Evaluating efficiency of counties in providing diabetes preventive care using data envelopment analysis

Hyojung Kang, Soyoun Kim, Kevin Malloy, Timothy L. McMurry, Rajesh Balkrishnan, Roger Anderson, Anthony McCall, Min Woong Sohn, Jennifer Mason Lobo

Research output: Contribution to journalArticlepeer-review


For patients with diabetes, annual preventive care is essential to reduce the risk of complications. Local healthcare resources affect the utilization of diabetes preventive care. Our objectives were to evaluate the relative efficiency of counties in providing diabetes preventive care and explore potential to improve efficiencies. The study setting is public and private healthcare providers in US counties with available data. County-level demographics were extracted from the Area Health Resources File using data from 2010 to 2013, and individual-level information of diabetes preventive service use was obtained from the 2010 Behavioral Risk Factor Surveillance System. 1112 US counties were analyzed. Cluster analysis was used to place counties into three similar groups in terms of economic wellbeing and population characteristics. Group 1 consisted of metropolitan counties with prosperous or comfortable economic levels. Group 2 mostly consisted of non-metropolitan areas between distress and mid-tier levels, while Group 3 were mostly prosperous or comfortable counties in metropolitan areas. We used data enveopement analysis to assess efficiencies within each group. The majority of counties had modest efficiency in providing diabetes preventive care; 36 counties (57.1%), 345 counties (61.1%), and 263 counties (54.3%) were inefficient (efficiency scores < 1) in Group 1, Group 2, and Group 3, respectively. For inefficient counties, foot and eye exams were often identified as sources of inefficiency. Available health professionals in some counties were not fully utilized to provide diabetes preventive care. Identifying benchmarking targets from counties with similar resources can help counties and policy makers develop actionable strategies to improve performance.

Original languageEnglish (US)
Pages (from-to)324-338
Number of pages15
JournalHealth Services and Outcomes Research Methodology
Issue number3
StatePublished - Sep 2021


  • Data envelopment analysis
  • Diabetes
  • Efficiency
  • Preventive care

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Evaluating efficiency of counties in providing diabetes preventive care using data envelopment analysis'. Together they form a unique fingerprint.

Cite this