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PubMed2003

Measuring the performance of neonatal care units in Scotland.

Policy makers continue to debate whether or not to increase the share of health care expenditures in United Kingdom. On the other hand, the pressure of operating within tight budgets and the advances in technology are forcing more locally based hospitals to close. One that could be used by policy makers as a benchmark is the measure of relative performance of hospitals. Many researchers have examined the source of inefficiency in health sectors (see, for example, Harris et al., Oper. Res. Soc. 57:801-811, 2000, Ozcan et al., Med. Case 30:781-784, 1992; Ozcan et aL., J. Med. Syst. 20(3)141-150, 1996; and Grosskopf and Valdmanis, J. Health. Econ. 6:89-107, 1987 but there is no evidence of measuring performance of neonatal care units of Scottish hospitals in the DEA literature. The purpose of this paper is to measure both technical and scale efficiency using data envelopment analysis in a selection of 22 neonatal care units in Scotland. The analysis suggests that major inefficiency likely exists in health care production in United Kingdom. There is potential for improving productivity by 20%.

Benchmarking↗

PubMed2000

Achievable standards, benchmarks for reporting, and criteria for evaluating cervical cytopathology. Second edition including revised performance indicators.

Endocervical cells are not essential for an adequate smear, except where the previous abnormality was seen in endocervical cells. When three consecutive smears are reported as inadequate, the recommendation for colposcopy should be made at the discretion of the pathologist in the light of a review of the relevant slides and the clinical history of the woman concerned. The cellularity of previous sequential smears should not be combined in order to judge the present smear test as negative. There should be no more than three abnormal smears (including borderline) over any 10-year period without a recommendation for colposcopy. At least three negative smears, at least 6 months apart, should be reported before a woman is returned to routine recall following a smear showing mild dyskaryosis or borderline nuclear change. There is no evidence that demonstrates that selective double screening is any more effective in preventing false-negatives than rapid review and this practice cannot therefore be justified. Sensitivity should be based on all abnormalities detected on primary screening rather than on moderate dyskaryosis or worse. Ranges for reporting rates are based on the 10-90th percentiles of the range for laboratories reporting over 10000 screening smears per year in KC61 returns, but apply to all laboratories reporting screening smears.

Algorithms↗

PubMed2004

Direct assessment of functional abilities: relevance to persons with schizophrenia.

OBJECTIVE: To review functional outcome assessment strategies specifically focusing on performance-based measures used in patients with schizophrenia. METHOD: In order to identify relevant performance-based measures of functioning we conducted a literature search using key words: functioning, disability, performance, situation, assessment, skills, scale, measurement, instrument, psychosis, and schizophrenia. RESULTS: A description of each of eight measures was provided including assessment protocol, domains of functioning assessed, scoring, basic psychometric properties, appropriateness for clinical trials and likely sensitivity to pharmacologic interventions. Methods for assessment of functioning in patients with schizophrenia are reviewed. CONCLUSIONS: The measurement of functional capacity, through performance-based activities, provides a critical benchmark by which to evaluate the efficacy and effectiveness of medications in clinical trials to improve both cognition and capacity for everyday functioning in seriously mentally ill persons with schizophrenia. In order to comprehensively evaluate functional outcome, a combination of performance-based and other assessment modalities may be required.

Antipsychotic Agents↗

PubMed2004

Does patient-centered care improve provision of preventive services?

OBJECTIVES: While patient-centered care (PCC) is desirable for many reasons, its relationship to treatment outcomes is controversial. We evaluated the relationship between PCC and the provision of preventive services. METHODS: We obtained facility-level estimates of how well each VA hospital provided PCC from the 1999 ambulatory Veterans Satisfaction Survey. PCC delivery was measured by the average percentage of responses per facility indicating satisfactory performance from items in 8 PCC domains: access, incorporating patient preferences, patient education, emotional support, visit coordination, overall coordination of care, continuity, and courtesy. Additional predictors included patient population and facility characteristics. Our outcome was a previously validated hospital-level benchmarking score describing facility-level performance across 12 U.S. Preventive Services Task Force-recommended interventions, using the 1999 Veterans Health Survey. RESULTS: Facility-level delivery of preventive services ranged from an overall mean of 90% compliance for influenza vaccinations to 18% for screening for seat belt use. Mean overall PCC scores ranged from excellent (>90% for the continuity of care and courtesy of care PCC domains) to modest (<70% for patient education). Correlates of better preventive service delivery included how often patients were able to discuss their concerns with their provider, the percent of visits at which patients saw their usual provider, and the percent of patients receiving >90% of care from a VA hospital. CONCLUSION: Improved communication between patients and providers, and continuity of care are associated with increased provision of preventive services, while other aspects of PCC are not strongly related to delivery of preventive services.

