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PubMed1995

Are the Twin Cities a Stage V marketplace?

The Twin Cities continues to be an outstanding laboratory for discovering what could be the future in many other markets. Over the last year or two it has been the site of massive consolidation among hospitals, physicians and health plans. Even as the entire infrastructure for healthcare financing and delivery has changed, the state has turned in a good performance in comparison with national cost averages. It is hard to beat premium levels that are 25%-35% lower than national benchmarks. And, these have been achieved by the marketplace, not by government. Nevertheless, employers aren't completely satisfied and the sources of discontent are very instructive. The natural course of market change throughout the country is consolidation from many fragmented competing groups down to a handful of large integrated systems. From an employer/consumer perspective, this natural evolution will reduce competition, concentrate power, eliminate choice, weaken the employer's negotiating leverage, discourage innovation, and reduce the responsiveness and sensitivity to customer service needs. Strategies have to be devised by those engaged in integrated health systems development to counter the perception that consolidation is only an attempt to grab market share. True integration should produce demonstrable improvements in the quality, coordination and delivery of care. But, the trick is understanding the employer and consumer perspective on "improvements". The financing and delivery of healthcare has literally been hidden inside a "black box" for as far back as anyone can remember.(ABSTRACT TRUNCATED AT 250 WORDS)

Capitation Fee↗
PubMed1998

The laboratory's role in outcome assessment.

How does the laboratorian influence patient outcome, and how is this influence measured? The clinical laboratory gives vital support to decisions about diagnosis, treatment, and management. Outcome assessment must include a structured approach to performance improvement, proper test utilization, and defining best practices.

Benchmarking↗
PubMedDate not supplied

The cost of poor quality: an opportunity of enormous proportions.

In all organizations, the state of finance is routinely reported in sublime detail for study and action. And yet, anywhere from 20 to 50 percent of the monies involved in that report are never identified as unnecessary and nonproductive. These monies, referred to as the Cost of Waste (COW), are the result of actions that have been taken or must be taken because quality is not served--inappropriate actions are being performed or appropriate actions are not being performed right the first time, every time. Proactively determining, reporting, and monitoring the COW brings a degree of objectivity to the quality management process and provides a powerful internal driver for performance improvement. A 10 step Cost of Waste system is proposed.

Benchmarking↗
PubMed2000

Reaping healthy profits. 100 hospitals manage to come out on top even in year plagued by financial ills.

The 100 Top Hospitals financially outperformed their peers this year by the widest margin ever, posting an 8.7% total profit margin. If hospitals nationwide performed at the level of the top facilities, hospital expenses would decline by $12 billion a year, deaths would go down by nearly 87,000 and complications would be cut by 57,000. Some 63 of this year's top performers have been on the list before. Knowing their secrets is valuable.

Benchmarking↗
PubMed2000

Primary care access improvement: an empowerment-interaction model.

Improving community primary care access is a difficult and dynamic undertaking. Realizing a need to improve appointment availability, a systematic approach based on measurement, empowerment, and interaction was developed. The model fostered exchange of information and problem solving between interdependent staff sections within a managed care system. Measuring appointments demanded but not available proved to be a credible customer-focused approach to benchmark against set goals. Changing the organizational culture to become more sensitive to changing beneficiary needs was a paramount consideration. Dependent-group t tests were performed to compare the pretreatment and posttreatment effect. The empowerment-interaction model significantly improved the availability of routine and wellness-type appointments. The availability of urgent appointments improved but not significantly; a better prospective model needs to be developed. In aggregate, appointments demanded but not available (empowerment-interaction model) were more than 10% before the treatment and less than 3% with the treatment.

Appointments and Schedules↗
PubMed2026

Response to: "best practices when benchmarking CATCH for the design of genome enrichment probes".

We clarify the design principles and evaluation choices underlying Syotti, a robust and scalable probe-design tool developed to support large, heterogeneous bacterial datasets with minimal parameter tuning. We highlight Syotti's ability to perform simultaneous large-scale designs and its effectiveness as a reliable alternative when existing tools such as CATCH are not well suited to the problem setting.

