Bench marking and performance management in neonatal care: easier said than done!
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Benchmarking↗
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Evaluation of JPEG 2000 encoder options: human and model observer detection of variable signals in X-ray coronary angiograms.
Previous studies have evaluated the effect of the new still image compression standard JPEG 2000 using nontask based image quality metrics, i.e., peak-signal-to-noise-ratio (PSNR) for nonmedical images. In this paper, the effect of JPEG 2000 encoder options was investigated using the performance of human and model observers (nonprewhitening matched filter with an eye filter, square-window Hotelling, Laguerre-Gauss Hotelling and channelized Hotelling model observer) for clinically relevant visual tasks. Two tasks were investigated: the signal known exactly but variable task (SKEV) and the signal known statistically task (SKS). Test images consisted of real X-ray coronary angiograms with simulated filling defects (signals) inserted in one of the four simulated arteries. The signals varied in size and shape. Experimental results indicated that the dependence of task performance on the JPEG 2000 encoder options was similar for all model and human observers. Model observer performance in the more tractable and computationally economic SKEV task can be used to reliably estimate performance in the complex but clinically more realistic SKS task. JPEG 2000 encoder settings different from the default ones resulted in greatly improved model and human observer performance in the studied clinically relevant visual tasks using real angiography backgrounds.
Algorithms↗
Benchmarking the OptiSpray-μPAC Workflow against a Traditional Nanospray Capillary Interface for Multiplexed Quantitative Proteomics.
Nanoflow liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) underpins modern quantitative proteomics, yet the column-to-mass spectrometer interface remains an important yet often underappreciated determinant of analytical depth, sensitivity, and reproducibility. Here, we benchmark an integrated workflow comprising the newly developed OptiSpray ion source and a micropillar array column (μPAC) cartridge against a conventional Nanospray Flex Source with an Accucore resin-packed capillary column. We performed a TMTpro 18-plex experiment across nine human cell lines on a FAIMS Pro-equipped Orbitrap Exploris 480. Following basic-pH reversed-phase fractionation, 12 fractions were analyzed on both workflow configurations under matched chromatographic gradient and acquisition conditions. Across both configurations, we quantified >9000 protein groups with highly comparable quantitative reproducibility and principal component clustering. Direct comparison of protein abundance ratios across cell lines showed agreement (Pearson R2 ≈ 0.7-0.8) without systematic bias. These results were achieved without workflow-specific optimization of the OptiSpray-μPAC platform, enabling direct transfer of established acquisition methods. Despite differences in column architecture, both configurations delivered comparable proteome coverage and quantitative fidelity. These findings establish the OptiSpray-μPAC workflow as a standardized alternative to conventional capillary-based interfaces, offering simplified operation while preserving quantitative performance.
Humans↗
Outcomes of carotid endarterectomy: how does the Australian state of New South Wales compare with international benchmarks?
OBJECTIVES: The objective of this study was to determine the outcomes of carotid endarterectomy (CEA) in New South Wales, Australia. METHODS: This state-wide prospective audit of all public and private hospitals during a 6-month period had main outcome measures of 30-day mortality, 30-day fatal stroke, 30-day nonfatal stroke, and 30-day combined stroke and mortality. RESULTS: Fifty-three of 54 eligible surgeons participated (response rate, 98%). The audit obtained inpatient data for 689 internal CEA procedures performed on 666 patients. Of 666 first or only procedures, 462 (69.4%) were performed on patients who were symptomatic and 204 (30.6%) on patients who were asymptomatic. After adjustment for cluster by surgeon, we determined a state-wide 30-day death rate of 1.2% (95% CI, 0.3% to 2.1%), a 30-day fatal or nonfatal stroke rate of 3.0% (95% CI, 1.6% to 4.4%; ipsilateral stroke, 2.6%), a 30-day nonfatal stroke rate of 2.3% (95% CI, 1.1% to 3.4%; ipsilateral stroke, 2.0%), and a 30-day combined stroke and death rate of 3.5% (95% CI, 2.1% to 4.9%). A significant linear relationship was found between patient preoperative hypertensive status and the combined 30-day stroke and death rate (trend odds ratio, 3.5; 95% CI, 1.6 to 7.7). No association was seen between any main outcome measures and hospital volume (<10 CEAs versus > or = 10 CEAs). Four patients underwent surgery outside guideline recommendations (CEA performed for either < or = 30% stenosis or occluded carotid artery). CONCLUSION: This first comprehensive state-wide audit confirms that Australian surgeons achieve 30-day outcomes comparable with international benchmarks.
Age Factors↗
Benchmark data from the literature for evaluation of new glucose sensing technologies.
New glucose sensors based on various technologies are being developed to provide information for improved therapy in diabetes. There is a need to establish rational performance standards for these sensors. Frequently sampled, direct blood glucose recordings representative of blood glucose excursions in diabetes are the "gold standard." An extensive literature search revealed a limited number of diabetic and nondiabetic blood glucose recordings suitable for this purpose. Certain blood glucose recordings reflect the diversity of glycemic dynamics and provide sufficient challenge for evaluation of sensor systems. These recordings were converted into an accessible electronic format. An example is given of the use of these benchmark data to estimate aliasing error, or the error due to insufficient sampling frequency, based on a hypothetical sensor system having some properties of conventional "fingerstick" systems. Discrete sampling systems accumulate substantial aliasing error as the sampling period increases.
