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Results for “Performance benchmarking”

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PubMed2002

Effectiveness of occupational medicine center-based physical therapy.

A 1-year study was performed to evaluate discharge from therapy and return-to-work outcomes from rehabilitation services offered at four occupational medicine centers for work-related musculoskeletal injuries. The mean number of visits before discharge from therapy for 699 patients was 45% less than a national benchmark (mean visit number, 5.7 +/- 4.2 vs 10.5 +/- 9.1; P < 0.001). Return-to-work outcomes at discharge from therapy showed that 94% had returned-to-work. A telephonic satisfaction survey failed to identify client complaints associated with therapy. Assuming that reduced visit numbers would be reflected in a proportionate decrease in lost workdays, the program saved employers approximately $1.4 million, or $2000 per client. The authors attribute the improved outcomes to early therapy using active rather than passive techniques and an emphasis on patient education and home exercise programs.

Ambulatory Care Facilities↗

PubMed2001

Transfusion rate associated with hysterectomy for benign disease.

The transfusion rate associated with hysterectomy for benign disease is an indirect indicator of haemorrhage. It is used in quality assurance activities and is one measure of standard of care. This retrospective study was conducted to determine the transfusion rate for these operations in a tertiary referral hospital. In addition, it was considered that the information could be used in deciding the need for a routine preoperative group and save policy (G and S). The Blood Bank records of all women undergoing hysterectomy for benign disease from 1993-1998 were examined and the number of women transfused was recorded. A total of 1220 hysterectomies were performed. Of women having vaginal hysterectomies only 0.38% required transfusion compared with 2.18% for abdominal hysterectomies. These data suggest that there is no need for a strict policy of preoperative G and S for all patients. In addition, this information can be used as a benchmark when reviewing morbidity associated with hysterectomy and in particular when various methods of hysterectomy are compared.

Adult↗

PubMed2003

Incorporation of a combinatorial geometry package and improved scoring capabilities in the EGSnrc Monte Carlo Code system.

A description is given of a generic EGSnrc Monte Carlo user code, GenUC, which was developed as an attempt to simplify and optimize the geometry and scoring coding of EGSnrc user codes. GenUC was developed using the methodology of combinatorial geometry that allows a straightforward implementation of complicated geometric setups with intersecting boundaries, where subsequent modifications to the geometry are easily performed. Presently, GenUC has five elemental volumes that can be defined in any position in space: spheres, ellipsoids, parallelepipeds, and circular cylinders and cones. The mortran macro-based implementation of the combinatorial geometry package allows an easy definition/extension of any other elemental volume, e.g., elliptical cylinders and cones. The scoring of the relevant parameters and the output of the results in GenUC are performed with two CERN data analysis packages, which permit the generation of nonplanar phase space distribution files and can also be used for geometry verification, among many other capabilities. GenUC has been successfully applied to complex geometric setups, e.g., intracavitary brachytherapy applicators and was also benchmarked against the EGSnrc user code, DOSRZnrc.

Algorithms↗

PubMed2000

Organizational interventions to encourage guideline implementation.

Evidence-based guidelines hold considerable promise for continued improvement of health-care delivery. However, the availability of clinical practice guidelines does not automatically lead to changes in practice patterns. Using a "push-pull-capacity" model, this article describes strategies to improve guideline implementation for three types of organizations: national organizations, insurer and health-care organizations, and health-care purchasers. Push strategies focus on the guideline development process and include rigorous review and meta-analysis of peer-reviewed research, and use of multidisciplinary expert teams, subjecting guidelines to peer review and comment and using measurable clinical outcomes to define guidelines. PULL: strategies focus on creating a demand for guideline implementation and include professional organization endorsement, quality measures based on guideline-related outcomes, and guideline-based performance objectives in purchaser contracts and physician compensation agreements. Capacity strategies focus on systems that facilitate guideline implementation. Example strategies are providing benefit coverage and reimbursement for guideline-based treatment protocols, and implementing clinical information systems for population-based tracking, outcomes monitoring, and benchmarking feedback.

Delivery of Health Care↗

PubMed2000

Disclosing data makes for higher quality.

The fourth edition of the National Committee for Quality Assurance's State of Managed Care Quality offers more proof that disclosing data makes plans perform better. While overall, managed care is improving the quality of care it offers patients, the survey shows particularly strong results among accredited plans and those that publicize their data.

