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Results for “Performance benchmarking”

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PubMed2002

The quality performance matrix: New York State's model for targeting quality improvement in managed care plans.

This article describes a methodology developed by the New York State Department of Health to analyze health plan performance data using two benchmarks: comparison to peers and comparison to historic results. It explains how that analysis is used to target quality improvement. Through this process the department effectively partners with health plans to foster improvement by identifying problems and barriers, encouraging health plans to set performance goals, and then working with health plans to design action plans to address the barriers. This model can be replicated for use by other states or other entities charged with monitoring quality improvement in managed care.

Benchmarking↗

PubMed1994

How hospitals can use internal benchmark data to create effective managed care arrangements.

Hospitals are now adopting benchmarking techniques, along with total quality management techniques, in order to provide employers with detailed data and process comparisons with hospital competitors. Traditionally, employers have relied on inpatient price and length of stay as primary measures of hospital performance. However, successful hospital benchmarking can expand those measures to include additional factors such as quality, value, and outcome. This article describes how hospitals can use internal benchmark data to create effective managed care arrangements with employers.

Contract Services↗

PubMed1999

Examine your emergency department, stat! ED is key to hospital reputation.

Hospitals say meeting patient expectations in the emergency department (ED) is key to survival. The best indicator of patient satisfaction in the ED is waiting times, which seem to matter more to some patients than clinical expertise. Few national standards on emergency waiting times exist; your best bet for benchmarking is to identify better performers such as the hospitals in this special report.

Benchmarking↗

PubMed2004

An assessment of the Down syndrome antenatal screening policies of East and West Gloucestershire between 1993 and 1999.

This retrospective observational study of registered pregnancies in Gloucestershire between 1 April 1993 and 31 March 1999 compares the impact of different Down syndrome antenatal screening policies on detection and amniocentesis rates. The screening policies in East and West Gloucestershire are based on early second-trimester maternal serum and maternal age screening, respectively. Maternal serum screening can identify a greater proportion of pregnancies affected by Down syndrome than a programme founded on age-based amniocentesis and 20 weeks' ultrasound. In addition, maternal serum screening of women older than 34 approximately halves the number of amniocenteses performed to detect one affected fetus. However, the proportion of pregnant women who have amniocentesis is nearly doubled by offering serum screening to women aged over 24 years. These findings of the impact of established second-trimester screening policies in low-risk populations provides an useful benchmark to compare the performance of screening procedures that will be introduced in the United Kingdom over the next 3 years.

Adult↗

PubMed2004

Listening to the occupants: a Web-based indoor environmental quality survey.

UNLABELLED: Building occupants are a rich source of information about indoor environmental quality and its effect on comfort and productivity. The Center for the Built Environment has developed a Web-based survey and accompanying online reporting tools to quickly and inexpensively gather, process and present this information. The core questions assess occupant satisfaction with the following IEQ areas: office layout, office furnishings, thermal comfort, indoor air quality, lighting, acoustics, and building cleanliness and maintenance. The survey can be used to assess the performance of a building, identify areas needing improvement, and provide useful feedback to designers and operators about specific aspects of building design features and operating strategies. The survey has been extensively tested and refined and has been conducted in more than 70 buildings, creating a rapidly growing database of standardized survey data that is used for benchmarking. We present three case studies that demonstrate different applications of the survey: a pre/post analysis of occupants moving to a new building, a survey used in conjunction with physical measurements to determine how environmental factors affect occupants' perceived comfort and productivity levels, and a benchmarking example of using the survey to establish how new buildings are meeting a client's design objectives. PRACTICAL IMPLICATIONS: In addition to its use in benchmarking a building's performance against other buildings, the CBE survey can be used as a diagnostic tool to identify specific problems and their sources. Whenever a respondent indicates dissatisfaction with an aspect of building performance, a branching page follows with more detailed questions about the nature of the problem. This systematically collected information provides a good resource for solving indoor environmental problems in the building. By repeating the survey after a problem has been corrected it is also possible to assess the effectiveness of the solution.

