RESUMO
BACKGROUND: Nigeria health sector, like that of other sub-Saharan African countries, increasingly faces critical resource constraints. Thus, there is need to seek for ways of improving efficient use of scarce health resources. The aim of this study was to determine resource utilization rate of teaching hospitals in Southeast Nigeria as a means of estimating their efficiency. METHODS: The study is a longitudinal cross sectional study. It applied ratio indicators and Pabon Lasso model using data on the number of hospital bed, number of inpatients and total inpatient-days from purposefully selected teaching hospitals in Southeast Nigeria to measure efficiency over a period of 6 years (2011-2011). RESULTS: The hospitals' mean bed occupancy rate was as low as 42.14%, far below standard benchmark of 80-85%. The mean average length of stay was as high as 8.15 days and observed mean bed turnover was 21.27 patients/bed/year. These findings portrayed high level of inefficiency in Nigeria teaching hospitals, which was further illustrated by Pabon Lasso graph, with only 10-20% of the hospital-years located within or near the efficient zone or quadrant. CONCLUSION: The study was able to show that health ratio indicators such as hospital bed turnover rate (BTR) and bed occupancy rate (BOR), as well as patients' average length of stay (ALS) can be used as tools for assessing hospital performance or its efficiency in resource utilization. Thus, in low and middle income countries where medical record keeping may be inadequate or poor, ratio indicators used alone or with Pabon Lasso graph/chart could be an optional metrics for hospital efficiency.
RESUMO
BACKGROUND: To determine how socioeconomic factors, such as level of education and employment status, affect patient experiences on quality of care for ambulatory healthcare services in teaching hospitals in southeast Nigeria. METHODS: The study is of a cross-sectional design and exit poll was used to collect its data. A pre-tested structured questionnaire was administered to clients accessing care in the outpatient departments of three tertiary hospitals in Nigeria. The assessment of patient experiences for quality of care was based on five (5) domains of care: waiting time; environment of the outpatient department; quality of doctor's care; quality of care by nurses/other health workers; and responsiveness of care. In addition, the overall quality of care was assessed. RESULTS: The mean rating of patient experience for quality of care for ambulatory healthcare services (outpatients' care) was 74.31 ± 0.32%. Moderate differences were observed between the hospitals assessed for various levels of patients' care, especially for waiting time, quality of doctors' care and overall quality of care. Employment status was a statistically significant (p ≤ 0.05) determinant of overall patient experience rating for quality of care, while the level of patient's education was an influence on the perception of waiting by the patients and their rating of care from nurses/other healthcare providers (apart from medical doctors). CONCLUSION: The study showed that educational and employment status (measures of socioeconomic status) of patients determined how patients receiving ambulatory (outpatient) healthcare services perceived the quality of care in the hospitals. Hence, in order to ensure equity, there is need to institutionalize patient-centered care, while full consideration is given to the patients' socioeconomic status.