Genomics↗
PubMed2005

National plan for reliable tuberculosis laboratory services using a systems approach. Recommendations from CDC and the Association of Public Health Laboratories Task Force on Tuberculosis Laboratory Services.

Since the mid-1990s, public health laboratories have improved tuberculosis (TB) test performance, which has contributed to the resumption of the decline in TB incidence in the United States. However, to eliminate TB in the United States, further improvements are needed in laboratory services to support TB treatment, prevention, and control. A critical step is the development of an integrated system that ensures prompt and reliable laboratory testing and flow of information among laboratorians, clinicians, and TB-control officials. Challenges to developing such a system include 1) establishing lines of communication among laboratorians, clinicians, and TB-control officials; 2) expediting reporting of laboratory results, which can avoid delayed or inappropriate treatment and missed opportunities to prevent transmission; 3) developing evidence-based recommendations for use of new laboratory technologies; 4) maintaining staff proficiency in light of declining numbers of specimens to test, workforce shortages, and loss of laboratory expertise; and 5) upgrading laboratory information systems and connecting all partners. The report of the Association of Public Health Laboratories Task Force presents a framework to improve the future of TB laboratory services and describes the role of the laboratory in TB treatment and control, Task Force processes, general principles and benchmarks, and steps for the dissemination of the Task Force recommendations. This MMWR expands on the Task Force report by describing specific actions and performance measures to guide development and implementation of an integrated system for providing TB laboratory services. CDC and the Association of Public Health Laboratories have developed these guidelines so that laboratorians, clinicians, public health officials, administrators, and funding entities can work together to ensure that health-care providers and TB-control officials have the information needed to treat TB patients, prevent TB transmission, and ultimately eliminate TB in the United States.

Clinical Laboratory Information Systems↗
PubMed2005

Accuracy of intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma.

BACKGROUND: The current report provides results from a large retrospective analysis of intraoperative imprint cytology performed on axillary sentinel lymph nodes (IIC(N)) removed over the course of 2137 breast surgeries (4905 lymph nodes). It is hoped that these results may serve as benchmarks for those interested in using this technique. METHODS: The current study included 2078 patients with T1-2 invasive breast carcinoma who underwent sentinel lymph node biopsy (SLNB) and IIC(N). Lymph nodes were bivalved, imprinted, stained with Diff-Quik (Baxter Diagnostics, McGaw Park, IL), and reviewed by a cytopathologist. A positive intraoperative diagnosis led to immediate complete axillary lymph node dissection (CALND). On final pathology, lymph nodes found to be negative on hematoxylin and eosin staining were submitted for cytokeratin staining. RESULTS: Of the 2137 cases for which SLNB was performed, 673 were found to have positive lymph node status on final pathology. Of these 673 cases, 359 were identified by IIC(N), resulting in a sensitivity rate of 53.3%. The specificity and overall accuracy rates for this technique were 99.5% and 85.0%, respectively. In IDC cases, IIC(N) had a sensitivity rate of 55.5%, compared with 38.7% in ILC cases. Based on these results, the reoperative CALND rate was calculated to be approximately 14.7%, with 54.5% of these reoperative procedures being performed for cases in which lymph nodes positive only for micrometastases were found. Macrometastasis-positive lymph nodes that went undetected by IIC(N) were present in only 154 of the 2137 cases examined (7.2%). CONCLUSIONS: IIC(N) accurately predicts final lymph node status in 85.0% of patients. Although the accuracy of this technique varies with tumor size and type, IIC(N) remains a time-efficient and cost-effective adjunct to SLNB.

Adult↗
PubMed2005

Strategies for defining financial benchmarks for the research mission in academic health centers.

