{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T19:23:08Z","timestamp":1770924188003,"version":"3.50.1"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["MOST 109-2410-H-110 -017 -MY3"],"award-info":[{"award-number":["MOST 109-2410-H-110 -017 -MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The increasing prevalence of end-stage renal disease (ESRD), especially in aging populations, presents significant challenges for healthcare systems. Dialysis centers must navigate growing demands for cost efficiency while maintaining high-quality care. This study aimed to evaluate the relationship between operational efficiency and clinical quality in dialysis centers, using a systems-based performance assessment framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 578 dialysis centers in Taiwan using Data Envelopment Analysis (DEA) to estimate operational efficiency. Clinical quality was assessed using outcome indicators including mortality rate, dialysis adequacy (urea reduction ratio [URR], Kt\/V), serum albumin and hemoglobin levels, calcium-phosphate (Ca\u2009\u00d7\u2009P) product, and cardiothoracic ratio. Multiple regression analyses were conducted to examine associations between efficiency scores, clinical outcomes, and organizational characteristics, including chain affiliation and ownership type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Higher efficiency scores were significantly associated with lower URR, Kt\/V, and Ca\u2009\u00d7\u2009P values, suggesting potential trade-offs between operational efficiency and clinical quality. Centers affiliated with chains generally reported better clinical outcomes. For-profit centers exhibited higher URR, Kt\/V, and albumin levels, as well as lower Ca\u2009\u00d7\u2009P values, compared to their non-profit counterparts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Operational efficiency in dialysis centers may come at the cost of certain clinical outcomes. However, organizational characteristics such as chain affiliation and for-profit ownership are linked to better quality indicators. These findings highlight the value of DEA as a tool for system-level performance evaluation and inform strategies to optimize dialysis care delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0343125","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T18:36:07Z","timestamp":1770921367000},"page":"e0343125","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Balancing efficiency and clinical quality in dialysis centers: Insights from a nationwide DEA study in Taiwan"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6142-6011","authenticated-orcid":true,"given":"Shu-Chuan Jennifer","family":"Yeh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen Chun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Pruett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsueh-Chih","family":"Chou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"issue":"1","key":"pone.0343125.ref001","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: an update 2022","volume":"12","author":"CP Kovesdy","year":"2022","journal-title":"Kidney Int Suppl (2011)"},{"key":"pone.0343125.ref002","unstructured":"United States Renal Data System. 2023 Annual Data Report. 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