Adult↗

PubMedDate not supplied

Achieving excellence in veterans healthcare--a balanced scorecard approach.

This article provides healthcare administrators and managers with a framework and model for developing a balanced scorecard and demonstrates the remarkable success of this process, which brings focus to leadership decisions about the allocation of resources. This scorecard was developed as a top management tool designed to structure multiple priorities of a large, complex, integrated healthcare system and to establish benchmarks to measure success in achieving targets for performance in identified areas. Significant benefits and positive results were derived from the implementation of the balanced scorecard, based upon benchmarks considered to be critical success factors. The network's chief executive officer and top leadership team set and articulated the network's primary operating principles: quality and efficiency in the provision of comprehensive healthcare and support services. Under the weighted benchmarks of the balanced scorecard, the facilities in the network were mandated to adhere to one non-negotiable tenet: providing care that is second to none. The balanced scorecard approach to leadership continuously ensures that this is the primary goal and focal point for all activity within the network. To that end, systems are always in place to ensure that the network is fully successful on all performance measures relating to quality.

Benchmarking↗

PubMed2001

Single centre, single domain validation of the EuroSCORE on a consecutive sample of primary and repeat CABG.

OBJECTIVES: Intra- and interdepartmental benchmarking require scoring systems with excellent performance on several properties: discrimination (resolution), reliability (calibration) and stability over the complete spectrum of peri-procedural risk. This single centre, single domain study validates the European system for cardiac operative risk evaluation (EuroSCORE) on an independent sample of primary and repeat coronary artery bypass grafting (CABG) patients and will evaluate these different properties. METHODS: The study population is a consecutive series of 2051 isolated primary and repeat CABG patients, inclusive of patients in cardiogenic shock or resuscitation, operated on in a single institution from January 1997 to July 2000. The age of the patients was 66+/-9 years, 77% were males and 7% were repeat procedures. The EuroSCORE was 5.0+/-3%, with a range from 0 to 22. The studied event was in-hospital death, defined as mortality during hospital stay, which was unlimited in time and included a stay in a secondary hospital without discharge home. RESULTS: The EuroSCORE predicted 102 deaths versus 81 deaths observed (P=0.14, Fisher exact test). The EuroSCORE described only 20% of the variance of in-hospital mortality. The EuroSCORE created an area under the receiver operating characteristic curve of 0.83+/-0.03. The highest discriminative accuracy was obtained with 8% EuroSCORE risk (only 64% sensitivity and 87% specificity). Further exploration identified an over score in the EuroSCORE range 0-8 (57%, P<0.0001). There was an equal score (-2%, P=1) in the range 9-11, but an under score in the range 12-22 (-133%, P=0.003). CONCLUSIONS: On the condition that these single centre results could be extended to any European cardiac surgery centre, it can be concluded that the overall acceptable performance of the EuroSCORE is the result of an over score in the lower risk and insufficient correction in the higher risk spectrum. The EuroSCORE is probably refined enough for improved informed consent versus aggregated results but should only be used for inter-institutional benchmarking with great caution, preferably below the 12% risk pivot.

Aged↗

PubMed2001

Getting 360 degrees feedback right.

