New application tracks nursing care, results.
More accurate information available both for self-evaluation and benchmarking. Outcome performance improvement can be tracked over time. Web-based version is under development.
Benchmarking↗
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Results for “Performance benchmarking”
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Markov model recognition and classification of DNA/protein sequences within large text databases.
MOTIVATION: Short sequence patterns frequently define regions of biological interest (binding sites, immune epitopes, primers, etc.), yet a large fraction of this information exists only within the scientific literature and is thus difficult to locate via conventional means (e.g. keyword queries or manual searches). We describe herein a system to accurately identify and classify sequence patterns from within large corpora using an n-gram Markov model (MM). RESULTS: As expected, on test sets we found that identification of sequences with limited alphabets and/or regular structures such as nucleic acids (non-ambiguous) and peptide abbreviations (3-letter) was highly accurate, whereas classification of symbolic (1-letter) peptide strings with more complex alphabets was more problematic. The MM was used to analyze two very large, sequence-containing corpora: over 7.75 million Medline abstracts and 9000 full-text articles from Journal of Virology. Performance was benchmarked by comparing the results with Journal of Virology entries in two existing manually curated databases: VirOligo and the HLA Ligand Database. Performance estimates were 98 +/- 2% precision/84% recall for primer identification and classification and 67 +/- 6% precision/85% recall for peptide epitopes. We also find a dramatic difference between the amounts of sequence-related data reported in abstracts versus full text. Our results suggest that automated extraction and classification of sequence elements is a promising, low-cost means of sequence database curation and annotation. AVAILABILITY: MM routine and datasets are available upon request.
Abstracting and Indexing↗
An introduction to benchmarking in healthcare.
Benchmarking--the process of establishing a standard of excellence and comparing a business function or activity, a product, or an enterprise as a whole with that standard--will be used increasingly by healthcare institutions to reduce expenses and simultaneously improve product and service quality. As a component of total quality management, benchmarking is a continuous process by which an organization can measure and compare its own processes with those of organizations that are leaders in a particular area. Benchmarking should be viewed as a part of quality management programs, not as a replacement. There are four kinds of benchmarking: internal, competitive, functional and generic. With internal benchmarking, functions within an organization are compared with each other. Competitive benchmarking partners do business in the same market and provide a direct comparison of products or services. Functional and generic benchmarking are performed with organizations which may have a specific similar function, such as payroll or purchasing, but which otherwise are in a different business. Benchmarking must be a team process because the outcome will involve changing current practices, with effects felt throughout the organization. The team should include members who have subject knowledge; communications and computer proficiency; skills as facilitators and outside contacts; and sponsorship of senior management. Benchmarking requires quantitative measurement of the subject. The process or activity that you are attempting to benchmark will determine the types of measurements used. Benchmarking metrics usually can be classified in one of four categories: productivity, quality, time and cost-related.
Outcome and Process Assessment, Health Care↗
Physician resource profiling enhances utilization management.
Physician resource profiling, the analysis of a physician's resource consumption, enhances performance uniformity and efficiency and assists in utilization management. Developing reliable profiles requires the shared participation of an organization's finance personnel and physicians. Selecting or developing benchmarks for performance comparisons, assessing the integrity of the organizational data used, and testing the developed profiles all should be completed before the physician resource profiling can be used to support decision making.
Benchmarking↗
An integrated care pathway for the last two days of life: Wales-wide benchmarking in palliative care.
Functional benchmarking assesses performance and practice across a broad range of settings and carries the potential to effect change in practice. An integrated care pathway (ICP) can assist in the benchmarking process, defining desired outcomes for specific patient groups over a designated time frame. Any variations to the agreed course of care are documented using the 'variance sheet'. This article describes the Wales-wide implementation of an ICP for the last two days of life. The project has enabled an ongoing centralized collection and analysis of variance sheets, which reflect the care of the dying patient in four different care settings crossing the voluntary and statutory sectors. Initial analysis of the first 500 variance sheets to be generated by the ICP for the last two days of life indicates that the management of pain, agitation, excess respiratory secretions and mouth care may be problematic. The same problems were experienced across acute, hospice, specialist inpatient units and community care. Closing the audit cycle involves incorporating the information from the variance analysis into clinical practice.
