{"id":"https://openalex.org/W7128740783","doi":"https://doi.org/10.1109/access.2026.3663563","title":"Beyond Opacity: Interpretable Machine Learning for Hospital Efficiency Assessment","display_name":"Beyond Opacity: Interpretable Machine Learning for Hospital Efficiency Assessment","publication_year":2026,"publication_date":"2026-01-01","ids":{"openalex":"https://openalex.org/W7128740783","doi":"https://doi.org/10.1109/access.2026.3663563"},"language":null,"primary_location":{"id":"doi:10.1109/access.2026.3663563","is_oa":true,"landing_page_url":"https://doi.org/10.1109/access.2026.3663563","pdf_url":null,"source":{"id":"https://openalex.org/S2485537415","display_name":"IEEE Access","issn_l":"2169-3536","issn":["2169-3536"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319808","host_organization_name":"Institute of Electrical and Electronics Engineers","host_organization_lineage":["https://openalex.org/P4310319808"],"host_organization_lineage_names":["Institute of Electrical and Electronics Engineers"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"IEEE Access","raw_type":"journal-article"},"type":"article","indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1109/access.2026.3663563","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5006995271","display_name":"Agostino Marengo","orcid":"https://orcid.org/0000-0003-2769-5642"},"institutions":[{"id":"https://openalex.org/I106296451","display_name":"University of Foggia","ror":"https://ror.org/01xtv3204","country_code":"IT","type":"education","lineage":["https://openalex.org/I106296451"]}],"countries":["IT"],"is_corresponding":false,"raw_author_name":"Agostino Marengo","raw_affiliation_strings":["Department of Agricultural Sciences, Food, Natural Resources, and Engineering, University of Foggia, Foggia, Italy"],"raw_orcid":"https://orcid.org/0000-0003-2769-5642","affiliations":[{"raw_affiliation_string":"Department of Agricultural Sciences, Food, Natural Resources, and Engineering, University of Foggia, Foggia, Italy","institution_ids":["https://openalex.org/I106296451"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5021224978","display_name":"Lerina Aversano","orcid":"https://orcid.org/0000-0003-2436-6835"},"institutions":[{"id":"https://openalex.org/I106296451","display_name":"University of Foggia","ror":"https://ror.org/01xtv3204","country_code":"IT","type":"education","lineage":["https://openalex.org/I106296451"]}],"countries":["IT"],"is_corresponding":false,"raw_author_name":"Lerina Aversano","raw_affiliation_strings":["Department of Agricultural Sciences, Food, Natural Resources, and Engineering, University of Foggia, Foggia, Italy"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Agricultural Sciences, Food, Natural Resources, and Engineering, University of Foggia, Foggia, Italy","institution_ids":["https://openalex.org/I106296451"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5125727736","display_name":"Anna Esposito","orcid":null},"institutions":[{"id":"https://openalex.org/I4210126337","display_name":"University of Campania \"Luigi Vanvitelli\"","ror":null,"country_code":"IT","type":null,"lineage":["https://openalex.org/I4210126337"]}],"countries":["IT"],"is_corresponding":false,"raw_author_name":"Anna Esposito","raw_affiliation_strings":["Department of Psychology, University of Campania “Luigi Vanvitelli,”, Caserta, Italy"],"raw_orcid":"https://orcid.org/0000-0002-7268-1795","affiliations":[{"raw_affiliation_string":"Department of Psychology, University of Campania “Luigi Vanvitelli,”, Caserta, Italy","institution_ids":["https://openalex.org/I4210126337"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5017821211","display_name":"Michele Mastroianni","orcid":"https://orcid.org/0000-0001-6415-1180"},"institutions":[{"id":"https://openalex.org/I106296451","display_name":"University of Foggia","ror":"https://ror.org/01xtv3204","country_code":"IT","type":"education","lineage":["https://openalex.org/I106296451"]}],"countries":["IT"],"is_corresponding":false,"raw_author_name":"Michele Mastroianni","raw_affiliation_strings":["Department