Over the past decade, 360-degree feedback has revolutionized performance management. But one of its components--peer appraisal--consistently stymies executives and can exacerbate bureaucracy, heighten political tensions, and consume lots of time. For ten years, Maury Peiperl has studied 360-degree feedback and has asked: under what circumstances does peer appraisal improve performance? Why does peer appraisal sometimes work well and sometimes fail? And how can executives make these programs less anxiety provoking for participants and more productive for organizations? Peiperl discusses four paradoxes inherent to peer appraisal: In the Paradox of Roles, colleagues juggle being both peer and judge. The Paradox of Group Performance navigates between assessing individual feedback and the reality that much of today's work is done by groups. The Measurement Paradox arises because simple, straightforward rating systems would seem to generate the most useful appraisals--but they don't. Customized, qualitative feedback, though more difficult and time consuming to generate, is more helpful in improving performance. During evaluations, most people focus almost exclusively on reward outcomes and ignore the constructive feedback generated by peer appraisal. Ironically, it is precisely this overlooked feedback that helps improve performance--thus, the Paradox of Rewards. These paradoxes do not have neat solutions, but managers who understand them can better use peer appraisal to improve their organizations.

Benchmarking↗

PubMed2006

[The use of diagnosis-related-groups data for external benchmarking of anesthesia and intensive care services].

Measurement and assessment of the economic efficiency of clinical departments is still an unresolved, yet important problem in hospital management. Benchmarking with other providers can help to evaluate one's own efficacy in anaesthesia and intensive care services. In this article we describe a method for using the diagnosis-related-groups (DRG) cost breakdown data, to achieve a case mix adjusted comparison of own costs for anaesthesia and intensive care services with the average costs in German hospitals. On the basis of 19,401 cases from 10 different surgical departments, we compared our own costs with the German-wide benchmark. Major factors for profit optimisation are discussed. Special attention is given to the close interaction of surgical, anaesthesiological and intensive care process performance and costs and its impact on benchmarking studies.

Anesthesia↗

PubMed2006

An audit of the indications for the reporting of blood films: results from the National Pathology Benchmarking Study.

BACKGROUND: The National Pathology Benchmarking Review has completed seven years of analysis of the workload of haematology laboratories in the United Kingdom. OBJECTIVE: To audit criteria that laboratories use for preparing blood films against guidelines published by the International Consensus Group for Haematology Review. METHODS: Each laboratory completed a standard questionnaire about the number of blood counts and blood films done each year. Information was collected on the criteria that were used for preparing a blood film and the manufacturer of the equipment used to carry out the full blood count. RESULTS: 46 NHS trusts (93 laboratory sites) participated in the study. There was wide variation in the criteria used for preparing blood films when compared with the consensus guidelines. The variation in practice appeared to be irrespective of the type of hospital or the manufacturer of the equipment used for the blood count. CONCLUSIONS: There is a wide range in laboratory practice in preparing blood films. The publication of the consensus guidelines should help to standardise practice in this area. The next step in the study is to determine what the film review rate should be if these guidelines are implemented. This will then provide a benchmark of good practice which laboratories can use to assess their performance.

Benchmarking↗

PubMed1996

A proposed model to monitor heparin therapy using the concentrated thrombin time which allows standardisation of reagents and improved estimation of heparin concentrations.

The concentrated thrombin time (CTT), a thrombin time performed with a high concentration of thrombin, was evaluated as an alternative to the activated partial thromboplastin time (APTT) for monitoring of heparin therapy. Forty-nine plasmas from patients receiving unfractionated heparin therapy were tested. It was first demonstrated that CTTs using three commercial reagents could be standardised against CTTs performed with a reference reagent, MRC reagent 66/305. For comparison, APTTs were performed on the plasmas. As a benchmark of the degree of heparinisation, the heparin concentration of the plasmas was determined by chromogenic anti-IIa heparin assays, therapeutic range being 0.2-0.4 units/ml. The optimal relationships of the CTTs and APTT with the heparin concentration were established. These were used to predict the heparin concentrations of the plasmas from the results of the APTT, CTT performed with the reference reagent, and transformed CTT performed with each of the three commercial reagents. In predicting the assayed plasma heparin concentrations, the accuracy of the APTT was only 53%, while the CTT was from 78 to 82%. The CTT can be standardised and, subject to results of clinical trials, could provide an improved method of monitoring heparin therapy.

Afibrinogenemia↗

PubMedDate not supplied

Prediction of MHC class II binders using the ant colony search strategy.