Benchmarking↗

PubMed2006

Educational strategies associated with development of problem-solving, critical thinking, and self-directed learning.

This article was developed for the Commission on Change and Innovation in Dental Education (CCI), established by the American Dental Education Association. CCI was created because numerous organizations within organized dentistry and the educational community have initiated studies or proposed modifications to the process of dental education, often working to achieve positive and desirable goals but without coordination or communication. The fundamental mission of CCI is to serve as a focal meeting place where dental educators and administrators, representatives from organized dentistry, the dental licensure community, the Commission on Dental Accreditation, the ADA Council on Dental Education and Licensure, and the Joint Commission on National Dental Examinations can meet and coordinate efforts to improve dental education and the nation's oral health. One of the objectives of the CCI is to provide guidance to dental schools related to curriculum design. In pursuit of that objective, this article summarizes the evidence related to this question: What are educational best practices for helping dental students acquire the capacity to function as an entry-level general dentist or to be a better candidate to begin advanced studies? Three issues are addressed, with special emphasis on the third: 1) What constitutes expertise, and when does an individual become an expert? 2) What are the differences between novice and expert thinking? and 3) What educational best practices can help our students acquire mental capacities associated with expert function, including critical thinking and self-directed learning? The purpose of this review is to provide a benchmark that faculty and academic planners can use to assess the degree to which their curricula include learning experiences associated with development of problem-solving, critical thinking, self-directed learning, and other cognitive skills necessary for dental school graduates to ultimately become expert performers as they develop professionally in the years after graduation.

Clinical Competence↗

PubMed2002

Paediatric regional anaesthesia, a survey of practice in the United Kingdom.

BACKGROUND: A variety of techniques and drugs, many unlicensed, is used in paediatric regional anaesthesia. This study is the first to survey paediatric anaesthetists about the techniques and drugs used in paediatric regional anaesthesia. The aim is to provide a record and benchmark of UK practice. METHODS: A postal questionnaire was sent to all members of the Association of Paediatric Anaesthetists residing in the UK. Information was requested on the type of hospital worked in, years of practice, paediatric anaesthesia workload, regional anaesthesia techniques used, and drugs used in regional anaesthesia. RESULTS: A total of 220 responses from 264 questionnaires (83.3%) were received. Of these respondents, 155 (70%) practised paediatric anaesthesia as more than 50% of their workload, and 10 had retired or returned blank forms. Two hundred and two of 210 (96%) use caudal anaesthesia and 151 (72%) use caudal, epidural and peripheral block. One hundred and ninety-two of 210 (91%) have no lower age limit for using caudal anaesthesia. One hundred and twenty-three of 210 anaesthetists (58%) used adjuvants with local anaesthetics in caudal block, the most common being fentanyl [44/210 (21%)], clonidine [55/210 (26%)], diamorphine [27/210 (13%)] and ketamine [67/210 (32%)]. Those working in specialist centres or teaching hospitals or who had a greater paediatric anaesthesia workload were more likely to use a greater variety of regional anaesthesia techniques. CONCLUSIONS: Caudal anaesthesia is widely used for patients of all ages by almost all practitioners. Most anaesthetists at all hospital types and experience levels use adjuvants with local anaesthetics when performing caudal anaesthesia. Those with more experience in paediatric anaesthesia and those in specialist centres commonly use other neuraxial and peripheral block techniques.

Adjuvants, Anesthesia↗

PubMed1999

Frequency of early occlusion and stenosis in a left internal mammary artery to left anterior descending artery bypass graft after surgery through a median sternotomy on conventional bypass: benchmark for minimally invasive direct coronary artery bypass.