Analysis of Variance↗
Same-day surgery has new benchmarking option. Patient survey offers national comparisons.
A new survey instrument developed by the Picker Institute in Boston uses highly specific questions to target same-day surgery successes and failures from the patients' perspectives. Hospitals and surgery centers can compare their performance with benchmarks from the academic institutions that are members of the University HealthSystem Consortium in Oak Brook, IL. Surveys will identify which specialty areas produce the most and least satisfied patients.
Ambulatory Surgical Procedures↗
Towards a benchmark simulation model for plant-wide control strategy performance evaluation of WWTPs.
The COST/IWA benchmark simulation model has been available for seven years. Its primary purpose has been to create a platform for control strategy benchmarking of activated sludge processes. The fact that the benchmark has resulted in more than 100 publications, not only in Europe but also worldwide, demonstrates the interest in such a tool within the research community In this paper, an extension of the benchmark simulation model no 1 (BSM1) is proposed. This extension aims at facilitating control strategy development and performance evaluation at a plant-wide level and, consequently, includes both pre-treatment of wastewater as well as the processes describing sludge treatment. The motivation for the extension is the increasing interest and need to operate and control wastewater treatment systems not only at an individual process level but also on a plant-wide basis. To facilitate the changes, the evaluation period has been extended to one year. A prolonged evaluation period allows for long-term control strategies to be assessed and enables the use of control handles that cannot be evaluated in a realistic fashion in the one-week BSM1 evaluation period. In the paper, the extended plant layout is proposed and the new suggested process models are described briefly. Models for influent file design, the benchmarking procedure and the evaluation criteria are also discussed. And finally, some important remaining topics, for which consensus is required, are identified.
Benchmarking↗
Revised sections F7.5 (quantitative amino acid analysis) and F7.6 (qualitative amino acid analysis): American College of Medical Genetics Standards and Guidelines for Clinical Genetics Laboratories, 2003.
Determination of plasma amino acid levels has become a key piece of information in the diagnosis and clinical management of a group of metabolic genetic disorders. Appropriate laboratory methodologies have been published for amino acid analysis, yet there is a need for direction for the laboratory in performing this testing. The following guidelines were generated by a working group of the American College of Medical Genetics Laboratory Quality Assurance Committee. Based upon a body of knowledge and professional experience, these guidelines and standards are to be the benchmark for performance of amino acid analysis for clinical interpretation.
Amino Acids↗
Judging trauma center quality: does it depend on the choice of outcomes?
BACKGROUND: Trauma centers routinely benchmark their survival outcomes against a national norm using the TRISS methodology. However, the use of survival as a measure of the effectiveness of trauma care may be too limited in scope because it fails to capture information regarding functional outcomes. METHODS: The objective of this study was to develop a prediction model that allows hospitals to benchmark their functional outcomes in blunt trauma patients, and to determine whether the assessment of hospital "quality" depends on the choice of outcome measure: survival or survival combined with functional outcome. This retrospective cohort study was based on patients, aged 18 years or older, in the National Trauma Database who sustained blunt trauma in 1999 without associated head or spinal cord injury. We developed a sequential logistic model to predict the probability of a good functional outcome. The TRISS methodology was customized to this data set to obtain a survival model. Using each of these prediction models, we then obtained two standardized measures of hospital performance: one based on the number of survivors and the other based on the number of survivors with good functional outcomes. These standardized outcome measures were then used to identify low-performance and high-performance hospitals. The ranking based on these two different measures were compared. RESULTS: Fifteen of the 27 hospitals in the study cohort were categorized differently when their performance was benchmarked using survival versus functional outcome. Kappa analysis revealed minimal agreement between these two quality measures on the identity of hospital quality outliers (kappa = 0.04; p = 0.35). CONCLUSION: The evaluation of hospital quality depends on whether hospital performance is judged by looking at survival or at survival combined with functional outcome. Because functional status is an important outcome of major concern to survivors, it is important to include it in hospital performance assessment. Consideration should be given to including functional outcome in the evaluation of trauma center performance.