Valid financial benchmarks are needed for the research mission in academic health centers (AHCs). Databases listing institutional success in obtaining sponsored research funding are publicly available. However, these databases are generally not adjusted for AHC size, confounding useful comparisons between institutions. The authors suggest simple strategies, which depend on a form of ratio analysis, to circumvent this limitation. Annual rates of growth (rates of return, R(f)) are determined for total National Institutes of Health research grant dollars, number of research grants, and average dollars per research grant for 15 U.S. AHCs. Selected institutions are compared to one another and to the total pool of medical school funding. Performance is evaluated over a ten-year period (1992-2001) to illustrate the advantages, limitations, and applications of the ratio analysis approach. Alternative strategies are suggested for individual AHCs to evaluate their departmental and organizational performance, again without regard to institution size, and also dependent on ratios. Application of these strategies, especially when individualized to the particular AHC, permits more accurate assessment of past performance and more accurate and effective planning for future growth.

Academic Medical Centers↗
PubMed2005

Performance of nurses in the Department of Health as service providers for a cervical screening programme.

A territory-wide cervical screening programme was launched in Hong Kong in March 2004. Since 2002, 160 nurses from the Department of Health's Maternal and Child Health Centres have completed the training necessary to carry out the screening procedures. A clinical audit of their performance was carried out between 2002 and 2004. A customer satisfaction survey revealed that 94% of respondents agreed or strongly agreed that they were satisfied with the cervical smear procedure performed by nurses. Since January 2003, all routine cervical screening tests at Maternal and Child Health Centres have been performed by nurses. The mean time required to complete a test is 7 minutes. The mean unsatisfactory smear rate for the year 2003 was 1.3%, well below the benchmark of 5% set by the Working Party on Quality Assurance of the Cervical Screening Task Force. The results of this survey confirm that nurses at Maternal and Child Health Centres are highly effective and efficient at taking smears and that this is well accepted by clients.

Female↗
PubMed2006

Parameter incremental learning algorithm for neural networks.

In this paper, a novel stochastic (or online) training algorithm for neural networks, named parameter incremental learning (PIL) algorithm, is proposed and developed. The main idea of the PIL strategy is that the learning algorithm should not only adapt to the newly presented input-output training pattern by adjusting parameters, but also preserve the prior results. A general PIL algorithm for feedforward neural networks is accordingly presented as the first-order approximate solution to an optimization problem, where the performance index is the combination of proper measures of preservation and adaptation. The PIL algorithms for the multilayer perceptron (MLP) are subsequently derived. Numerical studies show that for all the three benchmark problems used in this paper the PIL algorithm for MLP is measurably superior to the standard online backpropagation (BP) algorithm and the stochastic diagonal Levenberg-Marquardt (SDLM) algorithm in terms of the convergence speed and accuracy. Other appealing features of the PIL algorithm are that it is computationally as simple as the BP algorithm, and as easy to use as the BP algorithm. It, therefore, can be applied, with better performance, to any situations where the standard online BP algorithm is applicable.

Algorithms↗
PubMed2003

Use of failure rate databases and process safety performance measurements to improve process safety.

Employing equipment reliability databases can generate a process of continual improvement. This paper suggests a methodology that uses equipment reliability databases, and a process of benchmarking to establish a continual improvement procedure by learning "how others are doing it". A simple decision-making procedure is suggested too, to assist in prioritizing the processes/equipment that are considered to be improved as well as a methodology to measure the improvement.

Databases, Factual↗
PubMed2005

Neutron and photon shielding benchmark calculations by MCNP on the LR-0 experimental facility.

In the framework of the REDOS project, the space-energy distribution of the neutron and photon flux has been calculated over the pressure vessel simulator thickness of the LR-0 experimental reactor, Rez, Czech Republic. The results calculated by the Monte Carlo code MCNP4C are compared with the measurements performed in the Nuclear Research Institute, Rez. The spectra have been measured at the barrel, in front of, inside and behind the pressure vessel in different configurations. The neutron measurements were performed in the energy range 0.1-10 MeV. This work has been done in the frame of the 5th Frame Work Programme of the European Community 1998-2002.

Benchmarking↗
PubMed2006

Gene selection in cancer classification using sparse logistic regression with Bayesian regularization.

