1 Hospital	Not specified	N/A	Yrs N/A	Total costs Financial	Hosp discharge Health services		X		X	Ratios	No /No /No
							Total costs Financial	Outpatient procedure Health services				X	Ratios	No /No /No
							Total costs Financial	Outpatient procedure, Hosp discharge Health services		X		X	Ratios	No /No /No
O'Neal PV et al., 2002¹³	Research	Hospital	69 Hospitals, 7,961 Patients	Secondary data	Cross-sectional	1997	Drug capital costs, Other capital costs Financial	Hosp days Health services					DEA	No /No /No
							Drug capital costs, Other capital costs Financial	Hosp discharge Health services					DEA	No /No /No
Sari N, 2003¹⁴	Research	Hospital	125 Hospitals	Secondary data	Longitudinal	1990-1992-1994-1997	Other labor costs, Total costs Financial	Physician visit, Hosp discharge Health services	X	X	X	X	SFA, Other regression-based approach	No /Yes/No
Rosko MD, 2004¹⁵	Research	Hospital	616 Hospitals	Secondary data	Longitudinal	1990-1999	Total costs Financial	Physician visit, Hosp discharge Health services	X	X		X	SFA	No /Yes/No
Rosko MD et al., 2005¹⁶	Research	Hospital	1,368 Hospitals	Secondary data	Cross-sectional	1998	Other labor costs, Other capital costs, Total costs Financial	Outpatient procedure, Physician visit, Hosp discharge, Emergency visit Health services	X	X		X	SFA	No /Yes/No
Grosskopf S et al., 1987¹⁷	Research	Hospital	82 Hospitals	Secondary data	Cross-sectional	1982	Number of physicians, Number of other personnel, Total assets, Discharges Physical	Outpatient procedure, Inpatient procedure, Physician visit, Emergency visit, Hosp days Health services					DEA	No /Yes/No
Byrnes P et al., 1989¹⁸	Research	Hospital	123 Hospitals	Secondary data	Cross-sectional	1983	Number of physicians, Nurse time, Administrative staff time, Technical staff time, Beds (counts) Physical	Hosp discharge Health services					DEA	No /No /No
Ashby JL et al., 1992¹⁹	Descriptive, Develop methodology	Hospital	NR	Secondary data	Longitudinal	1980-1989	Number of other personnel Physical	Hosp discharge Health services	X			X	Ratios	No /No /No
							Number of other personnel Physical	Inpatient procedure Health services	X			X	Ratios	No /No /No
Valdmanis V, 1992²⁰	Research	Hospital	41 Hospitals	Secondary data	Cross-sectional	1982	Number of physicians, Number of nurses, Number of other personnel, Discharges, Total assets Physical	Hosp days Health services	X				DEA	No /No /No
							Number of physicians, Number of nurses, Number of other personnel, Beds (counts), Discharges Physical	Hosp days Health services	X				DEA	No /No /No
							Number of physicians, Number of nurses, Number of other personnel, Beds (counts) Physical	Hosp days Health services	X				DEA	No /No /No
							Number of physicians, Number of nurses, Number of other personnel, Total assets, Discharges Physical	Inpatient procedure, Physician visit, Emergency visit, Hosp days Health services	X				DEA	No /No /No
							Number of physicians, Number of other personnel, Discharges, Total assets Physical	Inpatient procedure, Hosp days, ICU days Health services	X				DEA	No /No /No
							Number of physicians, Number of other personnel, Discharges, Total assets Physical	Inpatient procedure, Hosp days, ICU days Health services	X				DEA	No /No /No
							Number of nurses, Number of other personnel, Discharges, Total assets Physical	Inpatient procedure, Hosp days, ICU days Health services	X				DEA	No /No /No
							Number of other personnel, Nurse time, Discharges, Total assets Physical	Inpatient procedure, Hosp days, ICU days Health services	X				DEA	No /No /No
							Number of other personnel, Discharges, Total assets Physical	Inpatient procedure(s), Hosp days(s), ICU days(s), House staff(other) Health services Other	X				DEA	No /No /No
