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Results for “Performance benchmarking”

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PubMed1995

Childhood immunization: one HMO's experience in benchmarking and improving plan performance.

In 1994, Health Net initiated a childhood immunization campaign and research project to improve health plan member immunization rates by motivating and educating parents of children 20-32 months old as to the importance of fully immunizing their child. The findings indicate that 88 percent of those parents with children who were not fully immunized believed their child had been fully immunized by age two. This lack of awareness may explain the unreliability of self-reported immunization status. Future immunization campaigns must include ongoing member reminder systems, educate members as to the immunization schedule, and must take into consideration the barriers, real and perceived, that block full immunization.

California↗

PubMed2005

Evaluating the performance of an institution using an intensive care unit benchmark.

OBJECTIVES: To describe the performances of selected intensive care units (ICUs) in a single institution using the Acute Physiology and Chronic Health Evaluation (APACHE) III benchmark and to propose interventions that may improve performance. PATIENTS AND METHODS: In this retrospective study, we analyzed APACHE III data from critically ill patients admitted to ICUs at the Mayo Clinic in Rochester, Minn, between October 1994 and December 2003. We retrieved ICU performance measures based on first ICU day APACHE III values. Standardized ratios were defined as ratios of measured to predicted values. The primary performance measure was the standardized mortality ratio, and secondary performance measures were length of stay (LOS) ratios, low-risk monitor ICU admission rates, and ICU readmission rates. We calculated 95% confidence intervals (CIs) for each performance, graded as good, average, or poor. RESULTS: Among 46,381 patients admitted during the study period, 57.5% were in surgical ICUs, 24.8% in a medical ICU, and 17.7% in a surgical-medical ICU. Low-risk monitoring accounted for 37.2% of admissions. Hospital standardized mortality ratios (95% CI) were 0.95 (0.90-0.99), 0.86 (0.81-0.91), and 0.70 (0.66-0.74) for medical, multispecialty, and surgical ICUs, respectively. Hospital LOS ratios (95% CI) were 0.83 (0.81-0.85), 0.91 (0.88-0.93), and 0.99 (0.97-1.00) for medical, multispecialty, and surgical ICUs, respectively. The ICU readmission rate for each ICU was higher than the 6.7% reported in the medical literature. Performances were good in mortality, average to good in LOS, average in low-risk admission, and poor in ICU readmission. CONCLUSIONS: A national benchmarking database can highlight the strengths and weaknesses of ICUs. The performances of ICUs in a single institution may differ; therefore, the performance of each unit should be evaluated individually.

APACHE↗

PubMed2006

Financial benchmarks for Ontario hospitals.

Since the inception of the Hospital Reports in 1998, researchers have focused on three separate but related problems--how to measure performance; how to evaluate performance; and how to transfer knowledge about excellent performance to the field. This article describes a method to address the second problem--how to evaluate performance by benchmarking two indicators of financial performance and condition through three years of recent data for Ontario hospitals.

Benchmarking↗

PubMed2006

The evolution of intensive care unit performance assessment.

Intensive care units (ICUs) share the problems experienced by the health care system at large. Various approaches to define and manage the quality of care patients receive in the ICU have been proposed. Performance measurement involves the collection of data to evaluate an ICU's performance against itself (over time), other ICUs, or other appropriate benchmarks. Successful performance assessment requires the quantification of relevant indexes of performance. Although these indexes are increasingly being developed, it will be some time before widely recognized, validated systems are available.

Benchmarking↗

PubMed1994

Compass: predicting biological activities from molecular surface properties. Performance comparisons on a steroid benchmark.

We describe a new method, Compass, for predicting the biological activities of molecules based on the activities and three-dimensional structures of other molecules. The method improves on previous techniques by representing only the surface of molecules, by incorporating a nonlinear statistical method, and by automatically choosing conformations and alignments of molecules. We use a benchmark problem of steroid binding affinity prediction to compare the performance of the method with that of two previous systems: CoMFA and a molecular similarity method. Compass predicts steroid affinities substantially more accurately than the others, which represent the state of the art. We present experiments showing that the improved performance depends on each of the technical innovations.