Air Pollution, Indoor↗

PubMed1999

HCIA expands '100 Top Hospitals' program to include clinical research.

For six years, HCIA, Inc. has identified 100 hospitals that set benchmark standards of superior performance in management, patient care, and cost efficiency. Now this health care data management firm has expanded the program to include clinical research and identify best practices of top hospitals.

Awards and Prizes↗

PubMed2001

Speeds and wingbeat frequencies of migrating birds compared with calculated benchmarks.

Sixteen species of birds passing Falsterbo in southwest Sweden during the autumn migration season were observed using short-range optical methods. Air speeds and wingbeat frequencies were measured, reduced to sea level, and compared with benchmark values computed by Flight.bas, a published flight performance program based on flight mechanics. The benchmark for air speed was the calculated sea-level value of the minimum power speed (V(mp)). The mean speeds of three raptor species that flew by flap-gliding were below V(mp), apparently because the flap-glide cycle involved slowing down below V(mp) when gliding and accelerating back up to V(mp) when flapping. The mean speeds of 11 species that flew by continuous flapping were between 0.82V(mp) and 1.27V(mp). Two passerine species that flew by bounding had mean speeds of 1.70V(mp) and 1.96V(mp), but these high mean speeds reflected their ability to fly faster against head winds. These results do not support predictions from optimal migration theory, which suggest that migrating birds 'should' fly faster, relative to V(mp). However, observations were restricted for technical reasons to birds flying below 200 m and may not represent birds that were seriously committed to long-distance migration. The benchmark wingbeat frequency (f(ref)) was derived from dimensional reasoning, not from statistical analysis of observations. Observed wingbeat frequencies ranged from 0.81f(ref) to 1.05f(ref), except in the two bounding species, whose wingbeat frequencies appeared anomalously high. However, the mechanics of bounding with a power fraction q imply that gravity during the flapping phase is increased by a factor 1/q, and when the value of gravity was so adjusted in the expression for f(ref), the wingbeat frequencies of the two bounding species were predicted correctly as a function of the power fraction. In small birds with more muscle power than is required to fly at speeds near V(mp), bounding is an effective method of adjusting the specific work in the muscle fibres, allowing conversion efficiency to be maximised over a wide range of speeds.

Animal Migration↗

PubMed1994

Collaborative benchmarking in a healthcare system.

Leading organizations outside of the healthcare industry have benefitted from benchmarking for more than a decade. In the last few years, healthcare organizations also have begun to use benchmarking to achieve breakthrough improvements in their performances. Most of these organizations have conducted their benchmarking studies independently, working one-on-one with outside benchmarking partners. More recently, some organizations have chosen to benchmark processes in conjunction with other healthcare organizations. This article discusses the application of a collaborative benchmarking project conducted by selected facilities within the Catholic Health Corporation (CHC). It reviews the rationale for implementing collaborative benchmarking efforts and the benefits such efforts bring to the organizations involved. Presentation of a work in process--a case study on workers' compensation--provides insights into collaborative benchmarking. The article focuses on the initial phases of the benchmarking process--selecting the project and establishing the benchmarking collaborative.

Catholicism↗

PubMedDate not supplied

Occupational injuries in Greece (1938-1955): history of medicine and descriptive epidemiology.

AIM: To describe the longitudinal trends in the rates of total and fatal occupational accidents in Greece during 1938-1955. MATERIAL AND METHODS: Information on occupational injuries have been provided from the yearly reports of the Organization of Social Insurances (1938-1955) and on population data from the tables of National Statistic Agency. Bio-statistical analysis was performed by the use of SPSS software and Stat-Calc of Epi Info. RESULTS: The evolution of the longitudinal trend of occupational accidents has revealed a biphasic character, with a decreasing trend during 1938-1945 and an increasing trend during 1946-1955. The phenomenon was obvious in both sexes and in all age groups. On the contrary fatal occupational injuries increased across the period 1938-1945 and subsequently decreased. These temporal trends can be interpreted on the light of the important reduction in the level of economic activity during the second world war and the subsequent gradual recovery in the post war period. CONCLUSION: The biphasic characteristics of the occupational accidents longitudinal trend seems to be influenced by historical factors. Important lessons were learnt from the period of war. The decrease of the rate of total occupational accidents does not necessary reflect a satisfactory level of safety at work. The level of the economic activity, the efficiency of the registration and prevention agencies play a role. In addition, the rate of fatal injuries has a critical role in benchmarking national occupational health performance.