							Number of other personnel, Discharges, Total assets Physical	Inpatient procedure(s), Hosp days(s), ICU days(s), House staff(other) Health services Other	X				DEA	No /No /No
Grosskopf S et al., 1993²¹	Research	Hospital	108 Hospitals	Secondary data	Cross-sectional	1982	Number of physicians, Number of other personnel, Total assets Physical	Outpatient procedure, Inpatient procedure, Physician visit, Emergency visit, Hosp days Health services				X	DEA	No /Yes/No
Ferrier GD et al., 1996²²	Research	Hospital	360 Hospitals	Secondary data	Cross-sectional	1989	Number of other personnel, Beds (counts), Wage rate/wages, Total assets Physical	Inpatient procedure, Physician visit, Hosp discharge, Hosp days Health services	X	X		X	DEA	No /Yes/No
Phillips JF, 1999²³	Descriptive	Hospital	39 Hospitals	Secondary data	Cross-sectional	1992-1996	Beds (counts) Physical	Hosp days Health services					Ratios	No /No /No
							Hosp days Physical	Hosp discharge Health services					Ratios	No /No /No
Grosskopf S et al., 2001²⁴	Research	Hospital	792 Hospitals	Secondary data	Cross-sectional	1994	Number of physicians, Number of nurses, Number of other personnel, Beds (counts) Physical	Outpatient procedure, Inpatient procedure, Physician visit, Hosp discharge, Emergency visit Health services	X				DEA	No /Yes/No
Mobley LR et al., 2002²⁵	Research	Hospital	348 Hospitals	Secondary data	Cross-sectional	1998	Number of physicians, Number of nurses, Number of administrative staff, Number of technical staff, Beds (counts) Physical	Physician visit, Hosp discharge, Hosp days, Ancillary care Health services	X	X		X	DEA	No /Yes/No
Saint S et al., 2003²⁶	Descriptive	Hospital	1 Hospital	Primary data	Cross-sectional	1993-1996	Hosp days Physical	Hosp discharge Health services				X	Ratios	No /No /No
							RVU Physical	Hosp discharge Health services				X	Ratios	No /No /No
Sherman HD, 1984²⁷	Research	Hospital	7 Hospitals	Primary data	Cross-sectional	1976	Number of other personnel(p), Supply capital costs(f), Beds (counts)(p) Physical Financial	Hosp days(s), Training(other) Health services Other			X		DEA	No /Yes/Yes
							Total costs Financial	Hosp days Health services					Ratios	No /No /Yes
Banker RD et al., 1986²⁸	Research	Hospital	114 Hospitals	Secondary data	Cross-sectional	1978	Nurse labor costs(f), Administrative staff labor costs(f), Beds (counts)(p), Ancillary cost(f) Physical Financial	Hosp days Health services			X		DEA, Other regression-based approach	No /Yes/No
Bitran GR et al., 1987²⁹	Research	Hospital	160 Hospitals	Primary data	Cross-sectional	1983	Number of other personnel(p), Physician labor costs(f), Other costs(f) Physical Financial	Hosp discharge Health services					DEA, Other regression-based approach	No /Yes/No
Borden JP, 1988³⁰	Research	Hospital	52 Hospitals	Secondary data	Longitudinal	1979-1984	Number of nurses(p), Number of other personnel(p), Other capital costs(f), Beds (counts)(p) Physical Financial	Hosp discharge Health services				X	DEA	No /No /No
							Total costs Financial	Hosp discharge Health services					Ratios	No /No /No
							Total costs Financial	Hosp discharge Health services				X	Other regression-based approach	No /No /No
Valdmanis VG, 1990³¹	Research	Hospital	41 Hospitals	Secondary data	Cross-sectional	1982	Number of physicians(p), Number of other personnel(p), Other capital costs(f) Physical Financial	Inpatient procedure, Physician visit, Emergency visit, Hosp days, ICU days Health services	X				DEA	No /Yes/No
Sear AM, 1991³²	Descriptive	Hospital	142 Hospitals	Secondary data	Longitudinal	1982-1988	Number of other personnel Physical	Beds Other	X				Ratios	No /No /No
							Number of other personnel Physical	Hosp days Health services	X				Ratios	No /No /No