OBJECTIVE: Predictions of the binding ability of antigen peptides to major histocompatibility complex (MHC) class II molecules are important in vaccine development. The variable length of each binding peptide complicates this prediction. METHODOLOGY: Motivated by the search properties of the ant colony system (ACS), a method for the identification of an alignment for a given set of short protein peptides has been developed. This alignment is further used for the derivation of a position specific scoring matrix. The distinguishing feature of this method is the use of the collective optimized search strategy of ants for the selection of the alignment. RESULTS: The performance of the new model has been evaluated with several benchmark datasets. It achieves better or comparable results as compared to the performance of existing methods. CONCLUSION: The experiments demonstrate that the predictive performance of the scoring matrix embodies several promising characteristics.

Algorithms↗

PubMed2000

Benchmarking and evidence-based practice: complementary approaches to achieving quality process improvement.

The terms benchmarking and evidence-based practice have gained a great deal of attention of late. Although these 2 processes are not identical, they are complementary and can be applied concurrently in an improvement strategy. This article aims to illustrate the strengths and potential weaknesses of the 2 processes and to explain how they may be used together to improve operational performance.

Benchmarking↗

PubMed2004

A comprehensive comparison of comparative RNA structure prediction approaches.

BACKGROUND: An increasing number of researchers have released novel RNA structure analysis and prediction algorithms for comparative approaches to structure prediction. Yet, independent benchmarking of these algorithms is rarely performed as is now common practice for protein-folding, gene-finding and multiple-sequence-alignment algorithms. RESULTS: Here we evaluate a number of RNA folding algorithms using reliable RNA data-sets and compare their relative performance. CONCLUSIONS: We conclude that comparative data can enhance structure prediction but structure-prediction-algorithms vary widely in terms of both sensitivity and selectivity across different lengths and homologies. Furthermore, we outline some directions for future research.

Algorithms↗

PubMed2006

Diabetes as a tracer condition in international benchmarking of health systems.

OBJECTIVE: To assess the performance of health systems using diabetes as a tracer condition. RESEARCH DESIGN AND METHODS: We generated a measure of "case-fatality" among young people with diabetes using the mortality-to-incidence ratio (M/I ratio) for 29 industrialized countries using published data on diabetes incidence and mortality. Standardized incidence rates for ages 0-14 years were extracted from the World Health Organization DiaMond study for the period 1990-1994; data on death from diabetes for ages 0-39 years were obtained from the World Health Organization mortality database and converted into age-standardized death rates for the period 1994-1998, using the European standard population. RESULTS: The M/I ratio varied >10-fold. These relative differences appear similar to those observed in cohort studies of mortality among young people with type 1 diabetes in five countries. A sensitivity analysis showed that using plausible assumptions about potential overestimation of diabetes as a cause of death and underestimation of incidence rates in the U.S. yields an M/I ratio that would still be twice as high as in the U.K. or Canada. CONCLUSIONS: The M/I ratio for diabetes provides a means of differentiating countries on quality of care for people with diabetes. It is solely an indicator of potential problems, a basis for stimulating more detailed assessments of whether such problems exist, and what can be done to address them.

Benchmarking↗

PubMed2025

PLNMFG: Pseudo-label guided non-negative matrix factorization model with graph constraint for single-cell multi-omics data clustering.

The development of single-cell multi-omics sequencing technologies has enabled the simultaneous analysis of multi-omics data within the same cell. Accurate clustering of these cells is crucial for downstream analyses of complex biological functions. Despite significant advances in multi-omics integration approaches, current methodologies exhibit two major limitations. First, they inadequately incorporate prior biological knowledge from various omic layers. Second, these methods often conduct independent dimensionality reduction on individual omic datasets, thereby failing to capture the intrinsic complementary information and potentially overlooking crucial cross-platform interactions. Motivated by these, this study investigates a non-negative matrix factorization model called PLNMFG, which integrates the unified latent representation learning that retains the features between and within omics and the cluster structure learning that retains the intrinsic structure of the data into one joint framework. Specially, PLNMFG performs adaptive imputation to handle dropout events and uses prior pseudo-labels as constraints during the process of collective non-negative matrix factorization, as a result, a more robust latent representation that preserves the double similarity information is obtained. Graph Laplacian constraint is applied during clustering which further preserves structure characteristic of multi-omics data. In addition, the weight of each omic is adaptively learned based on the omic contribution. A series of experiments on 8 benchmark datasets show that our model performs well in terms of clustering accuracy and computational efficiency.