Benchmarking↗
Agreement between experiment and hybrid DFT calculations for O--H bond dissociation enthalpies in manganese complexes.
Information on the accuracy of DFT functionals for redox reactions in transition metal systems is rather limited. To analyze the performance of some popular functionals for redox reactions in manganese systems, calculated O--H bond dissociation enthalpies for Mn-ligands in six different complexes are compared to experimental results. In this benchmark, B3LYP performs well with a mean absolute error of 3.0 kcal/mol. B98 gives similar results to B3LYP (error of 3.8 kcal/mol). B3LYP* gives lower O--H bond strengths than B3LYP and has a mean error of 5.0 kcal/mol. Compared to B98 and B3LYP, B3LYP* has an error trend for the manganese ligands that is more similar to the error for a free water molecule. The nonhybrid functional BLYP consistently and significantly underestimates the O--H bond strengths by approximately 20 kcal/mol. HCTH407 has a rather large mean error of 9.4 kcal/mol and shows no consistent trend. The results support the use of hybrid functionals and the present computational method for large model systems containing manganese. An example is the oxygen evolving complex in photosystem II where hybrid functionals predict the appearance of a Mn(IV)-oxyl radical before the O--O bond formation step.
Journal Article↗
SimFold energy function for de novo protein structure prediction: consensus with Rosetta.
Predicting protein tertiary structures by in silico folding is still very difficult for proteins that have new folds. Here, we developed a coarse-grained energy function, SimFold, for de novo structure prediction, performed a benchmark test of prediction with fragment assembly simulations for 38 test proteins, and proposed consensus prediction with Rosetta. The SimFold energy consists of many terms that take into account solvent-induced effects on the basis of physicochemical consideration. In the benchmark test, SimFold succeeded in predicting native structures within 6.5 A for 12 of 38 proteins; this success rate was the same as that by the publicly available version of Rosetta (ab initio version 1.2) run with default parameters. We investigated which energy terms in SimFold contribute to structure prediction performance, finding that the hydrophobic interaction is the most crucial for the prediction, whereas other sequence-specific terms have weak but positive roles. In the benchmark, well-predicted proteins by SimFold and by Rosetta were not the same for 5 of 12 proteins, which led us to introduce consensus prediction. With combined decoys, we succeeded in prediction for 16 proteins, four more than SimFold or Rosetta separately. For each of 38 proteins, structural ensembles generated by SimFold and by Rosetta were qualitatively compared by mapping sampled structural space onto two dimensions. For proteins of which one of the two methods succeeded and the other failed in prediction, the former had a less scattered ensemble located around the native. For proteins of which both methods succeeded in prediction, often two ensembles were mixed up.
Alanine↗
Corporatization as a means of improving water quality: the experience in Victoria, Australia.
Factors including fragmentation, a lack of direction, poor accountability, poor water quality, and a sizable state government subsidy contributed to the rural water industry in Victoria, Australia, in 1993. In 1993 the state government set out parameters for reform to change the size, structure, performance, and culture of the water industry. The path taken was not privatization, but corporatization. Tools used included amalgamation of organizations; separating water provisions from local government; changing the composition and reporting mechanisms of the boards; establishing clear benchmarks and performance criteria; making information publicly available; and providing a commercial orientation. The outcomes of the reforms were to be a focus on water quality and effluent management. In 2001, 15 water authorities were in place. There were significant improvements in accountability, finances, and performance. The authorities provided information on performance to both the state and the public. Reductions of operating costs have been in the range of 20-35%, with savings put back into new infrastructure. Water quality has significantly improved in a number of parameters and effluent management has also improved. This paper describes the challenges faced before the reform process, the reforms initiated, and the outcomes. It argues that privatization is not the only path to improvement: Developing a corporate structure and accountability can also deliver substantial improvements.
Benchmarking↗
Population approach to a neural discrimination task.
