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Public dissemination of provider performance comparisons in the United States.

As competition among healthcare providers has increased in the U.S., there has been a rapid growth in the amount of comparative information on provider performance made available to consumers. This availability requires hospitals to have information systems that will allow them to prepare proactively for the public dissemination of comparative performance data. The information contained in provider report cards can be a valuable tool for hospitals to use for internal management and planning.

Benchmarking↗

Taking aim at fall injury adverse events: best practices and organizational change.

Fall injuries represent a huge healthcare, social and financial burden to the Canadian population. In 2004, the McGill University Health Centre (MUHC) was awarded recognition as a National Spotlight Organization for Implementation of the Registered Nurses Association of Ontario Best Practice Guidelines (BPGs). That same year, the author and co-leader of the Best Practice Guideline Program began the CHSRF Executive Training in Research Application (EXTRA) Program with the goal of reducing falls injuries, one of the most common adverse events in the MUHC and in acute care in Canada. This demonstration project used multiple strategies to strengthen a culture of safety and improve performance relating to adverse events, including: pilot testing several evidence-based falls prevention interventions (autumn 2005), training teams of champions to work across multiple sites, developing an infrastructure to support organizational change, modifying existing quality indicators to become benchmarkable, conducting a cost analysis of falls prevention, evaluating pre- and post-pilot surveys of organizational climate and obtaining initial baseline measures of the safety climate within the organization. Positive patient, practitioner and organizational outcomes suggest that falls safety prevention is feasible in large, complex healthcare organizations--and that safety is both a moral and a financial imperative. Next stages of the BPG program include full rollout, and measuring sustainability via a formal outcome evaluation study.

Academic Medical Centers↗

Harnessing the Power of Large Language Models for Drug Discovery: A Systematic Review of Current Applications and Future Directions.

INTRODUCTION: The demand for inventive approaches to drug discovery has increased due to the rising costs, time, and failure rates in pharmaceutical research. Large Language Models (LLMs), with their sophisticated natural language processing and generative capabilities, have become potent instruments that have the potential to revolutionize biomedical research. The function of LLMs in different phases of drug development is methodically examined in this article. METHODS: The PRISMA 2020 principles were adhered to in this systematic study. A thorough search for research published between 2018 and 2025 was done using PubMed, Scopus, Web of Science, and Google Scholar. The search terms "large language model," "transformer," "drug discovery," and important sub-domains (such as "de-novo design" and "ADMET") were merged, and two reviewers independently screened the results. Predetermined inclusion and exclusion criteria were used to filter studies for relevance. 98 studies out of the 1,285 records that were initially retrieved met the requirements for the final qualitative synthesis. RESULTS: 98 studies that demonstrated the use of LLMs in various drug discovery domains were found during the review. These covered molecular generation, genomics, protein-ligand modeling, ADME/T and toxicity profiling, drug-target interaction and DTI prediction, and biomedical text mining. 42 different LLM-based tools were mapped, including BioBERT, SciSpacy, Drug- LLM, DNA-BERT, GPT-4, and ChatGPT. Predictive accuracy, hypothesis creation, target prioritization, and multi-modal data integration all showed notable gains with these techniques. DISCUSSION: By providing scalable, precise, and effective solutions for data-driven drug discovery, LLMs are revolutionizing the pharmaceutical industry. They allow for the creation of hypotheses and individualized insights across multi-modal biological data, and they perform better than conventional approaches in a number of subdomains. Improvements in performance were task-dependent; the most consistent gains occurred for biomedical text mining, disease-genedrug relationship mapping and drug-target interaction prediction tasks. Yet most evidence for clinical applications is still derived from retrospective studies and benchmark datasets, suggesting a higher need for prospective validation. CONCLUSION: There is revolutionary potential in incorporating LLMs into drug discovery processes. Clinical translation and regulatory uptake will depend heavily on collaborative validation, ethical deployment, and standardization as models become more multimodal and interpretable. Before normal use, extensive prospective benchmarking and head-to-head comparisons with established chemoinformatics pipelines are necessary.