Single-Cell Analysis↗

PubMed2003

A consistent potential energy parameter set for lipids: dipalmitoylphosphatidylcholine as a benchmark of the GROMOS96 45A3 force field.

The performance of the GROMOS96 parameter set 45A3 developed for aliphatic alkanes is tested on a bilayer of dipalmitoylphosphatidylcholine (DPPC) in water in the liquid-crystalline L(alpha) phase. Variants of the force-field parameter set as well as different sets of simulation conditions or simulation parameter sets are evaluated. In the case of the force-field parameters, the van der Waals constants for the non-bonded interaction of the ester carbonyl carbon and the partial charges and charge group definition of the phosphatidylcholine head group are examined. On the methodological side, different cut-off distances for the non-bonded interactions, use of a reaction-field force due to long-range electrostatic interactions, the frequency of removal of the centre of mass motion and the strength of the coupling of the pressure of the system to the pressure bath are tested. The area per lipid, as a measure of structure, the order parameters of the chain carbons, as a measure of membrane fluidity, and the translational diffusion of the lipids in the plane of the bilayer are calculated and compared with experimental values. An optimal set of simulation parameters for which the GROMOS96 parameter set 45A3 yields a head group area, chain order parameters and a lateral diffusion coefficient in accordance with the experimental data is listed.

1,2-Dipalmitoylphosphatidylcholine↗

PubMed2004

Analysis of superfamily specific profile-profile recognition accuracy.

BACKGROUND: Annotation of sequences that share little similarity to sequences of known function remains a major obstacle in genome annotation. Some of the best methods of detecting remote relationships between protein sequences are based on matching sequence profiles. We analyse the superfamily specific performance of sequence profile-profile matching. Our benchmark consists of a set of 16 protein superfamilies that are highly diverse at the sequence level. We relate the performance to the number of sequences in the profiles, the profile diversity and the extent of structural conservation in the superfamily. RESULTS: The performance varies greatly between superfamilies with the truncated receiver operating characteristic, ROC10, varying from 0.95 down to 0.01. These large differences persist even when the profiles are trimmed to approximately the same level of diversity. CONCLUSIONS: Although the number of sequences in the profile (profile width) and degree of sequence variation within positions in the profile (profile diversity) contribute to accurate detection there are other superfamily specific factors.

Benchmarking↗

PubMed2002

Volume and impact of second-opinion consultations by radiologists at a tertiary care cancer center: data.

RATIONALE AND OBJECTIVES: Patients with cancer who are referred to a dedicated oncology center usually have undergone previous imaging studies that the oncologists typically desire to have reviewed by radiologists. Such reinterpretations can be complex and time-consuming, yet many institutions do not systematically account for them as part of the total workload. The purpose of this study was to ascertain the numbers and types of second-opinion consultations performed by radiologists at a tertiary care cancer center, and to assess their effect on work volume. MATERIALS AND METHODS: A survey of referring clinicians was undertaken to evaluate the numbers and types of second-opinion consultations requested of radiologists at the Dana Farber Cancer Institute during a 12-month period. Consultations included review of studies from outside institutions, and cases from Dana Farber in which further comparison was needed. The number of consultations requiring additional tumor size measurements was tallied. The mean daily number of new studies interpreted by radiologists was used as a benchmark of work volume. RESULTS: Radiologists performed 4,664 consultations during 254 workdays, interpreting a mean of 18 additional studies (range, 4-42) per day as a result of referrals for second opinion. These included 3,638 (78%) cross-sectional studies (ie, computed tomographic [CT], magnetic resonance [MR], and ultrasound [US] studies), 674 (14%) mammograms, 220 (5%) plain radiographs, 132 (3%) nuclear medicine scans, and one galactogram. Of the 4,664 consultations, 1,306 (28%) were performed to obtain tumor measurements, many of these involving five to 10 bidimensional calculations per study. A mean of 101 new examinations per day was performed by radiologists during the same 12-month period, including cross-sectional studies (CT and US scans) (56%), plain radiographs (34%), and mammograms (11%). MR imaging was not performed. CONCLUSION: Second-opinion consultations increased the average daily work volume by 18%. This has implications for workforce, as well as for compensation in terms of relative value units and finances for this previously unquantified service.

Academic Medical Centers↗