This article gives insights into the possible neuronal processes involved in visual discrimination. We study the performance of a spiking network of Integrate-and-Fire (IF) neurons when performing a benchmark discrimination task. The task we adopted consists of determining the direction of moving dots in a noisy context using similar stimuli to those in the experiments of Newsome and colleagues. We present a neural model that performs the discrimination involved in this task. By varying the synaptic parameters of the IF neurons, we illustrate the counter-intuitive importance of the second-order statistics (input noise) in improving the discrimination accuracy of the model. We show that measuring the Firing Rate (FR) over a population enables the model to discriminate in realistic times, and even surprisingly significantly increases its discrimination accuracy over the single neuron case, despite the faster processing. We also show that increasing the input noise increases the discrimination accuracy but only at the expense of the speed at which we can read out the FR.
Action Potentials↗
Multicenter study of oxygen-insensitive handheld glucose point-of-care testing in critical care/hospital/ambulatory patients in the United States and Canada.
OBJECTIVES: Existing handheld glucose meters are glucose oxidase (GO)-based. Oxygen side reactions can introduce oxygen dependency, increase potential error, and limit clinical use. Our primary objectives were to: a) introduce a new glucose dehydrogenase (GD)-based electrochemical biosensor for point-of-care testing; b) determine the oxygen-sensitivity of GO- and GD-based electrochemical biosensor test strips; and c) evaluate the clinical performance of the new GD-based glucose meter system in critical care/hospital/ambulatory patients. DESIGN: Multicenter study sites compared glucose levels determined with GD-based biosensors to glucose levels determined in whole blood with a perchloric acid deproteinization hexokinase reference method. One site also studied GO-based biosensors and venous plasma glucose measured with a chemistry analyzer. Biosensor test strips were used with a handheld glucose monitoring system. Bench and clinical oxygen sensitivity, hematocrit effect, and precision were evaluated. SETTING: The study was performed at eight U.S. medical centers and one Canadian medical center. PATIENTS: There were 1,248 patients. RESULTS: The GO-based biosensor was oxygen-sensitive. The new GD-based biosensor was oxygen-insensitive. GD-based biosensor performance was acceptable: 2,104 (96.1%) of 2,189 glucose meter measurements were within +/-15 mg/dL (+/-0.83 mmol/L) for glucose levels of < or = 100 mg/dL (< or = 5.55 mmol/L) or within +/-15% for glucose levels of > 100 mg/dL, compared with the whole-blood reference method results. With the GD-based biosensor, the percentages of glucose measurements that were not within the error tolerance were comparable for different specimen types and clinical groups. Bracket predictive values were acceptable for glucose levels used in therapeutic management. CONCLUSIONS: The performance of GD-based, oxygen-insensitive, handheld glucose testing was technically suitable for arterial specimens in critical care patients, cord blood and heelstick specimens in neonates, and capillary and venous specimens in other patients. Multicenter findings benchmark the performance of bedside glucose testing devices. With the new +/-15 mg/dL --> 100 mg/dL --> +/-15% accuracy criterion, point-of-care systems for handheld glucose testing should score 95% (or better), as compared with the recommended reference method. Physiologic changes, preanalytical factors, confounding variables, and treatment goals must be taken into consideration when interpreting glucose results, especially in critically ill patients, for whom arterial blood glucose measurements will reflect systemic glucose levels.
Adult↗
Demonstration of a tool for automatic learning and re-use of knowledge in the activated sludge process.
Wastewater treatment plant operators encounter complex operational problems related to the activated sludge process and usually respond to these by applying their own intuition and by taking advantage of what they have learnt from past experiences of similar problems. However, previous process experiences are not easy to integrate in numerical control, and new tools must be developed to enable re-use of plant operating experience. The aim of this paper is to investigate the usefulness of a case-based reasoning (CBR) approach to apply learning and re-use of knowledge gained during past incidents to confront actual complex problems through the IWA/COST Benchmark protocol. A case study shows that the proposed CBR system achieves a significant improvement of the benchmark plant performance when facing a high-flow event disturbance.
Artificial Intelligence↗
Trends in acute myocardial infarction management: use of the National Registry ofMyocardial Infarction in quality improvement.