of Agricultural Sciences, Food, Natural Resources, and Engineering, University of Foggia, Foggia, Italy"],"raw_orcid":"https://orcid.org/0000-0001-6415-1180","affiliations":[{"raw_affiliation_string":"Department of Agricultural Sciences, Food, Natural Resources, and Engineering, University of Foggia, Foggia, Italy","institution_ids":["https://openalex.org/I106296451"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5092349665","display_name":"Vito Santamato","orcid":"https://orcid.org/0009-0005-9776-0106"},"institutions":[{"id":"https://openalex.org/I106296451","display_name":"University of Foggia","ror":"https://ror.org/01xtv3204","country_code":"IT","type":"education","lineage":["https://openalex.org/I106296451"]}],"countries":["IT"],"is_corresponding":false,"raw_author_name":"Vito Santamato","raw_affiliation_strings":["Department of Agricultural Sciences, Food, Natural Resources, and Engineering, University of Foggia, Foggia, Italy"],"raw_orcid":"https://orcid.org/0009-0005-9776-0106","affiliations":[{"raw_affiliation_string":"Department of Agricultural Sciences, Food, Natural Resources, and Engineering, University of Foggia, Foggia, Italy","institution_ids":["https://openalex.org/I106296451"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":5,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":{"value":1850,"currency":"USD","value_usd":1850},"apc_paid":{"value":1850,"currency":"USD","value_usd":1850},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.17941328,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":null,"first_page":"26314","last_page":"26344"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10357","display_name":"Efficiency Analysis Using DEA","score":0.8234999775886536,"subfield":{"id":"https://openalex.org/subfields/1803","display_name":"Management Science and Operations Research"},"field":{"id":"https://openalex.org/fields/18","display_name":"Decision Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10357","display_name":"Efficiency Analysis Using DEA","score":0.8234999775886536,"subfield":{"id":"https://openalex.org/subfields/1803","display_name":"Management Science and Operations Research"},"field":{"id":"https://openalex.org/fields/18","display_name":"Decision Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.03229999914765358,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11773","display_name":"Healthcare Operations and Scheduling Optimization","score":0.02969999983906746,"subfield":{"id":"https://openalex.org/subfields/3604","display_name":"Emergency Medical Services"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/interpretability","display_name":"Interpretability","score":0.7468000054359436},{"id":"https://openalex.org/keywords/health-care","display_name":"Health care","score":0.5250999927520752},{"id":"https://openalex.org/keywords/resource-allocation","display_name":"Resource allocation","score":0.4966000020503998},{"id":"https://openalex.org/keywords/data-envelopment-analysis","display_name":"Data envelopment analysis","score":0.49380001425743103},{"id":"https://openalex.org/keywords/cluster-analysis","display_name":"Cluster analysis","score":0.4154999852180481},{"id":"https://openalex.org/keywords/health-administration","display_name":"Health administration","score":0.38370001316070557},{"id":"https://openalex.org/keywords/decision-tree","display_name":"Decision tree","score":0.3691999912261963},{"id":"https://openalex.org/keywords/benchmarking","display_name":"Benchmarking","score":0.3564000129699707}],"concepts":[{"id":"https://openalex.org/C2781067378","wikidata":"https://www.wikidata.org/wiki/Q17027399","display_name":"Interpretability","level":2,"score":0.7468000054359436},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.6629999876022339},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.6549000144004822},{"id":"https://openalex.org/C119857082","wikidata":"https://www.wikidata.org/wiki/Q2539","display_name":"Machine