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International Journal for Quality in Health Care Advance Access originally published online on March 23, 2005
International Journal for Quality in Health Care 2005 17(3):259-267; doi:10.1093/intqhc/mzi032
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International Journal for Quality in Health Care vol. 17 no. 3 © The Author 2005. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved

The association between quality of care and technical efficiency in long-term care

Juha Laine1, U. Harriet Finne-Soveri1, Magnus Björkgren2, Miika Linna1, Anja Noro1 and Unto Häkkinen1

1 Centre for Health Economics at STAKES – CHESS, Helsinki, Finland, 2 Chydenius Institute, University of Jyväskylä, Kokkola, Finland

Objective. To analyse the association between quality of care and technical (productive) efficiency in institutional long-term care wards for the elderly.

Setting. One hundred and fourteen public health centre hospitals and residential homes in Finland.

Study design. Wards were divided into two categories according to their rank in the quality distribution, considering 41 quality variables separately. The technical efficiency scores of the good- and poor-quality groups were compared using cross-sectional data.

Methods. Data envelopment analysis was used for calculating technical efficiency. The Mann–Whitney test and correlation coefficients were used to explore the association between quality and efficiency.

Results. The wards where quality indicators indicated less pro-active (passive) nursing practice and more dependent patients—for instance, in terms of very high prevalence of bedfast residents or very high prevalence of daily physical restraints—performed more efficiently than the comparison group.

Conclusion. The results suggest that an association may exist between technical efficiency and unwanted dimensions of quality. Hence, the efficiency and quality of care are essential aspects of management and performance measurement in elderly care.

Keywords: data envelopment analysis, long-term care, quality, technical efficiency

Address reprint requests to Juha Laine, STAKES, Lintulahdenkuja 4, PO Box 220 FIN-00531 Helsinki, Finland. E-mail: juha.laine{at}stakes.fi


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