Efficiency, quality, and management practices in multidisciplinary and traditional diabetes healthcare services in Mexico

This study determined the efficiency of two different models of diabetes care (traditional units and multidisciplinary units), estimated quality levels, and identified management practices associated with better quality and efficiency of both models in Mexico. A random sample consisting of 40 units (20 for each type of unit), allowed us to estimate technical efficiency using data envelopment analysis (DEA) after we calculated quality scores (performance and competence). We mapped the relationship between efficiency and quality score, and using a positive deviance approach, we studied managerial determinants of best performance in terms of both efficiency and quality. We found that efficiency in multidisciplinary units was higher than in traditional units; traditional units scored very low in terms of efficiency. Likewise, in terms of the different quality metrics, the multidisciplinary units were much better evaluated than the traditional units. We found important differences in the quality scores for the different health care models. Two-thirds of the multidisciplinary units were in the best-performing group (above-median efficiency and above-median performance), and almost half of them were mapped to the high-competence quadrant. On the other hand, only 10% of the traditional units managed to position themselves in the best performance quadrant. Managerial characteristics were positively correlated with the probability of belonging to the group with the highest performance. Our findings indicate that multidisciplinary medical care can lead to better outcomes for patients with diabetes compared to traditional medical care. In both types of units, however, there is substantial opportunity to improve efficiency and quality levels.