Objectives: To expand care for chronic haemodialysis (HD) patients throughout England and Wales by studying two aspects of service delivery that are important: to identify relative performance of haemodialysis satellite units (HDSUs), and understand the factors that influence the performance. As a first step toward these aspects, this work reports a study of apparent comparative efficiency in the delivery of HDSUs and demonstrates the potential of data envelopment analysis (DEA).

Methods: DEA was applied to data obtained from a national survey of the organizational structures and processes of delivering care at HDSUs in England and Wales.

Results: DEA was found to be a judicious approach for performance assessment of HDSUs, although valid results depend on appropriate model specification and quality of data available. The available data were not of sufficient comprehensiveness or quality to produce definitive results but suggested that overall efficiency could improve; these data suggested by as much as 10% overall (mean efficiency score 90%) and variably within the sample (46 [65%] that HDSUs were potentially inefficient, the lowest unit scoring 38%).

Conclusions: Addressing questions raised by comparative inefficiency could help plans to improve capacity to deal with the growing demand for HD delivered in HDSUs. The application was an important start and needs to be followed by further research to establish model validity and obtain authoritative results.The authors thank HDSU staff who participated in the national satellite survey and colleagues contributing to the main project “An evaluation of the costs and effectiveness of and quality of care of renal replacement therapy provision in renal satellite units in England and Wales.” Particular thanks to Alison Armitage, Tricia Nicholson, and Joy Townsend. Funding was provided by the NHS Research and Development Health Technology Assessment Programme and South East NHS Executive Research and Development Directorate. The opinions and any errors made are the authors' responsibility alone.