Algorithms↗

PubMed2003

Accepting critically ill transfer patients: adverse effect on a referral center's outcome and benchmark measures.

BACKGROUND: Common methods of benchmarking clinical performance rarely, if ever, account for admission source and, in particular, the effect of a patient being transferred from one medical center to another. Small biases in comparisons of observed versus expected deaths can substantially affect how high-quality institutions compare with peer hospitals. With the most sophisticated and validated set of case-mix measures available for patients, the intensive care unit is an ideal setting in which to study the effect of a patient's being transferred from another hospital. OBJECTIVE: To determine the extent of bias in benchmarking outcomes when performance measures do not account for transfer patients' greater severity of illness. DESIGN: Prospectively developed cohort study. SETTING: Medical intensive care unit (MICU) at a tertiary care university hospital. PATIENTS: 4579 consecutive admissions for 4208 patients from 1 January 1994 to 1 April 1998. MEASUREMENTS: MICU and hospital lengths of stay, MICU readmission, and hospital mortality rates. RESULTS: Compared with directly admitted patients, MICU patients transferred from another hospital had significantly higher Acute Physiology Scores at the time of admission and discharge (P = 0.001). Even after full adjustment for case mix and severity of illness, transfer patients had a 38% longer MICU stay (95% CI, 32% to 45%), a 41% longer hospital stay (CI, 34% to 50%), and a 2.2 times greater odds of hospital mortality (CI, 1.7 to 2.8) than directly admitted patients. With identical efficiency and quality, a referral hospital with a 25% MICU transfer rate compared with another with a 0% transfer rate would be penalized by 14 excess deaths per 1000 admissions when a benchmarking program adjusts only for case mix and severity of illness and not for the source of admission. CONCLUSIONS: In a setting with the most thorough diagnostic-based, case-mix adjustment and the most physiologically precise severity-of-illness information, accepting transfer patients can adversely affect efficiency and quality benchmarks. Benchmarking and profiling efforts beyond intensive care units must also recognize and account for this phenomenon; otherwise, referral centers may have an incentive to refuse care for patients who could benefit from being transferred to their facility.

APACHE↗

PubMed2001

Benchmarking patient outcomes.

PURPOSE: To examine the usefulness of three types of benchmarking for interpreting patient outcome data. DESIGN: This study was part of a multiyear, multihospital longitudinal survey of 10 patient outcomes. The patient outcome used for this methodologic presentation was central line infections (CLI). The sample included eight hospitals in an integrated healthcare system, with a range in size from 144 to 861 beds. The unit of analysis for CLI was the number of line days, with the CLI rate defined as the number of infections per 1,000 patient-line days per month. METHODS: Data on each outcome were collected at the unit level according to standardized protocols. Results were submitted via standardized electronic forms to a central data management center. Data for this presentation were analyzed using a Bayesian hierarchical Poisson model. Results are presented for each hospital and the system as a whole. FINDINGS: In comparison to published benchmarks, hospital performances were mixed with regard to CLI. Five of the 8 hospitals exceeded 2.2 infections per 1,000 patient-line days. When benchmarks were established for each hospital using 95% credible intervals, hospitals did reasonably well with only isolated months reaching or going beyond the benchmark limits. When the entire system was used to establish benchmarks with the 95% credible intervals, the hospitals that reached or exceeded the benchmark limits remained the same, but some hospitals had CLI rates more frequently in the upper 50% of the benchmarking limits. CONCLUSIONS: Benchmarking of quality indicators can be accomplished in a variety of ways as a means to quantify patient care and identify areas needing attention and improvement. Hospital-specific and system-wide benchmarks provide relevant feedback for improving performance at individual hospitals.

Benchmarking↗

PubMed2002

Assessing the financial health of the endoscopy center.

