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Results for “Performance benchmarking”

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PubMed1997

HEDIS outcomes may not be the only ones you need to benchmark.

The Foundation for Accountability (FACCT), a coalition of employers, is leading a trend away from process-oriented performance measures by generating patient-centered data sets for a variety of disease states, including asthma, diabetes, and depression. Many large employers, dissatisfied with the National Center for Quality Assurance's focus on cost, are pressuring managed care organizations to use the FACCT measures, which largely rely on patient self-reports about the care they receive. Some plans are using the data sets voluntarily, as a tool to better assess the quality of services they provide and to evaluate physician groups.

Efficiency, Organizational↗

PubMedDate not supplied

Bringing measurement and management science to the cath laboratory: the National Cardiovascular Data Registry (ACC-NCDR) and the Cardiac Catheterization Laboratory Continuous Quality Improvement Toolkit (ACC-CathKIT).

Diagnostic cardiac catheterization and percutaneous coronary interventions are widely performed for the evaluation and treatment of patients with cardiac disease. Because of high utilization, cost, and complication rates, invasive cardiac procedures are closely monitored and frequently measured using national benchmark databases and public reports. Before decision makers can accept these data and reports as accurate, it is necessary that the measurement process be performed correctly. However, collecting and measuring data is only the first step and does not automatically lead to improvements in quality. For an improvement to occur, a continuous quality improvement effort must exist to transform data into improved outcomes for patients. Recognizing the need to supply healthcare providers with methods and standards for measurement reporting and tools to assist facilities in the development of effective continuous quality improvement efforts, the American College of Cardiology developed the National Cardiovascular Data Registry (ACC-NCDR). Subsequently, the American College of Cardiology Foundation, in cooperation with the Society for Cardiovascular Angiography and Interventions, the American College of Cardiovascular Administrators, and several other professional organizations, developed the ACC-Cardiac Catheterization Laboratory Continuous Quality Improvement Toolkit (ACC-CathKIT). The development and usefulness of these products is described in this paper.

Cardiac Catheterization↗

PubMed2004

Asymptotic optimality of likelihood-based cross-validation.

Likelihood-based cross-validation is a statistical tool for selecting a density estimate based on n i.i.d. observations from the true density among a collection of candidate density estimators. General examples are the selection of a model indexing a maximum likelihood estimator, and the selection of a bandwidth indexing a nonparametric (e.g. kernel) density estimator. In this article, we establish a finite sample result for a general class of likelihood-based cross-validation procedures (as indexed by the type of sample splitting used, e.g. V-fold cross-validation). This result implies that the cross-validation selector performs asymptotically as well (w.r.t. to the Kullback-Leibler distance to the true density) as a benchmark model selector which is optimal for each given dataset and depends on the true density. Crucial conditions of our theorem are that the size of the validation sample converges to infinity, which excludes leave-one-out cross-validation, and that the candidate density estimates are bounded away from zero and infinity. We illustrate these asymptotic results and the practical performance of likelihood-based cross-validation for the purpose of bandwidth selection with a simulation study. Moreover, we use likelihood-based cross-validation in the context of regulatory motif detection in DNA sequences.

Journal Article↗

PubMed1998

Current provision of care for older persons in A & E units in the UK.

This study investigates the state of care for older persons within Accident and Emergency (A & E) units in the UK. As the proportion of older persons in the population continues to inexorably increase, A & E units will be expected to cope with a greater number of older people than ever before. Are they prepared for this increase, and do they possess the skills, knowledge and environment to care adequately for older people and the many special problems they present? One hundred A & E units were surveyed by a postal questionnaire consisting of a benchmark of best practice deemed by literature search and expert opinion to be important in caring for older persons in A & E. The data produced gives an overall picture of the current provision of care for older persons in A & E units, and indicates to fellow A & E nursing professionals where current performance may be improved.

Aged↗

PubMed2001

Comparing alternative risk-adjustment models.

