PMID- 34639287
OWN - NLM
STAT- MEDLINE
DCOM- 20211025
LR  - 20211025
IS  - 1660-4601 (Electronic)
IS  - 1661-7827 (Print)
IS  - 1660-4601 (Linking)
VI  - 18
IP  - 19
DP  - 2021 Sep 23
TI  - Measuring Quality of Public Hospitals in Croatia Using a Multi-Criteria Approach.
LID - 10.3390/ijerph18199984 [doi]
LID - 9984
AB  - Quality of public hospital services presents one of the most important aspects of 
      public health in general. A significant number of health services are delivered 
      due to public hospitals. Under the World Bank program "Improving Quality and 
      Efficiency of Health Services: Program for Results", the competent bodies in 
      Croatia aimed to identify the top 40% best-performing public acute hospitals in 
      Croatia, based on a clinical audit in the preceding 12 months. This paper 
      presents how this goal was achieved, using a multi-criteria decision-making 
      (MCDM) approach. A MCDM approach was selected due to the multidimensionality and 
      complexity of healthcare performance and service quality. We aimed to develop a 
      methodology for ranking top-performing hospitals at the national level. We chose 
      the composite indicator methodology, combined with the analytic hierarchy process 
      (AHP) as a tool for determining weights for aggregation of individual indicators. 
      The study looked at three clinical entities: acute myocardial infarction, 
      cerebrovascular insult, and antimicrobial prophylaxis in colorectal surgery. 
      Indicators for each entity were evidence-based, following the national 
      guidelines, but limited by availability of data. The clinical audit and databases 
      of competent administrative bodies were used as sources of data. The problem 
      investigated in this paper has a significant impact at the strategic (national) 
      level. Even though the AHP has already been applied in the public health domain, 
      to the best of our knowledge, this is the first application of the AHP in 
      combination with composite indicators for hospital ranking at a national level. 
      The AHP enabled participation of experts from the audited hospitals in the 
      assessment of indicator weights. Results show that composite indicators can be 
      successfully implemented for acute hospital evaluation using the AHP methodology: 
      (1) the AHP supported a flexible structuring of the problem; (2) the resulting 
      complexity of pairwise comparisons was appropriate for the experts (consistency 
      ratios were under 0.1); (3) using the AHP approach enabled a successful 
      aggregation of different opinions into group priorities; (4) the developed 
      methodology was robust and enabled identifying the top 40% ranking 
      best-performing public acute hospitals in Croatia combining 20 criteria within 
      three entities, based on input from 36 clinical experts. The proposed methodology 
      can be useful to other researchers for assessment of healthcare quality at the 
      strategic level.
FAU - Kadoic, Nikola
AU  - Kadoic N
AUID- ORCID: 0000-0002-8455-9105
AD  - Faculty of Organization and Informatics, University of Zagreb, Pavlinska Cesta 2, 
      HR-42000 Varazdin, Croatia.
FAU - Simic, Diana
AU  - Simic D
AUID- ORCID: 0000-0002-6721-7250
AD  - Faculty of Organization and Informatics, University of Zagreb, Pavlinska Cesta 2, 
      HR-42000 Varazdin, Croatia.
FAU - Mesaric, Jasna
AU  - Mesaric J
AUID- ORCID: 0000-0003-3710-8931
AD  - Faculty of Health Sciences, Libertas International University, Trg J.F. Kennedy 
      6b, HR-10000 Zagreb, Croatia.
FAU - Begicevic Redep, Nina
AU  - Begicevic Redep N
AUID- ORCID: 0000-0002-6588-536X
AD  - Faculty of Organization and Informatics, University of Zagreb, Pavlinska Cesta 2, 
      HR-42000 Varazdin, Croatia.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210923
PL  - Switzerland
TA  - Int J Environ Res Public Health
JT  - International journal of environmental research and public health
JID - 101238455
SB  - IM
MH  - Croatia
MH  - *Delivery of Health Care
MH  - Health Services
MH  - *Hospitals, Public
PMC - PMC8507685
OTO - NOTNLM
OT  - analytic hierarchy process
OT  - composite indicator
OT  - group decision making
OT  - healthcare policy
OT  - hospital
OT  - performance indicator
COIS- The funders had no role in the design of the study; in the collection, analyses, 
      or interpretation of data; in the writing of the manuscript, or in the decision 
      to publish the results.
EDAT- 2021/10/14 06:00
MHDA- 2021/10/26 06:00
PMCR- 2021/09/23
CRDT- 2021/10/13 01:06
PHST- 2021/07/26 00:00 [received]
PHST- 2021/09/06 00:00 [revised]
PHST- 2021/09/14 00:00 [accepted]
PHST- 2021/10/13 01:06 [entrez]
PHST- 2021/10/14 06:00 [pubmed]
PHST- 2021/10/26 06:00 [medline]
PHST- 2021/09/23 00:00 [pmc-release]
AID - ijerph18199984 [pii]
AID - ijerph-18-09984 [pii]
AID - 10.3390/ijerph18199984 [doi]
PST - epublish
SO  - Int J Environ Res Public Health. 2021 Sep 23;18(19):9984. doi: 
      10.3390/ijerph18199984.