Just as a trend of a patient's physiologic vital signs is more informative than a single assessment, the most reliable measure of EASC financial health is achieved over a continuum of time. The earliest estimate of prognosis is accomplished with a business plan that is based on an analysis of practice history, strategic planning, and carefully derived assumptions. Periodic assessments of financial performance with benchmarking data provide a current assessment of health and allow trending of performance improvements or decline. Assurance of future financial health is derived from focusing on customer needs, developing EASC core competence, and creating value through innovation. Following these guidelines helps to ensure a strong, productive, and long-lasting EASC.

Ambulatory Surgical Procedures↗

PubMed2006

Result of a national audit of bariatric surgery performed at academic centers: a 2004 University HealthSystem Consortium Benchmarking Project.

HYPOTHESIS: Bariatric surgery performed at US academic centers is safe and associated with low mortality. DESIGN: Multi-institutional consecutive cohort study. SETTING: Academic medical centers. PATIENTS AND INTERVENTIONS: We audited the medical records from 40 consecutive bariatric surgery cases performed between October 1, 2003, and March 31, 2004, at each of the 29 institutions participating in the University HealthSystem Consortium Bariatric Surgery Benchmarking Project. All medical records that met inclusion criteria (patient age, >17 and <65 years; and body mass index [calculated as weight in kilograms divided by the square of height in meters], 35-70) and exclusion criteria (previous bariatric surgery) were reviewed and data were collected on a standardized form. MAIN OUTCOME MEASURES: Demographic data, operative time, blood loss, transfusion requirement, complications, readmission, reoperation, and in-hospital and 30-day mortality. RESULTS: Data from 1144 bariatric surgery cases were reviewed from 29 University HealthSystem Consortium institutions. The specific bariatric procedures included gastric bypass (91.7%), gastroplasty or gastric banding (8.2%), and biliopancreatic diversion (0.1%). For gastric bypass procedures (n = 1049), the mean patient age was 43 years and mean body mass index was 49; 76% of procedures were performed laparoscopically, with a conversion rate of 2.2%; the overall complication rate was 16%, with an anastomotic leakage rate of 1.6%; the 30-day readmission rate was 6.6%; and the 30-day mortality rate was 0.4%. For restrictive procedures (n = 94), the mean patient age was 45 years and mean body mass index was 45; 92% of procedures were performed laparoscopically with no conversion; the overall complication rate was 3.2%; the 30-day readmission rate was 4.3%; and the 30-day mortality rate was 0%. CONCLUSIONS: Within the context of the 2004 University HealthSystem Consortium Bariatric Surgery Benchmarking Project, the risk for death within 30 days after bariatric surgery at academic centers is less than 1%. In addition, the practice of bariatric surgery at these centers has shifted from open surgery to predominately laparoscopic surgery. These quality-controlled outcome data can be used as a benchmark for the practice of bariatric surgery at most US hospitals.

Adult↗

PubMed2002

Rating the quality of intensive care units: is it a function of the intensive care unit scoring system?

OBJECTIVE: Intensive care units (ICUs) use severity-adjusted mortality measures such as the standardized mortality ratio to benchmark their performance. Prognostic scoring systems such as Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score II, and Mortality Probability Model II0 permit performance-based comparisons of ICUs by adjusting for severity of disease and case mix. Whether different risk-adjustment methods agree on the identity of ICU quality outliers within a single database has not been previously investigated. The objective of this study was to determine whether the identity of ICU quality outliers depends on the ICU scoring system used to calculate the standardized mortality ratio. DESIGN, SETTING, PATIENTS: Retrospective cohort study of 16,604 patients from 32 hospitals based on the outcomes database (Project IMPACT) created by the Society of Critical Care Medicine. The ICUs were a mixture of medical, surgical, and mixed medical-surgical ICUs in urban and nonurban settings. Standardized mortality ratios for each ICU were calculated using APACHE II, Simplified Acute Physiology Score II, and Mortality Probability Model II. ICU quality outliers were defined as ICUs whose standardized mortality ratio was statistically different from 1. Kappa analysis was used to determine the extent of agreement between the scoring systems on the identity of hospital quality outliers. The intraclass correlation coefficient was calculated to estimate the reliability of standardized mortality ratios obtained using the three risk-adjustment methods. MEASUREMENTS AND MAIN RESULTS: Kappa analysis showed fair to moderate agreement among the three scoring systems in identifying ICU quality outliers; the intraclass correlation coefficient suggested moderate to substantial agreement between the scoring systems. The majority of ICUs were classified as high-performance ICUs by all three scoring systems. All three scoring systems exhibited good discrimination and poor calibration in this data set. CONCLUSION: APACHE II, Simplified Acute Physiology Score II, and Mortality Probability Model II0 exhibit fair to moderate agreement in identifying quality outliers. However, the finding that most ICUs in this database were judged to be high-performing units limits the usefulness of these models in their present form for benchmarking.