Accidents, Occupational↗

PubMedDate not supplied

Transfer rates from freestanding birth centers. A comparison with the National Birth Center Study.

This article reviews retrospective data derived from Sharp The BirthPlace. San Diego for 1993-94 and from the University of California. Irvine, Birthing Center for 1994 and compares these findings to data obtained from the National Birth Center Study (NBCS). The focus of this article is on intrapartum transfer rates from the two freestanding birth centers as a critical clinical indicator. Cause-specific transfer rates were calculated for eight clinical conditions. Data suggest that cause-specific intrapartum transfer rates are influenced by factors such as risk profile of the client population, distance to the referral center and mechanisms of transfer, definitions and diagnostic criteria used, and clinical practice guidelines. Reports from the literature, such as NBCS data, might serve as points of reference, but are likely not appropriate baseline indicators (benchmarks of "best practice") for clinical events, against which individual performance can be measured; rather, these benchmarks should be individually defined, based on characteristics unique to each birth center.

Birthing Centers↗

PubMed2002

Operational benchmarks. What CEOs want (need) to know.

Fazzi Associates began recruiting agencies to participate in a one-year study and later, for those interested, in a national benchmark service. What happened was nothing short of amazing. The response clearly showed how hungry home care leaders were for objective, valid comparative benchmark information on key performance indicators on all aspects of an agency's operation. And for the first time in the history of home care, agency CEOs could get clear answers to that one incredibly BIG question: "How are we doing?"

Administrative Personnel↗

PubMed2003

The benchmark dose method--review of available models, and recommendations for application in health risk assessment.

The benchmark dose method has been proposed as an alternative to the no-observed-adverse-effect level (NOAEL) approach for assessing noncancer risks associated with hazardous compounds. The benchmark dose method is a more powerful statistical tool than the traditional NOAEL approach and represents a step in the right direction for a more accurate risk assessment. The benchmark dose method involves fitting a mathematical model to all the dose-response data within a study, and thus more biological information is incorporated in the resulting estimates of guidance values (e.g., acceptable daily intakes, ADIs). Although there is an increasing interest in the benchmark dose approach, it has not yet found its way into the regulatory toxicology in Europe, while in the United States the U.S. Environmental Protection Agency (EPA) already uses the benchmark dose in health risk assessment. Several software packages are today available for benchmark dose calculations. The availability of software to facilitate the analysis can make modeling appear simple, but often the interpretation of the results is not trivial, and it is recommended that benchmark dose modeling be performed in collaboration with a toxicologist and someone familiar with this type of statistical analysis. The procedure does not replace expert judgments of toxicologists and others addressing the hazard characterization issues in risk assessment. The aim of this article is to make risk assessors familiar with the concept, to show how the method can be used, and to describe some possibilities, limitations, and extensions of the benchmark dose approach. In this article the benchmark dose approach is presented in detail and compared to the traditional NOAEL approach. Statistical methods essential for the benchmark dose method are presented in Appendix A, and different mathematical models used in the U.S. EPA's BMD software, the Crump software, and the Kalliomaa software are described in the text and in Appendix B. For replacement of NOAEL in health risk assessment it is considered important that consensus is reached on the crucial parts of the benchmark dose method, that is, selection of risk types and the determination of a response level corresponding to the BMD, especially for continuous data. It is suggested that the BMD method is used as a first choice and that in cases where it is not possible to fit a model to the data the traditional NOAEL approach should be used instead. The possibilities to make benchmark dose calculations on continuous data need to be further investigated. In addition, it is of importance to study whether it would be appropriate to increase the number of dose levels by decreasing the number of animals in each dose group.

