Hip fracture surgery efficiency in Israeli hospitals via a network data envelopment analysis

Data envelopment analysis (DEA) has been used previously for examining hospital efficiency, based on administrative data. Yet, previous DEA research devoted to quality assurance rarely considered medical processes or outcomes in efficiency studies. The goal of this study is to examine the relative efficiency of hip fracture surgery, based on clinical data reflecting medical process indicators and outcomes. To accomplish our goal, recent developments in DEA research were harnessed to model an output-oriented two-stage DEA network. The proposed DEA model has: two input variables reflecting the condition of the patient, fracture type and Charlson index; two intermediate variables reflecting clinical decisions, surgery within 48 h and usage of a drain for 1 day (rate); and two output variables reflecting the success of the surgery, survival rate after surgery and the rate of no infection. Using data from orthopedic wards in most of the acute Israeli hospitals (20 out of 22), no statistically significant correlation was found, either between the socio-economic index of patients who had hip fracture surgery and the relative efficiency scores produced by the two-stage network DEA model, or between efficiency and the geographical periphery status of the hospital. In addition to this, which points to a degree of social equality regarding hip fracture surgeries, we also compared the two-stage network model and related DEA models, providing several lemmas that represent the relationships between the various models mathematically.