learning","level":1,"score":0.646399974822998},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5250999927520752},{"id":"https://openalex.org/C29202148","wikidata":"https://www.wikidata.org/wiki/Q287260","display_name":"Resource allocation","level":2,"score":0.4966000020503998},{"id":"https://openalex.org/C22088475","wikidata":"https://www.wikidata.org/wiki/Q647974","display_name":"Data envelopment analysis","level":2,"score":0.49380001425743103},{"id":"https://openalex.org/C73555534","wikidata":"https://www.wikidata.org/wiki/Q622825","display_name":"Cluster analysis","level":2,"score":0.4154999852180481},{"id":"https://openalex.org/C137992405","wikidata":"https://www.wikidata.org/wiki/Q1137608","display_name":"Health administration","level":3,"score":0.38370001316070557},{"id":"https://openalex.org/C84525736","wikidata":"https://www.wikidata.org/wiki/Q831366","display_name":"Decision tree","level":2,"score":0.3691999912261963},{"id":"https://openalex.org/C86251818","wikidata":"https://www.wikidata.org/wiki/Q816754","display_name":"Benchmarking","level":2,"score":0.3564000129699707},{"id":"https://openalex.org/C2775860198","wikidata":"https://www.wikidata.org/wiki/Q7257872","display_name":"Public hospital","level":2,"score":0.3425999879837036},{"id":"https://openalex.org/C107327155","wikidata":"https://www.wikidata.org/wiki/Q330268","display_name":"Decision support system","level":2,"score":0.3422999978065491},{"id":"https://openalex.org/C27438332","wikidata":"https://www.wikidata.org/wiki/Q2873","display_name":"Principal component analysis","level":2,"score":0.33329999446868896},{"id":"https://openalex.org/C92835128","wikidata":"https://www.wikidata.org/wiki/Q1277447","display_name":"Hierarchical clustering","level":3,"score":0.33169999718666077},{"id":"https://openalex.org/C2777958785","wikidata":"https://www.wikidata.org/wiki/Q17120940","display_name":"Resource efficiency","level":2,"score":0.31369999051094055},{"id":"https://openalex.org/C42475967","wikidata":"https://www.wikidata.org/wiki/Q194292","display_name":"Operations research","level":1,"score":0.30309998989105225},{"id":"https://openalex.org/C11105738","wikidata":"https://www.wikidata.org/wiki/Q1895805","display_name":"Multiple-criteria decision analysis","level":2,"score":0.29429998993873596},{"id":"https://openalex.org/C2780609101","wikidata":"https://www.wikidata.org/wiki/Q17156588","display_name":"Resource management (computing)","level":2,"score":0.2897000014781952},{"id":"https://openalex.org/C46686674","wikidata":"https://www.wikidata.org/wiki/Q466303","display_name":"Boosting (machine learning)","level":2,"score":0.28290000557899475},{"id":"https://openalex.org/C124101348","wikidata":"https://www.wikidata.org/wiki/Q172491","display_name":"Data mining","level":1,"score":0.2766000032424927},{"id":"https://openalex.org/C206345919","wikidata":"https://www.wikidata.org/wiki/Q20380951","display_name":"Resource (disambiguation)","level":2,"score":0.2628999948501587},{"id":"https://openalex.org/C69738355","wikidata":"https://www.wikidata.org/wiki/Q1228929","display_name":"Linear discriminant analysis","level":2,"score":0.2581000030040741},{"id":"https://openalex.org/C2742236","wikidata":"https://www.wikidata.org/wiki/Q924713","display_name":"Efficient energy use","level":2,"score":0.25440001487731934},{"id":"https://openalex.org/C154874363","wikidata":"https://www.wikidata.org/wiki/Q3518464","display_name":"Medical classification","level":2,"score":0.25060001015663147}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1109/access.2026.3663563","is_oa":true,"landing_page_url":"https://doi.org/10.1109/access.2026.3663563","pdf_url":null,"source":{"id":"https://openalex.org/S2485537415","display_name":"IEEE Access","issn_l":"2169-3536","issn":["2169-3536"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319808","host_organization_name":"Institute of Electrical and Electronics Engineers","host_organization_lineage":["https://openalex.org/P4310319808"],"host_organization_lineage_names":["Institute of Electrical and Electronics Engineers"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"IEEE