Exploring the use of DEA for formative evaluation in primary diabetes care: An application to compare English practices

Abstract

Primary care is currently at the heart of the UK National Health Service policy. Primary care trusts have the crucial role of improving the efficiency and equity in primary care delivery. However, few studies have focused on performance assessment in primary care provision. In this paper, we examine the role of data envelopment analysis (DEA) in helping decision makers to understand and improve the performance of primary care practices. We discuss the results from a study of 14 practices in England in terms of their delivery of diabetes services. In order to take into account the multiple values that underlie public services provision, we have considered several different perspectives for evaluation. These were: technical, allocative and cost efficiency, clinical and patient-focused effectiveness, and equity. The approach adopted involved a deep engagement with the practices. The purpose was to understand the structures and processes supporting effective practice using DEA in a formative role rather than the more usual summative role with a large data set. This approach is in the tradition of the developmental engagement approach of operational research.

Keywords:

• data envelopment analysis
• health service
• equity
• efficiency
• effectiveness

Acknowledgements

Financial support for the research carried out by Carla Amado was gratefully received from the Fundação para a Ciência e a Tecnologia in Portugal. Acknowledgement is also due to all the participating Primary Care Trusts and practices. This research project was given full ethics approval on 24 July 2002 by the West Midlands Multi-centre Research Ethics Committee in England.