APACHE↗

PubMed1995

Establishing benchmarks for ambulatory surgery costs.

The acceleration of managed care activity has made benchmark data on performance especially important. To date, benchmark data on financial and clinical performance in ambulatory surgery have been lacking in both hospital-based and independent, freestanding ambulatory surgery centers. This article discusses tools, empirical data, and strategies to assist financial (and clinical) managers in healthcare organizations critically examine the efficiency of their ambulatory surgery services.

Ambulatory Surgical Procedures↗

PubMed2001

Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial.

CONTEXT: Performance feedback and benchmarking, common tools for health care improvement, are rarely studied in randomized trials. Achievable Benchmarks of Care (ABCs) are standards of excellence attained by top performers in a peer group and are easily and reproducibly calculated from existing performance data. OBJECTIVE: To evaluate the effectiveness of using achievable benchmarks to enhance typical physician performance feedback and improve care. DESIGN: Group-randomized controlled trial conducted in December 1996, with follow-up through 1998. SETTING AND PARTICIPANTS: Seventy community physicians and 2978 fee-for-service Medicare patients with diabetes mellitus who were part of the Ambulatory Care Quality Improvement Project in Alabama. INTERVENTION: Physicians were randomly assigned to receive a multimodal improvement intervention, including chart review and physician-specific feedback (comparison group; n = 35) or an identical intervention plus achievable benchmark feedback (experimental group; n = 35). MAIN OUTCOME MEASURE: Preintervention (1994-1995) to postintervention (1997-1998) changes in the proportion of patients receiving influenza vaccination; foot examination; and each of 3 blood tests measuring glucose control, cholesterol level, and triglyceride level, compared between the 2 groups. RESULTS: The proportion of patients who received influenza vaccine improved from 40% to 58% in the experimental group (P<.001) vs from 40% to 46% in the comparison group (P =.02). Odds ratios (ORs) for patients of achievable benchmark physicians vs comparison physicians who received appropriate care after the intervention, adjusted for preintervention care and nesting of patients within physicians, were 1.57 (95% confidence interval [CI], 1.26-1.96) for influenza vaccination, 1.33 (95% CI, 1.05-1.69) for foot examination, and 1.33 (95% CI, 1.04-1.69) for long-term glucose control measurement. For serum cholesterol and triglycerides, the achievable benchmark effect was statistically significant only after additional adjustment for physician characteristics (OR, 1.40 [95% CI, 1.08-1.82] and OR, 1.40 [95% CI, 1.09-1.79], respectively). CONCLUSION: Use of achievable benchmarks significantly enhances the effectiveness of physician performance feedback in the setting of a multimodal quality improvement intervention.

Aged↗

PubMed2006

All inclusive benchmarking.