BACKGROUND: Uncertainty exists regarding the frequency of early occlusion when the left internal mammary artery (LIMA) is anastomosed to the left anterior descending artery (LAD) through a sternotomy with conventional coronary artery bypass grafting (CABG). The issue has gained importance for comparison with less invasive surgical approaches in which operative exposure may be limited and graft anastomosis more difficult. METHODS AND RESULTS: Data were analyzed from the International Multicenter Aprotinin Graft Patency Experience (IMAGE) trial in which 617 patients underwent conventional CABG of the LAD with a LIMA between April 1993 and May 1995. Coronary angiography was performed a mean of 10.8 days postoperatively. Patients were randomized to receive intraoperative aprotinin, an inhibitor of several serine proteinases, or placebo. Because no differences existed in patency rates of LIMA grafts between patients who received aprotinin and placebo, both groups were analyzed collectively. On coronary angiography, the LIMA was widely patent (<50% stenosis) in 561 patients (91%), had > or = 50% and <99% stenosis in 48 patients (7.8%), and was occluded in 8 patients (1.3%). Therefore, the LIMA was patent in 609 patients (98.7%). Conclusions-In the IMAGE trial, the largest and most contemporary early angiographic analysis of CABG available, early patency of the LIMA was >98% when anastomosed to the LAD. These data provide an important benchmark for less invasive surgical approaches in which the LIMA is anastomosed to the LAD.

Aged↗

PubMed1996

Improving health care, Part 3: Clinical benchmarking for best patient care.

BACKGROUND: Benchmarking, which shows that a much better way of doing something may be possible, stimulates local interest in changing and in making changes previously thought not possible. A PLANNING WORKSHEET: The Worksheet has five basic steps: Identify measures, determine resources needed to find the "best of the best," design a data collection method and gather data, measure the best against own performance to determine gap, and identify the best practices producing best-in-class results. CASE EXAMPLE--BOWEL SURGERY: The Accelerating Clinical Improvement Bowel Surgery Team at Dartmouth-Hitchcock Medical Center (Lebanon, NH) was formed in November 1994 to improve the care of patients with diagnosis-related group (DRG) 148 or 149. Consulting two large, administrative databases and the medical literature, the team found that a substantial gap existed between the bowel surgery delivery process and the best results, as far as they were known, among comparable organizations. After flowcharting the delivery process, the team identified the high-leverage steps: same-day services, general surgery clinic, and routine care. The team then planned three successive PDCA (plan-do-check-act) cycles: utilization of same-day services for all elective surgery patients, establishment of a standardized preoperative bowel preparation, and utilization of pre- and postoperative routine care orders. These improvement cycles resulted in a reduction in length of stay from 9.66 to 8.29 days. Implementation of a critical pathway resulted in a further reduction to 5.04 days. CONCLUSION: Benchmarking can play an integral role in clinical improvement work and can stimulate wise clinical changes and promote measured improvements in quality and value.

Academic Medical Centers↗

PubMed2006

A statewide voluntary patient safety initiative: the Georgia experiene.

BACKGROUND: The Partnership for Health and Accountability (PHA), a voluntary quality improvement and patient safety program, has focused on comprehensive evaluation and feedback. Shared reporting of processes and outcomes is the vehicle for internal quality improvement. PHA provides access to quality and safety tools and benchmarking resources for a diverse group of hospitals, including rural and critical accessfacilities. PARTICIPATION AND OUTCOMES: Hospital participation in PHA-sponsored programs has increased each year, with all eligible hospitals participating in at least one PHA program. Participants in the Safe Medication Use initiative have seen reductions in targeted medication errors, and 97% of the hospitals have reported their performance on Joint Commission on Accreditation of Healthcare Organizations core measures. CASE STUDIES: Athens Regional Medical Center (315 beds) developed the Systematic Assessment of Flow and Error (SAFE) tool, which addresses patient information, clinical decisions, care processes, and patient flow, as a starting point for a wide range of quality improvement initiatives. Since 2004 Habersham County Medical Center, a small (53 beds), rural primary care hospital, has realized a decrease of more than 50% in the postoperative pneumonia rate and a significant decrease in surgical infection rates. DISCUSSION: PHA's challenge is to remain relevant, stable, and integrated and meet the needs of a diverse group of hospitals and yet remain flexible enough to evolve as systems and patient safety priorities change.

Benchmarking↗

PubMed2006

Measurement of infection control department performance: state of the science.