							Other labor costs Financial	Hosp days Health services	X				Ratios	No /No /No
DesHarnais S et al., 1991³³	Research	Hospital	245 Hospitals	Secondary data	Longitudinal	1983-1984	Number of physicians(p), Number of nurses(p), Number of administrative staff(p), Number of technical staff(p), Other capital costs(f), Beds (counts)(p), Other counts(p) Physical Financial	Outpatient procedure(s), Physician visit(s), Hosp discharge(s), Emergency visit(s), Sub-acute/long-term patients(s), Trainees (FTEs)(other) Health services Other			X	X	DEA	No /No /No
Dittman DA et al., 1991³⁴	Research	Hospital	105 Hospitals	Secondary data	Cross-sectional	1981	Nurse time(p), Beds (counts)(p), Other costs(f), Hosp days(p) Physical Financial	Hosp discharge, Charges Health services					DEA	No /No /No
							Nurse time(p), Beds (counts)(p), Other costs(f), Number of outpatient surgical centers(p), Wage rate/wages(p) Physical Financial	Hosp discharge, Charges Health services					DEA	No /No /No
							Nurse time(p), Beds (counts)(p), Other costs(f) Physical Financial	Hosp discharge, Hosp days Health services					DEA	No /No /No
Ozcan YA, 1992³⁵	Research	Hospital	40 Hospitals	Secondary data	Cross-sectional	1989	Number of nurses(p), Number of administrative staff(p), Number of other personnel(p), Beds (counts)(p), Operating cost(f), Total assets(p) Physical Financial	Physician visit(s), Hosp discharge(s), Hosp days(s), Trainees (FTEs)(other) Health services Other				X	DEA	No /Yes/No
Bradbury RC et al., 1993³⁶	Research	Hospital	10 Hospitals	Secondary data	Longitudinal	1988-1989	Total costs Financial	Hosp discharge Health services			X	X	Other regression-based approach	No /No /No
							Other costs Financial	Hosp discharge Health services			X	X	Other regression-based approach	No /No /No
							Hosp days Financial	Hosp discharge Health services			X	X	Other regression-based approach	No /No /No
McCue MJ et al., 1993³⁷	Descriptive	Hospital	84 Hospitals	Secondary data	Cross-sectional	1986-1990	Beds (counts) Physical	Hosp days Health services	X				Ratios	No /No /No
							Hosp days Physical	Hosp discharge Health services	X		X		Ratios	No /No /No
							Beds (counts) Physical	Hosp discharge Health services	X		X		Ratios	No /No /No
							Number of other personnel Physical	Hosp days Health services	X		X		Ratios	No /No /No
							Total costs Financial	Hosp days Health services	X		X		Ratios	No /No /No
							Total costs Financial	Hosp discharge Health services	X		X		Ratios	No /No /No
							Routine expenses Financial	Hosp days Health services	X		X		Ratios	No /No /No
							Routine expenses Financial	Hosp discharge Health services	X		X		Ratios	No /No /No
							Other labor costs Financial	Hosp days Health services	X		X		Ratios	No /No /No
							Other labor costs Financial	Hosp discharge Health services	X		X		Ratios	No /No /No
Hogan AJ et al., 1993³⁸	Research	Hospital	300 Hospitals	Secondary data	Cross-sectional	1983-1984	Number of physicians(p), Number of nurses(p), Number of administrative staff(p), Number of other personnel(p), Supply capital costs(f), Other capital costs(f), Beds (counts)(p), Other counts(p) Physical Financial	Outpatient procedure, Physician visit, Hosp discharge, Emergency visit, Hosp days, Training Health services	X	X		X	DEA	No /Yes/No
Ozcan YA et al., 1994³⁹	Research	Hospital	124 Hospitals	Secondary data	Longitudinal	1988-1990	Hosp days Physical	Hosp discharge Health services					Ratios	No /No /No
							Number of physicians(p), Number of nurses(p), Number of other personnel(p), Supply capital costs(f), Beds (counts)(p), Other counts(p) Physical Financial	Physician visit, Hosp days Health services					DEA	No /No /No
							Beds (counts) Physical	Hosp discharge Health services					Ratios	No /No /No
