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PubMed1999

Benchmarking patient relations within ambulatory care: lessons from a high-risk pregnancy program.

Ambulatory care providers are being challenged to deliver high-quality care at low cost with easy access. Patient satisfaction with services hinges on the ability of providers to meet these often elusive benchmarks. This article focuses on the barriers to benchmarking patient relations in ambulatory care organizations and strategies for improving patient relations through internal benchmarking that encourages service innovation and performance emphasis. A case study of programmatic benchmarking in the Lovelace Health System is used to illustrate how patient relations can benefit from establishing internal performance thresholds that guide service delivery. Examples from Lovelace's High Risk Pregnancy Program demonstrate the value of benchmarking efforts. The implications for patient relations benchmarking in other ambulatory care settings are discussed.

Ambulatory Care↗

PubMed2001

Benchmarking and the laboratory.

This article describes how benchmarking can be used to assess laboratory performance. Two benchmarking schemes are reviewed, the Clinical Benchmarking Company's Pathology Report and the College of American Pathologists' Q-Probes scheme. The Clinical Benchmarking Company's Pathology Report is undertaken by staff based in the clinical management unit, Keele University with appropriate input from the professional organisations within pathology. Five annual reports have now been completed. Each report is a detailed analysis of 10 areas of laboratory performance. In this review, particular attention is focused on the areas of quality, productivity, variation in clinical practice, skill mix, and working hours. The Q-Probes scheme is part of the College of American Pathologists programme in studies of quality assurance. The Q-Probes scheme and its applicability to pathology in the UK is illustrated by reviewing two recent Q-Probe studies: routine outpatient test turnaround time and outpatient test order accuracy. The Q-Probes scheme is somewhat limited by the small number of UK laboratories that have participated. In conclusion, as a result of the government's policy in the UK, benchmarking is here to stay. Benchmarking schemes described in this article are one way in which pathologists can demonstrate that they are providing a cost effective and high quality service.

Benchmarking↗

PubMed1999

Can data-driven benchmarks be used to set the goals of healthy people 2010?

OBJECTIVES: Expert panels determined the public health goals of Healthy People 2000 subjectively. The present study examined whether data-driven benchmarks provide a better alternative. METHODS: We developed the "pared-mean" method to define from data the best achievable health care practices. We calculated the pared-mean benchmark for screening mammography from the 1994 National Health Interview Survey, using the metropolitan statistical area as the "provider" unit. Beginning with the best-performing provider and adding providers in descending sequence, we established the minimum provider subset that included at least 10% of all women surveyed on this question. The pared-mean benchmark is then the proportion of women in this subset who received mammography. RESULTS: The pared-mean benchmark for screening mammography was 71%, compared with the Healthy People 2000 goal of 60%. CONCLUSIONS: For Healthy People 2010, benchmarks derived from data reflecting the best available care provide viable alternatives to consensus-derived targets. We are currently pursuing additional refinements to the data-driven pared-mean benchmark approach.

Benchmarking↗

PubMedDate not supplied

Occupational therapy benchmarks within orthopedic (hip) critical pathways.

OBJECTIVE: This study examined patient performance benchmarks for occupational therapy within orthopedic (hip) critical pathways. METHOD: Eight orthopedic (hip) critical pathways gathered from occupational therapy practitioners working in hospital and rehabilitation settings were examined to determine commonalities and differences of occupational therapy benchmarks, disciplines involved, and identified allowable variances. A comparison and contrast matrix was developed to provide a visual means of reviewing the data. RESULTS: Nursing, physical therapy, and occupational therapy were disciplines consistently involved in the pathways. Activities of daily living related to self-care were the most consistently used occupational therapy benchmark within the sample pathways, and functional transfers were the second most-used benchmark. The remaining occupational therapy benchmarks varied, and little commonality was found in their use. Frequency of use also varied among the eight pathways. Five of eight pathways specifically coded variances, with the remaining three providing space for explanation of the variance. CONCLUSION: Although these eight orthopedic (hip) critical pathways included occupational therapy benchmarks, further development and definition of the role of occupational therapy within subsequent orthopedic (hip) critical pathways is needed.