Access","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.1109/access.2026.3663563","is_oa":true,"landing_page_url":"https://doi.org/10.1109/access.2026.3663563","pdf_url":null,"source":{"id":"https://openalex.org/S2485537415","display_name":"IEEE Access","issn_l":"2169-3536","issn":["2169-3536"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319808","host_organization_name":"Institute of Electrical and Electronics Engineers","host_organization_lineage":["https://openalex.org/P4310319808"],"host_organization_lineage_names":["Institute of Electrical and Electronics Engineers"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"IEEE Access","raw_type":"journal-article"},"sustainable_development_goals":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":[],"abstract_inverted_index":{"Hospital":[0],"efficiency":[1,16,75,92,155],"optimization":[2,48,109,163],"remains":[3],"a":[4,69],"critical":[5],"challenge":[6],"as":[7,29],"healthcare":[8,36,208,229],"systems":[9],"worldwide":[10],"face":[11],"mounting":[12],"economic":[13],"pressures.":[14],"Traditional":[15],"assessment":[17],"methods":[18],"often":[19],"lack":[20],"predictive":[21],"capability,":[22],"while":[23,157,194],"machine":[24,44],"learning":[25,45],"approaches":[26],"frequently":[27],"operate":[28],"opaque":[30],"\"black":[31],"boxes\"":[32],"unsuitable":[33],"for":[34,50,88,114,206,227],"high-stakes":[35],"decisions.":[37],"This":[38],"study":[39],"presents":[40],"an":[41],"integrated":[42],"interpretable":[43],"and":[46,63,105,147],"multi-objective":[47],"framework":[49,129,218],"hospital":[51,89,184],"resource":[52,116,201,230],"allocation,":[53],"bridging":[54],"Data":[55],"Envelopment":[56],"Analysis":[57],"(DEA)":[58],"with":[59,85,98,110,178,214],"explainable":[60],"artificial":[61],"intelligence":[62],"prescriptive":[64,215],"analytics.":[65],"The":[66],"methodology":[67],"comprises":[68],"four-stage":[70],"analytical":[71],"pipeline:":[72],"(1)":[73],"DEA-based":[74],"scoring":[76],"through":[77],"Principal":[78],"Component":[79],"Analysis,":[80],"(2)":[81],"Agglomerative":[82],"Hierarchical":[83],"Clustering":[84],"Ward":[86],"linkage":[87],"stratification":[90],"into":[91,222],"tiers,":[93],"(3)":[94],"Decision":[95],"Tree":[96],"classification":[97,132],"SHAP":[99,137],"(SHapley":[100],"Additive":[101],"exPlanations)":[102],"interpretability":[103],"analysis,":[104],"(4)":[106],"NSGA-II":[107],"bi-objective":[108],"data-driven":[111],"grid":[112],"search":[113],"context-specific":[115],"allocation":[117,202],"strategies.":[118],"Validated":[119],"on":[120],"127":[121],"public":[122],"hospitals":[123,189],"across":[124,183],"five":[125],"institutional":[126],"typologies,":[127],"the":[128,153],"achieved":[130],"94.87%":[131],"accuracy":[133],"(AUC":[134],"=":[135,145],"0.993).":[136],"analysis":[138,213],"revealed":[139],"that":[140,199],"energy":[141],"costs":[142],"(mean":[143],"|SHAP|":[144],"0.2416)":[146],"medical":[148],"staffing":[149],"levels":[150],"(0.2257)":[151],"constitute":[152],"primary":[154],"determinants,":[156],"equipment":[158],"showed":[159],"negligible":[160],"contribution.":[161],"Multi-objective":[162],"demonstrated":[164],"substantial":[165],"strategic":[166],"heterogeneity:":[167],"optimal":[168],"weight":[169],"configurations":[170],"ranged":[171],"from":[172],"balanced":[173],"(0.5/0.5)":[174],"to":[175],"energy-focused":[176],"(0.9/0.1),":[177],"personnel":[179],"ratios":[180],"spanning":[181],"51%-77%":[182],"types.":[185],"Critically,":[186],"47%":[187],"of":[188],"require":[190,196],"clinical":[191],"staff":[192],"reductions":[193],"16%":[195],"increases,":[197],"demonstrating":[198],"uniform":[200],"guidelines":[203],"are":[204],"inadequate":[205],"heterogeneous":[207],"systems.":[209],"By":[210],"integrating":[211],"explanatory":[212],"optimization,":[216],"this":[217],"transforms":[219],"black-box":[220],"predictions":[221],"transparent,":[223],"context-specific,":[224],"evidence-based":[225],"recommendations":[226],"sustainable":[228],"management.":[231]},"counts_by_year":[],"updated_date":"2026-06-11T09:08:48.828518","created_date":"2026-02-13T00:00:00"}