Animals↗

PubMed2002

Evaluation of control strategies using an oxidation ditch benchmark.

This paper presents validation and implementation results of a benchmark developed for a specific full-scale oxidation ditch wastewater treatment plant. A benchmark is a standard simulation procedure that can be used as a tool in evaluating various control strategies proposed for wastewater treatment plants. It is based on model and performance criteria development. Testing of this benchmark, by comparing benchmark predictions to real measurements of the electrical energy consumptions and amounts of disposed sludge for a specific oxidation ditch WWTP, has shown that it can (reasonably) be used for evaluating the performance of this WWTP. Subsequently, the validated benchmark was then used in evaluating some basic and advanced control strategies. Some of the interesting results obtained are the following: (i) influent flow splitting ratio, between the first and the fourth aerated compartments of the ditch, has no significant effect on the TN concentrations in the effluent, and (ii) for evaluation of long-term control strategies, future benchmarks need to be able to assess settlers' performance.

Benchmarking↗

PubMed2003

Can IQCODE detect poststroke dementia?

BACKGROUND: Little is known about the performance of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in the screening of post-stroke dementia (PSDE). METHODS: At 3 months after the index stroke, a research assistant administered the IQCODE to relatives of 189 Chinese patients with acute stroke who were consecutively admitted to a general hospital. A psychiatrist, who was blind to the IQCODE scores, interviewed all 189 patients and made DSM-IV diagnosis of dementia, which served as the benchmark for judging the performance of IQCODE in screening PSDE. RESULTS: The optimal cut-off point of IQCODE was 3.40. The sensitivity, specificity, and positive and negative predictive values of IQCODE, and the area under the receiver operating characteristic curve, were 88%, 75%, 33%, 98%, and 0.88, respectively. CONCLUSIONS: When used as a sole instrument, IQCODE does not appear to be useful in screening PSDE in Chinese elderly.

Aged↗

PubMed2006

A summarization approach for Affymetrix GeneChip data using a reference training set from a large, biologically diverse database.

BACKGROUND: Many of the most popular pre-processing methods for Affymetrix expression arrays, such as RMA, gcRMA, and PLIER, simultaneously analyze data across a set of predetermined arrays to improve precision of the final measures of expression. One problem associated with these algorithms is that expression measurements for a particular sample are highly dependent on the set of samples used for normalization and results obtained by normalization with a different set may not be comparable. A related problem is that an organization producing and/or storing large amounts of data in a sequential fashion will need to either re-run the pre-processing algorithm every time an array is added or store them in batches that are pre-processed together. Furthermore, pre-processing of large numbers of arrays requires loading all the feature-level data into memory which is a difficult task even with modern computers. We utilize a scheme that produces all the information necessary for pre-processing using a very large training set that can be used for summarization of samples outside of the training set. All subsequent pre-processing tasks can be done on an individual array basis. We demonstrate the utility of this approach by defining a new version of the Robust Multi-chip Averaging (RMA) algorithm which we refer to as refRMA. RESULTS: We assess performance based on multiple sets of samples processed over HG U133A Affymetrix GeneChip arrays. We show that the refRMA workflow, when used in conjunction with a large, biologically diverse training set, results in the same general characteristics as that of RMA in its classic form when comparing overall data structure, sample-to-sample correlation, and variation. Further, we demonstrate that the refRMA workflow and reference set can be robustly applied to naïve organ types and to benchmark data where its performance indicates respectable results. CONCLUSION: Our results indicate that a biologically diverse reference database can be used to train a model for estimating probe set intensities of exclusive test sets, while retaining the overall characteristics of the base algorithm. Although the results we present are specific for RMA, similar versions of other multi-array normalization and summarization schemes can be developed.

Algorithms↗

PubMed2004

Can the Geriatric Depression Scale detect poststroke depression in Chinese elderly?