AIM: The aim of this article is to review published descriptions of benchmarking activity and synthesize benchmarking principles to encourage the acceptance and use of Essence of Care as a new benchmarking approach to continuous quality improvement, and to promote its acceptance as an integral and effective part of benchmarking activity in health services. BACKGROUND: The Essence of Care, was launched by the Department of Health in England in 2001 to provide a benchmarking tool kit to support continuous improvement in the quality of fundamental aspects of health care, for example, privacy and dignity, nutrition and hygiene. The tool kit is now being effectively used by some frontline staff. However, use is inconsistent, with the value of the tool kit, or the support clinical practice benchmarking requires to be effective, not always recognized or provided by National Health Service managers, who are absorbed with the use of quantitative benchmarking approaches and measurability of comparative performance data. REVIEW: This review of published benchmarking literature, was obtained through an ever-narrowing search strategy commencing from benchmarking within quality improvement literature through to benchmarking activity in health services and including access to not only published examples of benchmarking approaches and models used but the actual consideration of web-based benchmarking data. This supported identification of how benchmarking approaches have developed and been used, remaining true to the basic benchmarking principles of continuous improvement through comparison and sharing (Camp 1989). Descriptions of models and exemplars of quantitative and specifically performance benchmarking activity in industry abound (Camp 1998), with far fewer examples of more qualitative and process benchmarking approaches in use in the public services and then applied to the health service (Bullivant 1998). The literature is also in the main descriptive in its support of the effectiveness of benchmarking activity and although this does not seem to have restricted its popularity in quantitative activity, reticence about the value of the more qualitative approaches, for example Essence of Care, needs to be overcome in order to improve the quality of patient care and experiences. KEY ISSUES: The perceived immeasurability and subjectivity of Essence of Care and clinical practice benchmarks means that these benchmarking approaches are not always accepted or supported by health service organizations as valid benchmarking activity. CONCLUSIONS: In conclusion, Essence of Care benchmarking is a sophisticated clinical practice benchmarking approach which needs to be accepted as an integral part of health service benchmarking activity to support improvement in the quality of patient care and experiences.

Benchmarking↗

PubMed2000

Can benchmarking be applied to radiation protection? And is it useful?

PURPOSE: Any program of protection from the ionizing radiations used for health care must ultimately lead to the total prevention of graduated effects and to the limitation of probabilistic effects to acceptable levels. The latter are the more dangerous because they may occur even at very low doses and involve the whole population including unexposed subjects; these effects may appear in the generations to come. The specific protection of the health of operators, patients, and the general population, depends on a series of physical-technical and bureaucratic-administrative factors. These must be known and applied based on precise reference standards, recommended or stated by law, as well as on appropriately regulated and controlled procedures. We chose to apply the benchmarking method to radiation protection in order to standardize and increase the efficacy of prevention and to plan, according to Deming's cycle, the continuous improvement of radiation protection performance. METHOD: Benchmarking is a qualitative intercomparison method widely used in business economics to improve performance referring to best practice and the best in class. When applied in a department where all the partners belong (internal benchmarking), the method features a subdivision into different (sub)processes integrated according to the logic of problem-solving. These stages are: planning: 1) identifying benchmarking issues; 2) identifying the participants; 3) deciding the data collection method; 4) data collection; analysis: 5) measuring the gap; 6) planning future performance; integration: 7) reporting the results; 8) setting the functional goals; action: 9) developing and implementing plans; 10) checking results and resetting the target. The gross subdivision of resources into human and structural permits to check the gap between an actual and an ideal setting separately. Thus, the procedures will give information on the human factor which will be periodically checked in loco relative to all active and passive conducts, while standards will be used to assess the available spaces, facilities and equipment, as well as the relative regular activity. Specific physical-technical and bureaucratic-administrative indices will be needed in both cases. RESULTS AND DISCUSSION: Solving the operators' doubts and consequently decreasing the statistical errors and/or the cases of incorrect performance has resulted in improved rendered quality, which will be further increased after the planned replacement of substandard or unsafe equipment. Meanwhile, the early application of equipment quality controls has helped rationalize and markedly decrease maintenance costs, which results in possible technologic investment to improve emergency imaging. Greater attention to their protection has made patients feel an improvement in received quality and has increased empathy in general. Total quality, as compared with the best practice, has increased thanks to the positive stimulus from standardization, emulation and sharing, and not only to the controls performed. It is difficult to evaluate the management indices, especially the performance efficacy, that is the relationship between radiation protection and results, because the work is in progress and we still lack the actual data on the decrease in accidents at work or occupational diseases of the operators. Moreover, the epidemiological data on radiation-induced conditions will be difficult to collect and interpret, which will make the dynamics of lawsuits for unwarranted or excessive exposure a useful and more readily available piece of information. Finally, relative to economic results, we would like to stress that no additional costs have been necessary to implement safety and quality in a setting involving, directly or indirectly, thousands of people. (ABSTRACT TRUNCATED)