The use of mental health indicators to compare provider performance requires that comparisons be fair. Fair provider comparisons mean that scores are risk adjusted for client characteristics that influence scores and that are beyond provider control. Data for the study are collected from 336 outpatients receiving publicly funded mental health services in Washington State. The study compares alternative specifications of multiple regression-based risk-adjustment models to argue that the particular form of the model will lead to different conclusions about comparative treatment agency performance. In order to evaluate performance fairly it is necessary to not only incorporate risk adjustment, but also identify the most correct form that the risk-adjustment model should take. Future research is needed to specify; test, and validate the mental health risk-adjustment models best suited to particular treatment populations and performance indicators.

Adult↗

PubMed2002

Comparing apples to apples: the relative financial performance of Manitoba's acute care hospitals.

This paper presents comparative financial ratios that can be adopted by health system administrators and policy analysts to begin to evaluate the performance of acute care hospitals. We combined financial, statistical and clinical information for 73 acute care hospitals in Manitoba for fiscal 1997/98 to calculate 15 indicators of financial performance. Our findings suggest that there is variability between hospital types in their average costs per weighted case, cost structure and financial performance.

Acute Disease↗

PubMed2002

Comparing the accuracy of Dutch dentists and dental students in the radiographic diagnosis of dentinal caries.

OBJECTIVES: To compare the diagnostic accuracy of dental students using bitewing radiographs for the diagnosis of dentinal caries with that of general dental practitioners and to establish a bench mark for testing for improvement in diagnostic performance. METHODS: Fourth year dental students (n=259) viewed bitewing radiographs of 105 proximal tooth surfaces. According to a micro-radiography "gold standard" 45 surfaces had dentine caries. The students were asked to diagnose presence and absence of dentine caries from which, under supervision, they calculated their sensitivity (TPR) and false positive rate (FPR). The students binary diagnostic data was compared with the historical data from a random sample of Dutch dentists (n=273). The Summary Receiver Operating Characteristic (SROC) curve method was used to analyse the data. The two groups were tested for differences in (a) diagnostic odds ratio and (b) the area under the SROC curve. RESULTS: The students mean TPR for dentine caries diagnosis was 67.2% (s.d. 11.8%) and the FPR was 8.3% (s.d. 8.4%). The corresponding values for dentists were: TPR 54.0% (s.d. 14.1%) and FPR 3.1% (s.d. 4.5%). Significantly more dentists (85%) than students (72%, P<0.001) had a diagnostic odds ratio > or =21. The area under the SROC curve (Az) was 0.8194 for students and 0.8140 for dentists (P=0.70). CONCLUSIONS: In our study (i) the students had a higher TPR but also a higher FPR than the dental practitioners, (ii) their overall performance (Az) was similar but (iii) for a clinically relevant population the dental practitioners would out-perform the students in diagnostic performance.

Benchmarking↗

PubMed2003

Do star ratings really reflect hospital performance?

The publication of performance ratings for NHS Trusts (star ratings) is an important part of NHS policy. There are significant benefits to a Trust in being awarded the top rating of three stars. The methodology for awarding stars to acute hospitals is explained. The most significant areas of performance in determining a hospital's star rating are identified. The Department of Health claimed that performance in 2002 was better than in 2001, against standards that are getting tougher. This claim is assessed but no clear evidence is found to substantiate it. An alternative performance rating system using the same data is developed and compared with the official version to illustrate the importance of methodology--this system used only the outcome measures of hospital services included within the star ratings system, and not process measures. Only 41 per cent of hospitals would have received the same number of stars as their official rating. Some implications of the system of performance ratings are discussed.

Awards and Prizes↗

PubMed2003

Hospital marketing.

This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

Benchmarking↗

PubMed2006

Just rewards.

Pay for performance--reimbursing providers for the quality rather than the volume of care--seems so logical that it's a wonder it took so long to get here. Initial results of pilot programs indicate incentives do spur improvements. However, the pilots also point up weaknesses that must be resolved if pay for performance is to become the national standard.

Benchmarking↗

PubMed2005

Oxidative addition of the fluoromethane C-F bond to Pd. An ab initio benchmark and DFT validation study.