De novo design↗

Quality assurance in the endoscopy unit: An emphasis on outcomes.

This article identifies and reviews key elements of quality improvement programs for an endoscopy unit. The new paradigm of quality improvement seeks to improve all performance, and does not simply focus on the low outliers as in the traditional "quality assurance" program. The organization and key elements are emphasized, including selection of key indicators and methodologies for the development of standards of practice and benchmarks. Examples of quality improvement initiatives are discussed, demonstrating their value in improved patient care and the process or function of an endoscopy unit.

Endoscopy, Gastrointestinal↗

HR customer service--FedEx.com or BUST!

As the "customers" of the benefits department, employees, beneficiaries and retirees deserve best practice service delivery. This article describes a benefits administration operating model that can deliver high levels of customer service by furnishing accurate, consistent and timely information. Performance measurement is a key element in this type of customer satisfaction, particularly when outsourcing vendors are involved in the provision of benefits.

Benchmarking↗

Echocardiography in district general hospitals: trends over a five-year period 1993-1998.

Postal surveys were carried out in 1993 and 1998 to establish the range and nature of echocardiography facilities within district general hospitals in Scotland. This study examines some of the changes over this five year period. Echocardiography services vary widely between hospitals. There have been substantial changes in the last five years, with increases in both the staff involved in echocardiography and in the number of investigations performed. The facilities available have improved and more respondents to the survey in 1998 were happy with training than in 1993. Echocardiography has a major place in modern management of patients with cardiac problems. This survey provides a useful benchmark for comparison between services.

Benchmarking↗

Understanding medical group financial and operational performance: the synergistic effect of linking statistical process control and profit and loss.

There is ongoing pressure for medical groups owned by not-for-profit health care systems or for-profit entrepreneurs to generate profit. The fading promise of superior strategy through health care integration has boards of directors clamoring for bottom-line performance. While prudent, sole focus on the bottom line through the lens of the profit-and-loss (P&L) statement provides incomplete information upon which to base executive decisions. The purpose of this paper is to suggest that placing statistical process control (SPC) charts in tandem with the P&L statement provides a more complete picture of medical group performance thereby optimizing decision making as executives deal with the whitewater issues surrounding physician practice ownership.

Accounts Payable and Receivable↗

Research to practice: nursing stroke assessment guidelines link to clinical performance indicators.

Stroke is the fourth leading cause of death in Canada and, each year, approximately 50,000 Canadians will suffer a stroke with a range of severities from mild, short duration symptoms to significant long-term disability or death. Of these 50,000 patients, at least 20,000 are hospitalized. Earlier this year, a core set of evidence-based performance indicators were identified by a national consensus panel that may be used to determine the quality of care provided to stroke patients in hospital during the acute phase of illness. Nurses play a critical role in stroke care across the continuum and recently published stroke assessment guidelines for nurses clearly describe key approaches to assessment and/or screening of stroke survivors. Many of the nursing assessments and/or screening actions recommended in the guidelines have direct or indirect associations with the recent performance indicators. This article describes where those relationships exist and the role nurses may play in determining overall performance for acute stroke patient care delivery during the hospitalization phase of the stroke continuum of care.

Acute Disease↗

Linking operating margin to payer contracting.

Hospital performance is driven by the revenue generated through paver contracts--and hospitals must demand the contracts they need in order to meet their margin.

Benchmarking↗

Profiling care and benchmarking best practice in care of hospitalized elderly: the Geriatric Institutional Assessment Profile.

This article reports on a new instrument, the Geriatric Institutional Assessment Profile (GIAP), developed to assess (1) hospital workers' knowledge, attitudes, and perceptions regarding care of geriatric patients, and (2) the perceived adequacy of an institutional environment to serve geriatric patients' needs. Findings are reported from 303 questionnaires completed by health care employees from a 658-bed academic medical center. Internal consistency estimates were consistently high for the various components of the GIAP. Factor analysis was performed to examine underlying dimensions of knowledge and institutional environment. The GIAP has the potential to narrow the gap between actual and best practice in geriatric care by identifying staff information needs and concerns, as well as institutional barriers and facilitators to providing quality geriatric hospital care.