							Beds (counts) Physical	Hosp days Health services					Ratios	No /No /No
							Number of other personnel Physical	Physician visit Health services					Ratios	No /No /No
Byrnes, Patricia et al., 1994⁴⁰	Research	Hospital	123 Hospitals	Secondary data	Cross-sectional	1983	Number of nurses(p), Number of administrative staff(p), Number of technical staff(p), Number of other personnel(p), Other capital costs(f), Beds (counts)(p) Physical Financial	Hosp discharge Health services					DEA	No /No /No
Zuckerman S et al., 1994⁴¹	Research	Hospital	4,149 Hospitals	Secondary data	Cross-sectional	1986-1987	Other capital costs(f), Total costs(f), Wage rate/wages(p) Physical Financial	Physician visit, Hosp discharge, Hosp days Health services	X	X	X	X	SFA	No /No /No
Vitaliano DF et al., 1996⁴²	Research	Hospital	219 Hospitals	Secondary data	Cross-sectional	1991	Nurse labor costs(f), Technical staff labor costs(f), Other counts(p), Total costs(f) Physical Financial	Physician visit, Emergency visit, Hosp days Health services	X			X	SFA	No /No /Yes
White KR et al., 1996⁴³	Research	Hospital	170 Hospitals	Secondary data	Cross-sectional	1992	Number of other personnel(p), Beds (counts)(p), Service volume(p), Operating cost(f) Physical Financial	Physician visit, Hosp discharge Health services	X			X	DEA	No /No /No
Morey RC et al., 1996⁴⁴	Research	Hospital	105 Hospitals	Secondary data	Cross-sectional	1978	Nurse labor costs(f), Administrative staff labor costs(f), Beds (counts)(p), Total costs(f), Total assets(p), Ancillary cost(f) Physical Financial	Hosp days Health services	X				DEA	No /No /No
Koop G et al., 1997⁴⁵	Research	Hospital	382 Hospitals	Secondary data	Longitudinal	1987-1991	Other labor costs(f), Other capital costs(f), Beds (counts)(p), Operating cost(f), Total assets(p) Physical Financial	Physician visit, Hosp discharge, Hosp days Health services	X			X	SFA	No /Yes/No
Chirikos TN, 1998⁴⁶	Research	Hospital	186 Hospitals	Secondary data	Longitudinal	1982-1993	Other labor costs(f), Equipment capital costs(f), Other capital costs(f), Beds (counts)(p), Total costs(f) Physical Financial	Hosp discharge, Hosp days Health services	X	X		X	SFA	No /Yes/No
O'Neill L, 1998⁴⁷	Research	Hospital	27 Hospitals	Secondary data	Cross-sectional	1992	Number of other personnel(p), Beds (counts)(p), Other counts(p), Operating cost(f) Physical Financial	Physician visit, Hosp discharge, Training Health services				X	DEA	No /No /No
Chirikos TN, 1998⁴⁸	Research	Hospital	186 Hospitals	Secondary data	Longitudinal	1982-1993	Equipment capital costs(f), Other capital costs(f), Total costs(f), Wage rate/wages(p) Physical Financial	Hosp discharge, Hosp days Health services	X			X	SFA	No /No /No
Ozcan YA et al., 1998⁴⁹	Research	Hospital	214 Hospitals	Secondary data	Cross-sectional	1989	Hosp days(p), Total charges(f), Other costs(f) Physical Financial	Hosp discharge Health services	X				DEA	No /No /No
Picker Institute, 1999⁵⁰	Descriptive	Hospital	NR	Data source N/A	Longitudinal	Yrs N/R	Total costs Financial	Hosp discharge Health services				X	Ratios	No /No /No
							Number of other personnel Physical	Hosp days Health services					Ratios	No /No /No

[This table is continued in next section]

*Explanatory variables: PR=Provider characteristics, AC=Area characteristics, PT=Patient characteristics, CM=Case mix adjustment, PM=Payment method

Page last reviewed April 2008

Internet Citation: Appendix G: Characteristics of Health Care Efficiency Measures Published in Peer-Reviewed Literature [1982-2006]: Health Care Efficiency Measures: Identification, Categorization, and Evaluation. April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/final-reports/efficiency/hcemappg.html