Benchmarking↗

PubMedDate not supplied

Developing benchmarks for prior learning assessment. Part 1: Research.

AIM: The aim of the study was to develop and promote national benchmarks for those engaged in accreditation of prior learning (APL) termed 'prior learning assessment and recognition' (PLAR) assessment in Canada, in all sectors and communities. The study objectives were to gain practitioner consensus on the development of benchmarks for APL (PLAR) across Canada; produce a guide to support the implementation of national benchmarks; make recommendations for the promotion of the national benchmarks; and distribute the guide. The study also investigated the feasibility of developing a system to confirm the competence of APL (PLAR) practitioners, based on nationally agreed benchmarks for practice. METHOD: A qualitative research strategy was developed, which used a benchmarking survey and focus groups as the primary research tools. These were applied to a purposive sample of APL practitioners (n = 91). The participants were identified through the use of an initial screening survey. RESULTS: Respondents indicated that in Canada, PLAR is used in a variety of ways to assist with individual and personal growth for human resource development, the preparation of professionals and the achievement of academic credit. The findings of the focus groups are summarised using a SWOT analysis CONCLUSION: The study identified that the main functions of the PLAR practitioners are to prepare individuals for assessment and conduct assessments. Although practitioners should be made aware of the potential conflicts in undertaking combined roles, they should be encouraged to develop confidence in both functions.

Accreditation↗

PubMed2001

Benchmarking initiatives in the water industry.

Customer satisfaction and service care are every day pushing professionals in the water industry to seek to improve their performance, lowering costs and increasing the provided service level. Process Benchmarking is generally recognised as a systematic mechanism of comparing one's own utility with other utilities or businesses with the intent of self-improvement by adopting structures or methods used elsewhere. The IWA Task Force on Benchmarking, operating inside the Statistics and Economics Committee, has been committed to developing a general accepted concept of Process Benchmarking to support water decision-makers in addressing issues of efficiency. In a first step the Task Force disseminated among the Committee members a questionnaire focused on providing suggestions about the kind, the evolution degree and the main concepts of Benchmarking adopted in the represented Countries. A comparison among the guidelines adopted in The Netherlands and Scandinavia has recently challenged the Task Force in drafting a methodology for a worldwide process benchmarking in water industry. The paper provides a framework of the most interesting benchmarking experiences in the water sector and describes in detail both the final results of the survey and the methodology focused on identification of possible improvement areas.

Benchmarking↗

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↗

PubMed2006

Benchmarks of Fairness for health care reform in Thailand--combining evidence with opinion of the civic group.

The concept of the Benchmarks of Fairness was tried in Thailand before the big reform of universal coverage policy in 2001. The first phase of the Benchmarks in 1999 involved the analysis of the national health reform proposal as well as the analysis of ongoing field trials of health reforms in two provinces. Though the participants were predominately health personnel, the results suggested the power of combining qualitative viewpoints of participants with the quantitative indicators within the province to move health reforms to more equitable, more efficient and more democratic directions. The second phase of the Benchmarks of Fairness, therefore, tested the possibility of involving wider participation of the civic groups related, and not-related to health, in assessing their provincial health system. The health achievements of the provinces a measured by 81 indicators, in the 9 benchmarks, were provided to the civic groups before focus group discussions in 10 selected provinces to facilitate discussions based on evidence. More qualitative data were obtained from the discussions as well as their judgements on the fairness of their provincial health system. Having completed this second phase, it was recommended that the benchmarks tool could be further endorsed as the basis for monitoring the progress of health reform by province and the effect of health care decentralization. To accomplish this monitoring, the civic groups should have continuous access to evidence, in line with the benchmarks, and they should be provided with the opportunity to express their views, which is helpful in monitoring fairness in the long run.

Benchmarking↗

PubMed1994

Calculation of benchmark doses from teratology data.