Adult↗

Developing and Benchmarking One Health Genomic Surveillance Tools for Influenza A Virus in Wastewater.

Influenza A viruses (IAV) remain a persistent One Health threat, and whole-genome sequencing from wastewater offers a promising surveillance tool. However, IAV is at low abundance in wastewater, making it difficult to sequence. We benchmarked four targeted enrichment methods suited for whole-genome sequencing including custom and off-the-shelf amplicon and probe-based methods. Our custom HA tiled-amplicon panel was sensitive, fast, and cost-effective, making it suitable for monitoring low-abundance seasonal variants of known subtypes. However, its reliance on conserved and intact primer-binding sites limited primer design to fewer subtypes. A previously published universal amplicon method targeted all IAV subtypes, but it performed poorly in wastewater due to its reliance on intact genome segments. Probe-capture methods were resilient to RNA degradation and mismatches, potentially enabling broader surveillance and detection of emerging strains. However, probes were costly, labor-intensive, and less sensitive than tiled-amplicon. When testing compatibility of sequencing methods with upstream virus concentration and extraction methods, ultrafiltration-based virus concentration outperformed large-volume direct extraction with all four sequencing methods. This set of benchmarking comparisons and custom panels provides needed information for the translation of IAV genomic sequencing into a routine component of wastewater surveillance.

Journal Article↗

Confirmatory factor analysis of the Consumer Assessment of Health Plans Study (CAHPS) 1.0 Core Survey.

The National Consumer Assessment of Health Plans Study (CAHPS) Benchmarking Database was used to assess the factor structure and invariance of the CAHPS 1.0 Core Survey. Separate analyses were conducted with Latino and non-Latino Caucasian consumers drawn from commercial and Medicaid sectors (N = 15,092). Results demonstrated that the 23 CAHPS 1.0 report items measure consumer reports of experiences with 5 aspects of health plan performance: Access to Care, Timeliness of Care, Provider Communication, Health Plan Consumer Service, and Office Staff Helpfulness. Four items assessed global ratings of care. Analyses revealed an identical pattern of fixed and free factor loadings across all samples. Magnitude of factor loadings and correlations among factors was essentially equivalent within a common health service sector. A higher order factor analysis revealed that rating and reports of care showed marked convergence.

Adult↗

Collaborative use of informatics among hospitals to benchmark medication use processes.

BACKGROUND: In spring 1995 pharmacists representing each of the 23 member hospitals in Synernet, a hospital cooperative in Maine, decided to collaborate in developing a multihospital medication use evaluation (MUE) program. The committee set up task forces for adverse drug reaction reporting and prevention, MUE plans, and medication error reporting and prevention, for exploration of opportunities to eliminate duplication of efforts, compare performance, and share best practices. PLANNING THE PROGRAM: The members retained a consulting firm to manage the SynRx medication use program from conceptualization through implementation. Modules--on individual drug dosing, switching from intravenous to oral administration, pharmacists' clinical recommendations, and surgical antibiotic prophylaxis--were designed so that participants could adopt the entire plan as a turnkey procedure by inserting their hospital name in the appropriate blanks, modify it to more closely fit their own organizations, use portions of it for inclusion in their current plans, or not use it at all. The goal was to build in maximum flexibility to accommodate the variations in the participating hospital pharmacies and their respective hospitals. RESULTS: Early program benefits include improvements in medication event reporting, documentation of the measured aspects of medication use, delivery of care processes, and administrative efficiency. LESSONS LEARNED AND CONCLUSIONS: The participants, consultants, and programmers involved in the SynRx program learned firsthand the complexity and magnitude of hospital medication use processes. Yet it is possible to overcome the wide variability in systems among hospitals to create standards that allow for more meaningful comparisons of medication use.

Adverse Drug Reaction Reporting Systems↗

Edge vulnerability in neural and metabolic networks.