Biosensing Techniques↗
The impact of evidence-based guideline dissemination for the assessment and treatment of major depression in a managed behavioral health care organization.
This study tests whether a managed behavioral health care organization can influence adherence to practice guidelines for the treatment of major depression in a randomized trial of guideline dissemination. Guidelines were disseminated to mental health clinicians (N = 443) under one of three conditions: (1) a general mailing of guidelines to clinicians, (2) a mailing in which guidelines were targeted to a patient starting treatment with the clinician, and (3) no mailing of guidelines. The results showed no effects of guideline dissemination as measured by self-report of patients and clinicians and through episode characteristics derived from claims data, despite sentinel effects. Results also showed high rates of clinician-reported guideline adherence that were not detected in the claims data, indicating significant undertreatment of depression. Results suggest that mental health systems must look to other dissemination strategies to improve adherence to standards of care and raise the performance of independent practicing clinicians.
Benchmarking↗
Using a quality scorecard to measure and improve medical groups' performance.
BACKGROUND: Blue Cross of California (BCC) uses an annual Quality Scorecard to measure performance of participating medical groups (PMGs) and independent practice associations (IPAs). The scorecard provides information to the PMGs/IPAs on their performance in several domains relative to the average network score. BCC pays annual bonuses to PMGs/IPAs with superior quality performance. A structured intervention was designed to improve the performance of PMGs/IPAs that performed poorly on the scorecard. METHODS: A cohort study was conducted in a large health maintenance organization in California in 1997. All PMGs/IPAs received a detailed summary of the components of the annual quality scorecard. Scorecard components include an annual audit of quality, utilization management, credentialing, and members' rights and responsibilities, grievance rates, member transfer for quality reasons, a satisfaction survey, and a preventive health review. Twenty-two of 124 PMGs/IPAs with more than 1,000 BCC members during 1996 that had scored lower than 1 standard deviation below the mean were targeted. These 22 outlier PMGs/IPAs received additional information indicating that their performance was below average. A BCC quality team subsequently visited the outlier PMGs/IPAs to provide supplementary information on the deficient areas and provide assistance in making improvements. RESULTS: The outlier groups showed significant improvements in the annual audit of quality score, member satisfaction with access, member satisfaction with last visit, overall member satisfaction with PMGs/IPAs, mammography screening, and the total score. CONCLUSIONS: A structured quality improvement intervention in poorly performing PMGs/IPAs was followed by improvements in specific performance measures.
Benchmarking↗
Quantifying optimal accuracy of local primary sequence bioinformatics methods.
MOTIVATION: Traditional bioinformatics methods scan primary sequences for local patterns. It is important to assess how accurate local primary sequence methods can be. RESULTS: We study the problem of donor pre-mRNA splice site recognition, where the sequence overlaps between real and decoy datasets can be quantified, exposing the intrinsic limitations of the performance of local primary sequence methods. We assess the accuracy of primary sequence methods generally by studying how they scale with dataset size and demonstrate that our new primary sequence ranking methods have superior performance.
Algorithms↗
Use of outcome data by purchasers and consumers: new strategies and new dilemmas.
OBJECTIVE: The complexities involved in measuring outcomes of care are perceived as a core challenge of health services research. However, the complexities associated with making outcomes data useable for purchasers and consumers are just beginning to be recognized. The purpose of this paper is to outline some of the barriers to purchaser and consumer use of clinical outcome (and other performance) data and to identify strategies for supporting greater use of these data. Dilemmas associated with current and proposed strategies are highlighted and recommendations are proposed. EVIDENCE: Three recent studies focusing on consumer and purchaser use of outcome data are used to illustrate barriers. The decision research literature is also drawn upon to describe the information processing challenges faced by purchasers and consumers when using performance information for making choices. FINDINGS: Information packaging strategies and decision support tools designed to overcome barriers are described, and dilemmas associated with their use are outlined. One major concern is that if we adopt strategies to make report card data more digestible, we may be trading off some of the market effects (e.g. improved health plan performance) that justify report card efforts in the first place.
Benchmarking↗
Improving the quality of long-term care with better information.
Publicly reporting information stimulates providers' efforts to improve the quality of health care. The availability of mandated, uniform clinical data in all nursing homes and home health agencies has facilitated the public reporting of comparative quality data. This article reviews the conceptual and technical challenges of applying information about the quality of long-term care providers and the evidence for the impact of information-based quality improvement. Quality "tools" have been used despite questions about the validity of the measures and their use in selecting providers or offering them bonus payments. Although the industry now realizes the importance of quality, research still is needed on how consumers use this information to select providers and monitor their performance and whether these efforts actually improve the outcomes of care.
Benchmarking↗
Managing a national pilot site project. The Derby Theatre Project experience.