The benchmark dose approach has several potential advantages over the no observed adverse effect level (NOAEL) as a basis for risk assessment of toxic chemicals, based upon animal toxicity data. The practical use of the benchmark dose has been evaluated by applying dose-response models to an extensive historical database of teratology bioassays. Doses corresponding to 1 and 5% increases in incidence of lesions are calculated and compared to NOAELs. The statistical accuracy of these estimates was determined by calculating confidence intervals. The lower confidence limit on the 5% benchmark dose (LED05) is found to be comparable to the NOAEL for most datasets, and slightly higher on average. Benchmark doses at the 1% level could not be estimated accurately (i.e., they had wide confidence intervals) for a significant fraction of the datasets. LED01 values were lower on average than the NOAEL. Based on these results, it is concluded that benchmark doses for a 5% increases in incidence can be calculated for most datasets, and could be used as a satisfactory basis for risk assessment, e.g., to set reference doses or acceptable daily intakes. An exception occurs when the benchmark dose exceeds the highest dose of the study. This is only likely to occur when the chemical causes a small, but significant, increase in a finding that is uncommon in untreated animals.

Abnormalities, Drug-Induced↗

PubMed1995

Application of benchmark dose risk assessment methodology to developmental toxicity: an industrial view.

The U.S. EPA first signalled its intention to use benchmark dose risk techniques in 1991. Subsequently, publication of draft Guidelines for the Risk Assessment of Reproductive Toxicity data indicated the Agency's intention for wide use of the technique. In developmental toxicity experiments, a number of factors need to be considered before attempting benchmark dose calculations, as compared to the conventional NOAEL approach. For example, care in the assessment of potential litter effects (the litter is the unit of such a study) on the data and whether the data are continuous (e.g. foetal body weight) or discontinuous (e.g. specific or grouped developmental defects where the abnormality is present or absent). Two examples of the use of the benchmark dose approach will be made. First, in the analysis of foetal body weight, where a benchmark dose estimate for an agent producing a 5% decrease in mean foetal weight may be calculated from a shift in the distribution of foetal weights between groups, or by conversion of data to reflect changes in the incidence of 'small' pups (i.e. those towards the extreme of the normal range). The second example involves studies conducted on the developmental toxicity of a triazole antifungal. In the first study, the agent was clearly teratogenic, but a NOAEL was not established and thus necessitated a second study. Analysis of benchmark does estimates (e.g. for % foetuses malformed) from the first study indicated that these were not significantly changed when the data from the second study were combined (i.e. the second study did not aid the risk assessment). The benchmark dose approach has significant scientific and practical advantages over the conventional NOAEL methodology in risk assessments derived from developmental toxicity studies.

Animals↗

PubMed1993

Understanding benchmarking.

In order to meet the challenges facing health care today, organizations are turning to new approaches. Benchmarking is one such approach. Benchmarking is externally driven, encouraging organizations to look outside their own walls to learn from others and achieve exemplar performance. Organizations can benchmark within their own systems, against competitors, against "best-in-class" companies in the same general industry and against "best-in-class" companies in different industries. A four-step approach to benchmarking includes planning, collecting information, analyzing results and adapting and improving. A benchmarking study team composed of the process owner and other users of the process conducts the study. Application of benchmarking to healthcare materiel management is particularly appropriate, since many materiel management processes occur in other industries and, therefore, best practices outside the healthcare industry may be adapted. The practice, through growing in other industries, is still very new in health care.

Data Collection↗

PubMed1995

Benchmarking in healthcare: selecting and working with partners.

The process of selecting a benchmarking partner begins with gathering information to establish industry standards, identifying potential partners and supplying data on the subject to be benchmarked. Suggested sources of information are business and trade publications; investment industry analysts; journalists; trade associations and professional organizations; government research reports; disclosure documents; current and former employees; and product and service providers. Potential partners should be approached only after careful preparation of a project plan that includes information about the benchmarking team's organization and purpose, description of the subject and a statement of benefits for the prospective partner. After obtaining a commitment from the benchmarking partner, relevant comparative data is gathered and analyzed, using some of the following methods: library research, questionnaires, telephone surveys, site visits and consultants. Because benchmarking often involves sharing information with competitors, a code of ethical conduct has been developed by the International Benchmarking Clearinghouse.