Biological networks, such as cellular metabolic pathways or networks of corticocortical connections in the brain, are intricately organized, yet remarkably robust toward structural damage. Whereas many studies have investigated specific aspects of robustness, such as molecular mechanisms of repair, this article focuses more generally on how local structural features in networks may give rise to their global stability. In many networks the failure of single connections may be more likely than the extinction of entire nodes, yet no analysis of edge importance (edge vulnerability) has been provided so far for biological networks. We tested several measures for identifying vulnerable edges and compared their prediction performance in biological and artificial networks. Among the tested measures, edge frequency in all shortest paths of a network yielded a particularly high correlation with vulnerability and identified intercluster connections in biological but not in random and scale-free benchmark networks. We discuss different local and global network patterns and the edge vulnerability resulting from them.

Animals↗

ESMpHLA: Evolutionary Scale Model-Based Deep Learning Prediction of HLA Class I Binding Peptides.

The recognition of endogenous peptides by HLA class I plays a crucial role in CD8+ T cell immune responses and human adaptive cell immune. Thus, the prediction of HLA class I-peptide binding affinities is always the core issue for the research of immune recognition and vaccine development. In this study, an evolutionary scale model (ESM) combined with parallel CNN blocks and a cross attention mechanism was used to construct a novel ESMpHLA model for predicting HLA class I binding peptides. Based on the 91,560 binding peptides of 41 HLA-A alleles, 56,731 of 50 HLA-B alleles and 2444 of 10 HLA-C alleles, the ESMpHLA model was successfully established and achieved satisfying prediction performances with the overall accuracy and AUC values of 0.874 and 0.938 for the test dataset. The results indicate that the ESMpHLA model performs well in dealing with different HLA class I 2-field alleles as well as the peptides with different lengths. Then, the generalisation ability of the ESMpHLA model was validated by an independent test dataset compiled from recent IEDB weekly benchmark datasets. The results showed that the ESMpHLA model achieved the highest ROC-AUC and PR-AUC values when compared with the latest BVMHC, CapsNet-MHC, STMHCpan and BVLSTM models. In addition, two ensemble models were also established by integrating the above 5 deep learning models using soft-voting and hard-voting strategies.

Humans↗

Uncoupling protein production from growth: different strategies for intracellular and secreted proteins in yeast.

BACKGROUND: Precision fermentation offers a sustainable alternative production route for proteins but still suffers from moderate productivities and low yields. Especially compared to biomass yields, recombinant protein yields on substrate are very low. Uncoupling recombinant protein production from growth would allow higher product yields, but requires that productivity is maintained. So far, two-phase production processes mostly rely on inducers to activate recombinant protein production after an initial growth phase, e.g., a change in carbon source. On large scale, specific growth rates can be controlled by nutrient availability, and we aim to use this as trigger to uncouple recombinant protein production from growth. RESULTS: We investigated the correlation between low specific growth rates (0.02&#xa0;h-&#x2009;1&#x2009;<&#x2009;&#xb5;&#x2009;<&#x2009;0.1&#xa0;h-&#x2009;1) and specific recombinant protein production rates, both for intracellularly accumulating and secreted proteins. By comparing two differently regulated promoters, the strong, constitutive PTEF1 and stress-induced PHSP12, we show that recombinant protein production rates and yields in Saccharomyces cerevisiae can be partially uncoupled from growth. The optimal strategy thereby differs for intracellular and secreted production. The PHSP12 resulted in increased product yields of intracellular protein at very low growth rates, including a 10-fold increase in intracellular protein titer, while titers remained virtually constant for the benchmark PTEF1. The PTEF1 on the other hand led to increased protein secretion rates and efficiencies at lower specific growth rates cumulating in higher extracellular protein titers. CONCLUSION: Our results demonstrate that promoter selection plays a critical role in production performance under slow growing conditions. Moreover, it highlights that optimising intracellular and extracellular recombinant protein production requires distinct, strategy-specific approaches.

Saccharomyces cerevisiae↗