The National Theatre Project was set up in March 2001 by the Modernization Agency to improve the patient and carer experience, improve employee satisfaction, optimise theatre utilisation and reduce cancelled operations. This is the first in a series of four articles, looking at issues involved in managing a national project, improving operating theatre performance and how to engage the organisation in innovation and change.
Benchmarking↗
Study examines clinical practices that distinguish 100 top hospitals.
What distinguishes the 100 Top Hospitals from others? In angioplasty, it's greater use of stents and a new class of costly drugs, according to a new study from HCIA-Sachs. The study indicates that better-performing hospitals tend to respond sooner than others to the latest clinical research.
Benchmarking↗
Tool sites offer quick way to bolster performance improvement.
Many sites are made available free of charge to the public. Tools can empower departments to initiate their own performance improvement programs. Tools can vary from simple checklists to more complex processes.
Benchmarking↗
A model structure for an EBM program in a multihospital system.
Evidence-based medicine (EBM) offers a great opportunity to translate advances in medical science into advances in clinical practice. We describe the structure of a comprehensive EBM program in a multihospital community teaching system. This EBM model is distinct and separate from the peer review process and has achieved substantial physician involvement. The program emanates from the Board of Directors Quality of Care Committee and has strong administrative support. The approach relies extensively on physician involvement and expert physician panels to enhance existing EBM practice guidelines, with an explicit strategy of performance reports and feedback.
Benchmarking↗
Technical-economical evaluation of the operation of oxidation ditches.
The optimisation of the economic performance is a central aspect in the management of wastewater treatment plants. A model-based procedure was developed that could provide a clearly enunciated and concise way of reporting to the stakeholders on how well the assets are performing and can perform, separating the firm inefficiency from the effect of the treatment. The applied modelling method is conventional considering current modelling research practice, but very good from practical point of view in that it is applicable utilising existing plant data, i.e. without the use of additional measuring campaigns. This paper illustrates the validity of the developed procedures through the evaluation of the performance of oxidation ditches.
Benchmarking↗
Provider profiling: severity-adjusted versus severity-based outcomes.
Providers will continue to experience increasing pressure to demonstrate cost-effective, high-quality care. For relevant comparisons between providers, outcomes must be evaluated with respect to severity of illness and mortality risk. However, most hospitals use patient classification methods, such as Medicare and Health Care Financing Administration diagnosis-related groups (DRGs), which group together different levels of severity and mortality risk. The most common approach for developing severity-adjusted outcomes for groups of cases with dissimilar severity levels is to divide a statistic by a factor such as the Medicare case mix index, which was not designed or intended for that purpose. As an alternative, providers are increasingly using severity-based methods that classify patients as to severity levels within each diagnosis-related group. The key to severity-based profiling is the classification of cases to similar patient groups and comparison to selected benchmarks for variance analysis at each severity level. Effective provider profiling requires that hospital staff and physicians work together toward the common goal of accurate and complete documentation and coding of all medical conditions. Through use of more accurate severity-based profiling, providers are better able to identify opportunities to improve performance and demonstrate cost-effectiveness and quality to buyers, beneficiaries, and third-party reviewers.
Acute Disease↗
Benchmark calculations of reaction energies, barrier heights, and transition-state geometries for hydrogen abstraction from methanol by a hydrogen atom.
We report benchmark calculations of reaction energies, barrier heights, and transition-state geometries for the reaction of CH(3)OH with H to produce CH(2)OH and H(2). Highly accurate composite methods, such as CBS, G2, G3S, G3X, G3SX, and multi-coefficient correlation methods (MCCMs), are used to calibrate lower-cost methods. We also performed single-level CCSD(T) calculations extrapolated to the infinite-basis limit on the basis of aug-cc-pVXZ (X = 3, 4) correlation consistent basis sets. The benchmark high-level calculations give consensus values of the forward reaction barrier height and the reaction energy of 9.7 kcal/mol and - 6.4 kcal/mol, respectively. To evaluate the accuracy of cost-efficient methods that are potentially useful for dynamics studies of the title reaction, we further include the results obtained by hybrid density functional theory methods and hybrid meta density functional theory methods that have recently been designed for chemical kinetics. Results obtained by popular semiempirical methods are also given for comparison. On the basis of the benchmark gas-phase results, we suggest MC-QCISD/3, MC3BB, and BB1K as reasonably accurate and affordable electronic structure methods for calculating dynamics for the title reaction.
Journal Article↗
The antisaccade task as a research tool in psychopathology: a critical review.
The antisaccade task is a measure of volitional control of behavior sensitive to fronto-striatal dysfunction. Here we outline important issues concerning antisaccade methodology, consider recent evidence of the cognitive processes and neural mechanisms involved in task performance, and review how the task has been applied to study psychopathology. We conclude that the task yields reliable and sensitive measures of the processes involved in resolving the conflict between volitional and reflexive behavioral responses, a key cognitive deficit relevant to a number of neuropsychiatric conditions. Additionally, antisaccade deficits may reflect genetic liability for schizophrenia. Finally, the ease and accuracy with which the task can be administered, combined with its sensitivity to fronto-striatal dysfunction and the availability of suitable control conditions, may make it a useful benchmark tool for studies of potential cognitive enhancers.
Humans↗