Decision Making, Organizational↗

PubMed2004

Towards a common benchmark for long-term process control and monitoring performance evaluation.

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 biological wastewater treatment processes. The fact that the benchmark has resulted in more than 100 publications, not only in Europe but also worldwide, demonstrates the interest for such a tool in the research community. In this paper, an extension of the benchmark simulation model no. 1 (BSM1) is proposed. It aims at facilitating evaluation of two closely related operational tasks: long-term control strategy performance and process monitoring performance. The motivation for the extension is that these two tasks typically act on longer time scales. The extension proposed here consists of 1) prolonging the evaluation period to one year (including influent files), 2) specifying time varying process parameters and 3) including sensor and actuator failures. The prolonged evaluation period is necessary to obtain a relevant and realistic assessment of the effects of such disturbances. Also, a prolonged evaluation period allows for a number of long-term control actions/handles that cannot be evaluated in a realistic fashion in the one week BSM1 evaluation period. In the paper, models for influent file design, parameter changes and sensor failures, initialization procedure and evaluation criteria are discussed. Important remaining topics, for which consensus is required, are identified. The potential of a long-term benchmark is illustrated with an example of process monitoring algorithm benchmarking.

Algorithms↗

PubMed1999

Benchmarking PSI-BLAST in genome annotation.

The recognition of remote protein homologies is a major aspect of the structural and functional annotation of newly determined genomes. Here we benchmark the coverage and error rate of genome annotation using the widely used homology-searching program PSI-BLAST (position-specific iterated basic local alignment search tool). This study evaluates the one-to-many success rate for recognition, as often there are several homologues in the database and only one needs to be identified for annotating the sequence. In contrast, previous benchmarks considered one-to-one recognition in which a single query was required to find a particular target. The benchmark constructs a model genome from the full sequences of the structural classification of protein (SCOP) database and searches against a target library of remote homologous domains (<20 % identity). The structural benchmark provides a reliable list of correct and false homology assignments. PSI-BLAST successfully annotated 40 % of the domains in the model genome that had at least one homologue in the target library. This coverage is more than three times that if one-to-one recognition is evaluated (11 % coverage of domains). Although a structural benchmark was used, the results equally apply to just sequence homology searches. Accordingly, structural and sequence assignments were made to the sequences of Mycoplasma genitalium and Mycobacterium tuberculosis (see http://www.bmm.icnet. uk). The extent of missed assignments and of new superfamilies can be estimated for these genomes for both structural and functional annotations.

Algorithms↗

PubMed1999

Benchmark testing the Digital Imaging Network-Picture Archiving and Communications System proposal of the Department of Defense.

The Department of Defense issued a Request for Proposal (RFP) for its next generation Picture Archiving and Communications System in January of 1997. The RFP was titled Digital Imaging Network-Picture Archiving and Communications System (DIN-PACS). Benchmark testing of the proposed vendors' systems occurred during the summer of 1997. This article highlights the methods for test material and test system organization, the major areas tested, and conduct of actual testing. Department of Defense and contract personnel wrote test procedures for benchmark testing based on the important features of the DIN-PACS Request for Proposal. Identical testing was performed with each vendor's system. The Digital Imaging and Communications in Medicine (DICOM) standard images used for the Benchmark Testing included all modalities. The images were verified as being DICOM standard compliant by the Mallinckrodt Institute of Radiology, Electronic Radiology Laboratory. The Johns Hopkins University Applied Physics Laboratory prepared the Unix-based server for the DICOM images and operated it during testing. The server was loaded with the images and shipped to each vendor's facility for on-site testing. The Defense Supply Center, Philadelphia (DSCP), the Department of Defense agency managing the DIN-PACS contract, provided representatives at each vendor site to ensure all tests were performed equitably and without bias. Each vendor's system was evaluated in the following nine major areas: DICOM Compliance; System Storage and Archive of Images; Network Performance; Workstation Performance; Radiology Information System Performance; Composite Health Care System/Health Level 7 communications standard Interface Performance; Teleradiology Performance; Quality Control; and Failover Functionality. These major sections were subdivided into workable test procedures and were then scored. A combined score for each section was compiled from this data. The names of the involved vendors and the scoring for each is contract sensitive and therefore can not be discussed. All of the vendors that underwent the benchmark testing did well. There was no one vendor that was markedly superior or inferior. There was a typical bell shaped curve of abilities. Each vendor had their own strong points and weaknesses. A standardized benchmark protocol and testing system for PACS architectures would be of great value to all agencies planning to purchase a PACS. This added information would assure the purchased system meets the needed functional requirements as outlined by the purchasers PACS Request for Proposal.