We have computed a state-of-the-art benchmark potential energy surface (PES) for two reaction pathways (oxidative insertion, OxIn, and S(N)2) for oxidative addition of the fluoromethane C-F bond to the palladium atom and have used this to evaluate the performance of 26 popular density functionals, covering LDA, GGA, meta-GGA, and hybrid density functionals, for describing these reactions. The ab initio benchmark is obtained by exploring the PES using a hierarchical series of ab initio methods (HF, MP2, CCSD, CCSD(T)) in combination with a hierarchical series of seven Gaussian-type basis sets, up to g polarization. Relativistic effects are taken into account through a full four-component all-electron approach. Our best estimate of kinetic and thermodynamic parameters is -5.3 (-6.1) kcal/mol for the formation of the reactant complex, 27.8 (25.4) kcal/mol for the activation energy for oxidative insertion (OxIn) relative to the separate reactants, 37.5 (31.8) kcal/mol for the activation energy for the alternative S(N)2 pathway, and -6.4 (-7.8) kcal/mol for the reaction energy (zero-point vibrational energy-corrected values in parentheses). Our work highlights the importance of sufficient higher angular momentum polarization functions for correctly describing metal-d-electron correlation. Best overall agreement with our ab initio benchmark is obtained by functionals from all three categories, GGA, meta-GGA, and hybrid DFT, with mean absolute errors of 1.4-2.7 kcal/mol and errors in activation energies ranging from 0.3 to 2.8 kcal/mol. The B3LYP functional compares very well with a slight underestimation of the overall barrier for OxIn by -0.9 kcal/mol. For comparison, the well-known BLYP functional underestimates the overall barrier by -10.1 kcal/mol. The relative performance of these two functionals is inverted with respect to previous findings for the insertion of Pd into the C-H and C-C bonds. However, all major functionals yield correct trends and qualitative features of the PES, in particular, a clear preference for the OxIn over the alternative S(N)2 pathway.

Computer Simulation↗

PubMed2005

Distraction and action slips in an everyday task: evidence for a dynamic representation of task context.

We report here a novel and counterintuitive effect of distraction on routine sequential action. The effect, predicted by a recent computational model of sequential behavior, relates to the tendency for a momentary distraction, such as a brief interruption, to lead to subsequent slips of action. The specific prediction is that errors should be more likely following a distraction occurring toward the middle of a subtask sequence than following a distraction occurring at the end of a subtask. This was tested and confirmed in an experiment involving repeated performance of an everyday task (coffee making) under conditions involving frequent interruption. The observed effect provides differential support for existing models of sequential behavior and offers a highly constraining benchmark for future theories.

Adolescent↗

PubMed2004

Mismatch string kernels for discriminative protein classification.

MOTIVATION: Classification of proteins sequences into functional and structural families based on sequence homology is a central problem in computational biology. Discriminative supervised machine learning approaches provide good performance, but simplicity and computational efficiency of training and prediction are also important concerns. RESULTS: We introduce a class of string kernels, called mismatch kernels, for use with support vector machines (SVMs) in a discriminative approach to the problem of protein classification and remote homology detection. These kernels measure sequence similarity based on shared occurrences of fixed-length patterns in the data, allowing for mutations between patterns. Thus, the kernels provide a biologically well-motivated way to compare protein sequences without relying on family-based generative models such as hidden Markov models. We compute the kernels efficiently using a mismatch tree data structure, allowing us to calculate the contributions of all patterns occurring in the data in one pass while traversing the tree. When used with an SVM, the kernels enable fast prediction on test sequences. We report experiments on two benchmark SCOP datasets, where we show that the mismatch kernel used with an SVM classifier performs competitively with state-of-the-art methods for homology detection, particularly when very few training examples are available. Examination of the highest-weighted patterns learned by the SVM classifier recovers biologically important motifs in protein families and superfamilies.

Algorithms↗

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↗

PubMed2002

Benchmarking working time in health care: the case of Excelcare.

