What Counts in Nursing Homes’ Quality and Efficiency? Results From Data Envelopment Analysis in Italy

Purpose: Economic resource constrains in public spending budget in a country, such as Italy, with an ageing population with high incidence of chronic diseases calls for better strategies to improve measuring quality and efficiency in nursing homes (NHs). This paper analyses the efficiency of 40 NHs based in Tuscany considering not only structural characteristics but also quality of care, including residents, relatives and staff satisfaction. Methodology: We run a classic data envelopment analysis (DEA) on data gathered by the NHs' regional performance evaluation system. We include as inputs the number of total work hours as labour and the daily cost for services as economic resources. As outputs we include measures for quality of care (number of falls, urinary infections and antidepressants), satisfaction (residents, relatives and professionals) and quality of life (days of recreational activities). We run a multivariate regression to analyse the determinants of previously obtained efficiency scores considering factors such as: institutional (ownership), managerial (training) and clinical (patient's severity). Findings: Results find 35% efficient NHs. Moreover, management and the managerial factor (staff trained in end-of-life support) are predictors of the efficiency score. Originality: Our study uses satisfaction (residents, relatives and professionals) measures as proxy for quality output in the DEA model and measures related to staff management (eg training) as predictors of the efficiency scores.