Benchmarking↗

PubMed2003

Derivation of aquatic screening benchmarks for 1,2-dibromoethane.

Ethylene dibromide (1,2-dibromoethane or EDB) was primarily used in the United States as an additive in leaded gasoline and as a soil and grain fumigant for worm and insect control until it was banned in 1983. Historical releases of EDB have resulted in detectable EDB in groundwater and drinking wells, and recently concentrations up to 16 microg/L were detected in ground water at two fuel spill plumes in the vicinity of the Massachusetts Military Reservation Base on Cape Cod, Massachusetts. Because the ground water in this area is used to flood cranberry bogs for the purposes of harvesting, the U.S. Air Force sponsored the development of aquatic screening benchmarks for EDB. Acute toxicity tests with Pimephales promelas (fathead minnow), Daphnia magna, and Ceriodaphnia dubia were conducted to provide data needed for development of screening benchmarks. Using a closed test-system to prevent volatilization of EDB, the 48-h LC50S (concentration that kills 50% of the test organisms) for P. promelas, D. magna, and C. dubia were 4.3 mg/L, 6.5 mg/L, and 3.6 mg/L, respectively. The screening benchmark for aquatic organisms, derived as the Tier II chronic water quality criteria, is 0.031 mg EDB/L. The sediment screening benchmark, based on equilibrium partitioning, is 2.45 mg EDB/kg of organic carbon in the sediment. The screening benchmarks developed here are an important component of an ecological risk assessment, during which perhaps hundreds of chemicals must be evaluated for their potential to cause ecological harm.

Animals↗

PubMed2002

Benchmarking in ambulatory surgery.

The health care industry is relatively new to benchmarking. More clinical benchmarking is needed because little is known about which practices and processes lead to which outcomes. Benchmarking is a valuable quality improvement tool that can be used to improve practices and performances when instituted properly. This article describes the benchmarking process, its usefulness, and how ambulatory surgery centers can improve performance by using benchmarking.

Ambulatory Surgical Procedures↗

PubMed2002

Controller performance analysis with LQG benchmark obtained under closed loop conditions.

This paper proposes a new method for obtaining a linear quadratic Gaussian (LQG) benchmark in terms of the variances of process input and output from closed-loop data, for assessing the controller performance. LQG benchmark has been proposed in the literature to assess controller performance since the LQG tradeoff curve represents the limit of performance in terms of input and output variances. However, an explicit parametric model is required to calculate the LQG benchmark. In this work, we propose a data driven subspace approach to calculate the LQG benchmark under closed-loop conditions with certain external excitations. The optimal LQG-benchmark variances are obtained directly from the subspace matrices corresponding to the deterministic inputs and the stochastic inputs, which are identified using closed-loop data with setpoint excitation. These variances are used for assessing the controller performance. The method proposed in this paper is applicable to both univariate and multivariate systems. Profit analysis for the implementation of feedforward control to the existing feedback-only control system is also analyzed under the optimal LQG performance framework. The proposed method is illustrated through a simulation example and an application on a pilot scale process.

Benchmarking↗