In the 2000-2004 Enterprise Bargaining round between the Australian Nursing Union and the South Australian state government, it was agreed that public hospitals would be staffed according to Excelcare timings or benchmarks. Excelcare is a computerised workload produce that measures the number of hours and minutes needed to perform a range of nursing tasks for patients on a given ward. This brought into sharp relief disagreements between the various parties over Excelcare timings, but more importantly, it illustrates the unions' strategic use of the Enterprise Bargaining process to de-intensify nursing labour.

Benchmarking↗

PubMedDate not supplied

Benchmarking surgeon satisfaction at academic health centers: a nationwide comparative survey.

BACKGROUND: Forty-six academic health centers (AHCs) belonging to the University HealthSystem consortium joined forces to compare the efficiency of their surgical services and to identify best practices. In addition to measures of operational performance, surgeon satisfaction with the surgical services provided was measured by using a standardized questionnaire. METHODS: From hospital records, indicators of the efficiency of surgical services were collected in three main areas: scheduling, preoperative testing and assessment, and the intraoperative process. Responding to a mail questionnaire, a sample of surgeons rated their satisfaction with key aspects of surgical services including scheduling, operating room staff, and equipment/supplies. On the basis of a review of the operational measures and the survey results, high performers were identified. Site visits were made to several of these high performers to uncover the critical factors responsible for their success. RESULTS: The survey revealed distinct variations in surgeon satisfaction across the participating institutions. Numerical benchmarks were obtained for surgeon satisfaction with each key component of surgical services. Scheduling was the most important component of overall surgeon satisfaction, explaining 71% of the variance in the rating of overall satisfaction with surgical services. High operational efficiency and high surgeon satisfaction were not incompatible. Several of the participating institutions were able to achieve both. These results were disseminated to all of the participants at a national meeting as well as in written form. CONCLUSIONS: The surgeon satisfaction survey allowed the participants to establish benchmarks for surgeon satisfaction for each key component of the surgical services they receive. The site visits revealed several common characteristics of highly efficient surgical services. Taken by themselves, the participating institutions might have been reluctant to consider adopting these best practices for fear of alienating the surgical staff. The availability of data on surgeon satisfaction showed the participants that these best practices can coexist with high levels of surgeon satisfaction. This has helped to promote their adoption by the other participating institutions.

Academic Medical Centers↗

PubMed2001

Untreated short-term course of major depression: a meta-analysis of outcomes from studies using wait-list control groups.

INTRODUCTION: While the short-term response rates to antidepressant medication and placebo are well established, very little is known about the short-term course of untreated depression. Knowledge of the course of untreated depression can serve as a benchmark for assessing the true benefits of active treatment. METHOD: A meta-analysis was performed analyzing the outcomes of all psychotherapy studies that randomized adult outpatients with major depressive disorder to a wait-list control group. RESULTS: Nineteen studies involving 221 subjects were reviewed. The mean decrease in Hamilton Rating Scale for Depression scores over 2-20 weeks was 11.9%, while the mean decrease in Beck Depression Inventory scores was 15.7%. Using a subsample of studies that reported individual outcomes, we estimated that 15 of 76 subjects (19.7%) improved to a degree comparable to what would be considered a positive response in antidepressant trials. CONCLUSIONS: In the short-term, depressive symptomatology can be expected to decrease by about 10-15% on average without treatment. As many as 20% of subjects who participate in a short-term antidepressant trial may experience a spontaneous remission.

Adult↗

PubMedDate not supplied

Strategies for developing competency models.

There is an emerging trend within healthcare to introduce competency-based approaches in the training, assessment, and development of the workforce. The trend is evident in various disciplines and specialty areas within the field of behavioral health. This article is designed to inform those efforts by presenting a step-by-step process for developing a competency model. An introductory overview of competencies, competency models, and the legal implications of competency development is followed by a description of the seven steps involved in creating a competency model for a specific function, role, or position. This modeling process is drawn from advanced work on competencies in business and industry.

Behavioral Medicine↗