Algorithms↗

PubMedDate not supplied

Measuring quality and effectiveness of prehospital EMS.

INTRODUCTION: In today's health care environment, the demand for objective comparative information about the performance of health care organizations and providers has created a need for data-driven evaluation processes. In response, national organizations and federal agencies have established quality indicators, created tools to measure performance according to those indicators, and issued report cards for individual providers, as well as health care organizations. PURPOSE: Emergency medical services (EMS) systems are no different from other health care systems in the need for objective comparative system information to assist government officials at all levels in establishing relevant policy, selecting appropriate system design, and monitoring system quality and effectiveness. Governmental decision makers, payers, and consumers are demanding objective evidence that they are receiving value and quality for the cost of EMS. EMS systems administrators also require objective feedback about performance that can be used internally to support improvement efforts and externally to demonstrate accountability to the public and other stakeholders. To date, there are few validated indicators of effectiveness and quality in EMS systems. Moreover, most potential indicators have not been studied for use in systemwide evaluation. As a result, there are no universally accepted methods of measurement. The following paper examines traditional efforts to assure quality in EMS systems, while assessing the need to go beyond the traditional to establish measurable indicators of system quality. Valid and measurable indicators will provide a basis for establishing benchmarks of performance. In the future, these benchmarks will facilitate comparisons of a system with itself, as well as with other systems.

Decision Making↗

PubMedDate not supplied

What kind of feedback are you soliciting?

How can you assess how well you're performing? From benchmarking to finding a mentor, here are some suggestions to help you solicit meaningful feedback to improve your performance. The feedback that's most beneficial isn't an opinion--even the CEO's, although it's important--because it's often the opposite of fact. You need standards against which to measure yourself that aren't tightly linked to your organization's culture, so you'll need to research what's going on with your competitor's employees and network with other professionals.

Administrative Personnel↗

PubMed1996

Assessing the performance of fold recognition methods by means of a comprehensive benchmark.

Recently there has been an explosion of methods for fold recognition. These methods seek to align a protein sequence to a three-dimensional structure and measure the compatibility of the sequence to the structure. In this work, we present a benchmark to assess the performance of such methods. The benchmark consists of a set of protein sequences matched by superposition to known structures. This set covers a wide range of protein families, and includes matching proteins with insignificant sequence similarity. To demonstrate the usefulness of this benchmark, we apply it here to compare different fold-recognition methods developed through the years in our group as well as several sequence-sequence substitution matrices. The results show that "global-local" alignments are superior to either local or global alignments. The most effective sequence-sequence matching matrix is the Gonnet table. The best performance overall is obtained by a method which combines the 3D-1D profiles of Bowie et al. with a substitution matrix and takes into account residue pairwise interactions.

Amino Acid Sequence↗

PubMed1998

Outcomes measurement in the operating room suite.

The objectives of quality improvement in the OR include improved perioperative care of the patient and OR efficiency, decreased hospital length of stay, and decreased costs. We submit that multidisciplinary outcome measurement is a prerequisite for coordinated outcomes management to achieve quality patient care in an effective, efficient, and financially responsible way, and we provide a guide to do so. The data obtained by such cross-discipline study can identify the need for patient, family, and/or staff education, improved interaction and collaboration across disciplines, revision of clinical paths, and improved hospital systems as well as benchmarking the performance of the OR against local or national standards.

Benchmarking↗