BACKGROUND: Little is known about the performance of the Geriatric Depression Scale (GDS) in the screening of post-stroke depression (PSD) among Chinese elderly. METHODS: Three months after the index stroke, a research assistant administered the 15-item GDS to 127 Chinese elderly patients with acute stroke who were consecutively admitted to a general hospital. A psychiatrist, who was blind to the GDS scores, administered the Structured Clinical Interview for DSM-IV to all patients and made DSM-IV diagnosis of depression, which served as the benchmark for judging the performance of GDS in screening PSD. RESULTS: The optimal cut-off point of GDS was 6/7. The sensitivity, specificity, positive and negative predictive values of GDS and the area under the receiver operating characteristic curve, were 89, 73, 37, 98 and 90%, respectively. LIMITATIONS: The sample size was small and there was no separate analysis of the performance of GDS for subtypes of PSD. CONCLUSIONS: Due to its low positive predictive value, a more specific instrument should supplement GDS in screening PSD in Chinese elderly.

Aged↗

PubMed2003

Evidence-based referral results in significantly reduced mortality after congenital heart surgery.

OBJECTIVE: Significant interinstitutional variation in mortality after congenital heart surgery has been demonstrated. Noting an association between reduced mortality and higher volume, a center with a small annual case volume began in August 1998 to selectively refer to high-volume surgical centers based on published or "apparent" low mortality rates for specific cardiac lesions. This study was undertaken to evaluate the effect of evidence-based referral in this practice. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort comparison over a 10-year period for a small Midwestern pediatric cardiology practice. The institutional database was retrospectively reviewed for children (<18 years) undergoing surgery from August 1992 to July 2002. Data were divided into 3 time periods (August 1992 to July 1995, period 1; August 1995 to July 1998, period 2; and August 1998 to July 2002, period 3). Hospital discharge abstract data from 5 states (California, Illinois, Massachusetts, Pennsylvania, and Washington) in 1992, 1996, and 1998 provided contemporaneous benchmarks. Risk adjustment was performed using the Risk Adjustment in Congenital Heart Surgery-1 method. Risk category, age at surgery, prematurity, and major noncardiac structural anomaly were entered into a multivariate logistic regression model to compare in-hospital mortality adjusting for case-mix differences. RESULTS: A total of 514 congenital heart surgical cases were identified from August 1992 to July 2002; 507 cases (98.6%) were assigned to a risk category and analyzed further. Unadjusted in-hospital mortality rates were 9.3% in period 1, 5.9% in period 2, and 1.3% in period 3. Unadjusted mortality rates for cases from benchmark data were 6.4% in 1992, 4.8% in 1996, and 3.7% in 1998. Risk adjusted mortality was comparable to the benchmark data in periods 1 and 2, but superior outcomes (odds ratio = 0.24) were demonstrated in period 3. CONCLUSIONS: Evidence-based referrals from a small-volume pediatric cardiac center to large-volume institutions resulted in a reduction in mortality after congenital heart surgery.

Adolescent↗

PubMed2005

Screening of dementia in stroke patients with lacunar infarcts: comparison of the mattis dementia rating scale and the mini-mental state examination.

There have been no data on the performance of the Initiation-Perseveration subtest of the Mattis Dementia Rating Scale (MDRS-IP) in screening poststroke dementia (PSDE). Three months after the index stroke, a research assistant administered the MDRS-IP and Mini-Mental State Examination (MMSE) to 83 Chinese stroke patients with lacunar infarcts who were consecutively admitted to the stroke unit of a general hospital. A psychiatrist, who was blind to the MDRS-IP and MMSE scores, interviewed all 83 patients and made a Diagnostic and Statistical Manual of Mental Disorders (4th edition) diagnosis of dementia, which served as the benchmark for judging the performance of MDRSIP. The optimal cutoff point of MDRS-IP was 22/23. The sensitivity, specificity, and positive and negative predictive values of MDRS-IP, and the area under the receiver operating characteristic curve were 82%, 90%, 0.41, 0.98, and 0.91, respectively. The overall performance of the MDRS-IP was comparable to the MMSE.

Activities of Daily Living↗