BACKGROUND: The Study of the Efficacy of Nosocomial Infection Control (SENIC) conducted in 1975-1976 is the gold standard for judging the resource needs of infection control departments; however, the scope of responsibilities of infection control and the patient populations served have changed dramatically over the last 30 years. OBJECTIVES: The objective of this paper is to explore the state of the science for performance measurement of infection control departments. METHODS: A search of English language literature was conducted using the PubMed, Medline, and CINAHL databases. The terms "infection control" and "department" along with the words "performance," "measurement," "staffing," "effectiveness," and "requirements" were used to search for relevant articles. Reference lists of selected articles were also searched for other papers of interest. RESULTS: Twelve articles were deemed relevant to infection control department performance since the SENIC study. These fell into four main categories: time management studies, expert opinion, outcome studies, and reports about international infection control departments. CONCLUSION: The SENIC study remains the most thorough assessment of the relationship between infection control department activities and patient outcomes. However, the scope of infection control practice has broadened, and the health care delivery system has changed dramatically since that study was performed. Few new studies have assessed infection control department performance and its relationship to patient outcomes, compliance with accepted standards of patient care, or cost of care. A current assessment of infection control department resources, functions and scope of responsibility linked to patient outcomes and cost is needed to give health care institutions a relevant benchmark for infection control resource needs and the return to be expected from that investment.

Cross Infection↗

PubMed2004

Development of a robust procedure for assessing powder flow using a commercial avalanche testing instrument.

The objectives of this work were to develop a robust procedure for assessing powder flow using a commercial avalanche testing instrument and to define the limits of its performance. To achieve this a series of powdered pharmaceutical excipients with a wide range of flow properties was characterized using such an instrument (Aeroflow, TSI Inc., St. Paul, MN, USA). The experimental conditions (e.g., sample size, rotation speed) were rationally selected and systematically evaluated so that an optimal standard-operating-procedure could be identified. To evaluate the inherent variability of the proposed methodology samples were tested at multiple sites, using different instruments and operators. The ranking of the flow properties of the powders obtained was also compared with that obtained using a conventional shear-cell test. As a result of these experiments a quick, simple, and rugged procedure for determining the flow properties of pharmaceutical powders in their dilated state was developed. This procedure gave comparable results when performed at four different testing sites and was able to reproducibly rank the flow properties of a series of common pharmaceutical excipient powders. The limits of the test method to discriminate between different powder samples were determined, and a positive correlation with the results of a benchmark method (the simplified shear cell) was obtained.

Chemistry, Pharmaceutical↗

PubMed1999

HyFIS: adaptive neuro-fuzzy inference systems and their application to nonlinear dynamical systems.

This paper proposes an adaptive neuro-fuzzy system, HyFIS (Hybrid neural Fuzzy Inference System), for building and optimising fuzzy models. The proposed model introduces the learning power of neural networks to fuzzy logic systems and provides linguistic meaning to the connectionist architectures. Heuristic fuzzy logic rules and input-output fuzzy membership functions can be optimally tuned from training examples by a hybrid learning scheme comprised of two phases: rule generation phase from data; and rule tuning phase using error backpropagation learning scheme for a neural fuzzy system. To illustrate the performance and applicability of the proposed neuro-fuzzy hybrid model, extensive simulation studies of nonlinear complex dynamic systems are carried out. The proposed method can be applied to an on-line incremental adaptive learning for the prediction and control of nonlinear dynamical systems. Two benchmark case studies are used to demonstrate that the proposed HyFIS system is a superior neuro-fuzzy modelling technique.

Journal Article↗

PubMed1996

Atrial switch (Senning procedure) in the era of the arterial switch operation: current indications and results.

OBJECTIVE: Since 1990, the policy at Oregon Health Sciences University is to perform an arterial switch for all patients with transposition of the great arteries. In the last four years we have performed the Senning operation in two patients. Our impression is that the long-term results with Senning procedure at our center are quite good. This prompted a review of our experience with this procedure. METHODS: A retrospective review of all patients' charts was undertaken to document preoperative and operative clinical variables. During follow-up, emphasis was placed on reviewing all cardiology clinic charts, transthoracic echocardiograms and ambulatory holter monitor logs. Transthoracic echocardiograms and 24 hour Holter monitoring were performed yearly on all patients during follow-up. RESULTS: Since September, 1982, 54 patients underwent the Senning operation for transposition of the great arteries. All patients were palliated at birth with the Rashkind atrial septostomy. The interatrial septum was reconstructed with a dacron patch, and the systemic and pulmonary venous baffles were constructed with autogenous atrial tissue. All but 2 patients underwent profound hypothermia and total circulatory arrest during their operative repair. Of 54 patients, early mortality occurred in 5 patients (9%). Follow-up is complete for the 49 operative survivors. The length of follow-up ranges from 6.0 months to 12.1 years (mean 6.4 +/- 0.5 years). There are no late deaths. Forty-five patients (94%) are in NYHA Class I. All late survivors are in sinus rhythm with brief episodes of junctional rhythm (32 patients). CONCLUSIONS: Our series demonstrates that the Senning operation can be safely performed in early infancy. Further, it provides excellent symptomatic and clinical outcomes during late follow-up. Thus, in the era of the arterial switch procedure, close and complete late follow-up results with the Senning procedure, as in this series, should be considered the benchmark in the continued evaluation of the arterial switch operation.

