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

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.