Cardiovascular disease, including acute myocardial infarction (AMI), is the leading cause of death in the United States and was the primary disease category among hospital discharges in 1996. Efforts to improve hospital care of patients with AMI should be measured and assessed routinely for appropriateness of care and improvement of medical staff performance. The National Registry of Myocardial Infarction (NRMI), an observational Phase IV study, has enrolled > 1 million AMI patients since 1990, and is now in its third phase. NRMI 3 collects patient data and facilitates the measurement of improvement in care and outcomes, while allowing participating institutions to benchmark their performance against national, state, and like-hospital data. Three measures from NRMI 3 are accepted for the Joint Commission on Accreditation of Healthcare Organizations' ORYX initiative: (1) aspirin use within 24 hours of AMI diagnosis; (2) door-to-drug time for fibrinolysis; and (3) no initial reperfusion strategy given to eligible patients.
Anti-Inflammatory Agents, Non-Steroidal↗
Benchmarking and quality in residential and nursing homes: lessons from the US.
BACKGROUND: Performance measurement and benchmarking are common concerns in the delivery of long term care. It is common to measure the performance of providers and to publicly report these data. This paper examines selected technical challenges facing those who design, implement and disseminate health care quality performance measures. METHOD: Review of the application of measures of performance in the US nursing home sector. RESULTS: Using examples drawn from the skilled nursing home arena, problems ranging from data reliability and validity, the multi-dimensional nature of quality measures and selection bias as well as differential measurement abilities are discussed. CONCLUSIONS: Benchmarking of performance is an inherently complex issue. However, to ensure that such comparisons are both fair and valid requires measures to be more technically sophisticated and sensitive to real changes attributable to changes in care.
Benchmarking↗
Initial twelve months experience and analysis for 2001-2002 from the Australasian Society of Cardiac and Thoracic Surgeons--Victorian database project.
UNLABELLED: The Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) have established a database for the collection and analysis of the results of cardiac surgery in Australia and New Zealand. Initially data has been collected only in Victoria public hospitals. This report covers the first 12 months of data collection from 1st August 2001 to 1st July 2002. BACKGROUND: Whilst cardiac surgical performance in Australia is considered to be of a high standard equivalent to other developed countries, there is currently no systematic approach to data collection in order to provide performance indicators and benchmarks. The development of an Australasian cardiac surgical database and performance indicators will enable benchmarking and comparison with international standards which should lead to performance improvements. METHODS: A database definition set and standardised data collection form was developed by the ASCTS for all participating cardiac surgery units in public hospitals in Victoria. Opt-off consent for subject inclusion in the database was approved by each participating institutional ethics review committee. An electronic database and reporting application was developed. Data included in this analysis is from the initial 12 months collection from all hospitals participating in the project from 1st August 2001 to 31st July 2002. RESULTS: Overall, there were 2982 procedures performed in this period of which 2969 had sufficient data to be included in this analysis (99.5%). The majority of procedures 2017 (68%) being undertaken were isolated coronary artery bypass surgery (CABG). The mean age of all subjects undergoing procedures was 65 years (range: 18-91 years) and 70% were male. 64% of all procedures were elective and 6.1% emergency or salvage. Median post-procedure length of hospital stay for all procedures was 6.0 days and intensive care unit (ICU) stay was 23.0h. Re-operation for haemorrhage occurred in 2.1% of all cases and deep sternal infection in 0.4% of all cases. Crude 30-day operative mortality was 3.6% for all procedures; 2.1% for isolated CABG, 3.6% for valve procedures, 5.2% for valve and CABG and 11.4% for other cardiac surgical procedures. Mortality rates increased from 1.8% for elective procedures to 4.1% for urgent and 24.6% for emergency or salvage operations. In comparison to international figures from the USA and UK, mortality rates following isolated CABG were lower whilst average length of hospital stay post-procedure was higher. CONCLUSION: The ASCTS database project is now well established and the electronic database and reporting module is in operation in all participating sites. The risk-adjusted isolated operative mortality suggests cardiac surgical performance in Victoria compares well with international standards. As the database develops, local risk-adjustment models for mortality and morbidity for each procedure will be developed to enable appropriate between hospital comparisons.
Journal Article↗