Arteries↗

PubMed2006

Isothermal calorimetry as a tool to investigate slow conformational changes in proteins and peptides.

A new calorimetric method has been developed to follow the time course of slow conformational changes during the refolding of denatured proteins. The method is based on the ability of isothermal titration calorimeters (ITC) to detect small amounts of heat continuously over a minute to an hour time range without being disturbed by baseline drift. We benchmarked the method on the basis of the slow kinetic phases resulting from prolyl cis/trans isomerization of oligopeptides. Using this method, the simultaneous investigation of the kinetics and thermodynamics of slow phases in the refolding of GdmCl-denatured RNase A by single jump techniques was performed. Time traces of heat production in the presence of a peptidyl prolyl cis/trans isomerase support the classical model of rate-limiting prolyl trans to cis isomerizations in the folding reactions of RNase A. However, we also observed that, unlike prolyl cis/trans isomerizations in oligopeptides, those found in RNase A refolding are highly exothermic. It appears that coupling between slow prolyl trans to cis isomerization and relocation of remote backbone segments increases the number of contacting sites during formation of the native protein. The results demonstrate that calorimetrically monitored folding kinetics will be of relevance in the detection of otherwise silent folding events.

Calorimetry↗

PubMedDate not supplied

The specialist role of the music therapist in developmental programs for hospitalized children.

Music therapy is used to address the needs of hospitalized children in the attainment of their normal growth and development milestones. Clinical practice literature proposes that the achievement of musical milestones parallels the developmental competence achieved in the areas of gross motor and fine motor skills; speech, language, and communication skills; sensory motor skills; and social and interactive skills. Pediatric health care workers are encouraged to use music appropriately in their work settings and, where possible, consult and liaise with a registered music therapist, that is, a trained and qualified practitioner, to achieve best practice outcomes in this field.

Benchmarking↗

PubMed2006

Combining genetic algorithms and Lyapunov-based adaptation for online design of fuzzy controllers.

This paper proposes a hybrid approach for the design of adaptive fuzzy controllers (FCs) in which two learning algorithms with different characteristics are merged together to obtain an improved method. The approach combines a genetic algorithm (GA), devised to optimize all the configuration parameters of the FC, including the number of membership functions and rules, and a Lyapunov-based adaptation law performing a local tuning of the output singletons of the controller, and guaranteeing the stability of each new controller investigated by the GA. The effectiveness of the proposed method is confirmed using both numerical simulations on a known case study and experiments on a nonlinear hardware benchmark.

Algorithms↗

PubMedDate not supplied

Best practice using Excellence in Practice Accreditation Scheme.

This article describes how the University of Teesside School of Health and Social Care practice development team, in partnership with local professional colleagues and organizations, have addressed the issue of providing continuous quality evidence-based practice within the context of clinical governance. The newly devised Excellence in Practice Accreditation Scheme (EPAS) measures the standard of practice for a given health and social care setting by providing objective data indicating the level of clinical excellence obtained for the team or organization. The EPAS differs from other organizational accreditation schemes by facilitating excellence based upon a comprehensive set of measurable core standards: working in organizations, collaborative working, user-focused care, continuous quality improvements, performance management, and measuring efficiency and effectiveness. The standards are derived from a professional peer review of best practices. The uniqueness of EPAS is in consolidating the various organizational standards to elicit the core themes related to best practice where individuals, teams and organizations can be benchmarked and accredited for a level of excellence.

Accreditation↗