MOTIVATION: Gene selection algorithms for cancer classification, based on the expression of a small number of biomarker genes, have been the subject of considerable research in recent years. Shevade and Keerthi propose a gene selection algorithm based on sparse logistic regression (SLogReg) incorporating a Laplace prior to promote sparsity in the model parameters, and provide a simple but efficient training procedure. The degree of sparsity obtained is determined by the value of a regularization parameter, which must be carefully tuned in order to optimize performance. This normally involves a model selection stage, based on a computationally intensive search for the minimizer of the cross-validation error. In this paper, we demonstrate that a simple Bayesian approach can be taken to eliminate this regularization parameter entirely, by integrating it out analytically using an uninformative Jeffrey's prior. The improved algorithm (BLogReg) is then typically two or three orders of magnitude faster than the original algorithm, as there is no longer a need for a model selection step. The BLogReg algorithm is also free from selection bias in performance estimation, a common pitfall in the application of machine learning algorithms in cancer classification. RESULTS: The SLogReg, BLogReg and Relevance Vector Machine (RVM) gene selection algorithms are evaluated over the well-studied colon cancer and leukaemia benchmark datasets. The leave-one-out estimates of the probability of test error and cross-entropy of the BLogReg and SLogReg algorithms are very similar, however the BlogReg algorithm is found to be considerably faster than the original SLogReg algorithm. Using nested cross-validation to avoid selection bias, performance estimation for SLogReg on the leukaemia dataset takes almost 48 h, whereas the corresponding result for BLogReg is obtained in only 1 min 24 s, making BLogReg by far the more practical algorithm. BLogReg also demonstrates better estimates of conditional probability than the RVM, which are of great importance in medical applications, with similar computational expense. AVAILABILITY: A MATLAB implementation of the sparse logistic regression algorithm with Bayesian regularization (BLogReg) is available from http://theoval.cmp.uea.ac.uk/~gcc/cbl/blogreg/

Algorithms↗
PubMed1995

Intermediate and long-term anaerobic performance of elite Alpine skiers.

Physiological requirements of Alpine skiing, demanding power from both aerobic and anaerobic sources, were first reported in 1965 by Bengt Saltin and coworkers. An update on the physiology of Alpine skiing was presented by Karlsson and colleagues in 1978, and their work remains a benchmark for most current research dealing with Alpine skiers. These works have identified muscular strength and complex motor skill abilities as essential to the competitive ski racer. The energy demands of Alpine ski racing dominate the range between 45 and 2 min. Since the late 1970s, many researchers have reported a variety of tests that associate test scores to skiing performance. Traditionally, short tests of anaerobic power such as the 30-s Wingate test have been used to reflect anaerobic capacity. Only recently have researchers and coaches begun to question whether a test that is shorter in duration than most skiing performances can estimate anaerobic power as it relates to Alpine ski racing. This study reviews current literature relative to physiological requirements for Alpine skiing as well as relating 18 nationally ranked male (N = 10) and female (N = 8) Alpine ski racers' USSA national points lists for slalom and giant slalom to power measures from 30-s and 90-s Wingate cycle ergometer tests. Further directions of physiological research in Alpine skiing are also offered.

Adult↗
PubMed1996

Dose-response relationship of teratogenicity and prenatal-toxic risk estimation of 6-mercaptopurine riboside in mice.

6-Mercaptopurine riboside (6-MPr) is used as a cytostatic chemotherapeutic. The teratogenic potential in rodents has been well known for several decades. In this study, the teratogenic risk of low doses of 6-MPr in NMRI mice was estimated based on a dose-response study. The effective doses corresponding to the incidences of 5%, 1%, and 0.1% were calculated using the probit and Weibull model. The evaluation was performed on the basis of both the fetus and the litter by evaluating the variable all gross structural abnormalities. From these experiments, benchmark doses were obtained which were used in low-dose risk assessment to define a reference dose. Depending on the biometrical model and the statistical unit used, values between 1.9 and 5.2 mg/kg (benchmark ED1) and 3.8 and 6.7 mg/kg (benchmark ED5) were obtained. These values were compared to the no observed adverse effect level (NOAEL) which was determined experimentally. The NOAEL was found to be 5 mg/kg, which is quite similar to the ED5 benchmark doses.

Abnormalities, Drug-Induced↗