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Clinical benchmarking has huge potential for improving health care. Students exploring benchmarks for fundamental and essential aspects of care produced a number of interesting key factors and continuums of care. A significant feature of the development of the Department of Health benchmarks has been the inclusion of service users.
Although there are many valid applications for comparative data--sometimes simply "knowing where you stand" is valuable--it is time for home care agencies to use benchmarking that moves beyond that point. Benchmarking is integral to organizational and management strategies whose ultimate goal is to improve, and not simply measure, performance. Peer benchmarks can be a critical resource in addressing the full spectrum of management challenges.
We are witnessing an enormous growth in biological nitrogen removal from wastewater. It presents specific challenges beyond traditional COD (carbon) removal. A possibility for optimised process design is the use of biomass-supporting media. In this paper, attached growth processes (AGP) are evaluated using dynamic simulations. The advantages of these systems that were qualitatively described elsewhere, are validated quantitatively based on a simulation benchmark for activated sludge treatment systems. This simulation benchmark is extended with a biofilm model that allows for fast and accurate simulation of the conversion of different substrates in a biofilm. The economic feasibility of this system is evaluated using the data generated with the benchmark simulations. Capital savings due to volume reduction and reduced sludge production are weighed out against increased aeration costs. In this evaluation, effluent quality is integrated as well.
Benchmarking provides data necessary to evaluate an organization against norms for various administrative and clinical purposes. There are many different types of statistical comparisons used to benchmark one organization against others, or against itself over time. Careful selection of benchmarking strategies can give an organization confidence in the results, thereby maximizing the usefulness of the data for decision making and performance improvement.
You can't go to a state conference, read a home care publication or log on to an Internet listserv ... without hearing or reading someone ... talk about benchmarking. What are your average case mix weights? How many visits are your nurses averaging per day? What is your average caseload for full time nurses in the field? What is your profit or loss per episode? The benchmark systems now available in home care potentially can serve as an early warning and partial protection for agencies. Agencies can collect data, analyze the outcomes, and through comparative benchmarking, determine where they are competitive and where they need to improve. These systems clearly provide agencies with the opportunity to be more proactive.
Healthcare is ever changing environment and with the Joint Commission for the Accreditation of Hospital Organization (JCAHO) emphasis on quality improvement during the past several years, and the cost-focused healthcare reforms of the 1990s, benchmarking with peer comparison, and more recently benchmarking against competitors, has taken on a new emphasis. All acute healthcare organizations accredited by JCAHO now require participation in a program titled ORYX, which is designed to use comparisons with other organizations and promote national benchmarks. The knowledge management system designed assists clinical engineering department to convert vast amounts of available data into information, which is ultimately transformed into knowledge to enable better decision-making. The systems assist in using the data as a comparison tool, to compare the performance internally and also compare performance with peer organizations using the same measures within the same measurement system. Collectively, these applications support better, faster data-driven decisions. This tool provides fast and easy access to financial and quality metrics to clinical engineering department managers, which increases their ability to perform sophisticated analysis to develop accurate models and forecasts, and make timely, data driven decisions. The project also provides a platform by means of which clinical engineering departmental procedures, data, and methods can be assessed and shared among institutions.
By its very nature, a large-scale evaluation of client satisfaction with public education using a quantitative approach, places almost impossibly competing demands on the research methodology. This paper reports on the use of a suite of Rasch measurement techniques to meet the competing demands in establishing state-wide benchmarks relating to the School Opinion Survey carried out over 1200 government schools in one state of Australia. Although the evaluation had to establish system-wide representative parent and student benchmarks, meaningful quantitative estimates of client satisfaction had to be provided at the smallest public schools. The final 20-item School Opinion Survey Parent and Student Forms were designed following feedback from the administration of trial forms. Instrument development was monitored by the results of Rasch modeling. The Rasch modeling property of specific objectivity was empirically verified when calculation of identical benchmark estimates resulted from the construction of simulated population proportional samples using sample:population size weightings.
The benchmarking process in a multidisciplinary radiology department began by identifying the after-care needs of patients undergoing a barium enema. The benchmark focused on privacy and dignity and covered the related issues of nutrition, continence and bowel care. The resultant benchmark has changed practice and provided tools for ongoing assessment and audit.
INTRODUCTION: Early detection of disease outbreaks enables public health officials to implement immediate disease control and prevention measures. Computer-based syndromic surveillance systems are being implemented to complement reporting by physicians and other health-care professionals to improve the timeliness of disease-outbreak detection. Space-time disease-surveillance methods have been proposed as a supplement to purely temporal statistical methods for outbreak detection to detect localized outbreaks before they spread to larger regions. OBJECTIVE: The aims of this study were twofold: 1) to design and make available benchmark data sets for evaluating the statistical power of space-time early detection methods and 2) to evaluate the power of the prospective purely temporal and space-time scan statistics by applying them to the benchmark data sets at different parameter settings. METHODS: Simulated data sets based on the geography and population of New York City were created, including effects of outbreaks of varying size and location. Data sets with no outbreak effects were also created. Scan statistics were then run on these data sets, and the resulting power performances were analyzed and compared. RESULTS: The prospective space-time scan statistic performs well for a spectrum of outbreak models. By comparison, the prospective purely temporal scan statistic has higher power for detecting citywide outbreaks but lower power for detecting geographically localized outbreaks. CONCLUSIONS: The benchmark data sets created for this study can be used successfully for formal statistical power evaluations and comparisons. If an anomaly caused by an outbreak is local, purely temporal surveillance methods might be unable to detect it, in which case space-time methods would be necessary for early detection.
The Benchmarks of Fairness instrument is an evidence-based policy tool developed in generic form in 2000 for evaluating the effects of health-system reforms on equity, efficiency and accountability. By integrating measures of these effects on the central goal of fairness, the approach fills a gap that has hampered reform efforts for more than two decades. Over the past three years, projects in developing countries on three continents have adapted the generic version of these benchmarks for use at both national and subnational levels. Interdisciplinary teams of managers, providers, academics and advocates agree on the relevant criteria for assessing components of fairness and, depending on which aspects of reform they wish to evaluate, select appropriate indicators that rely on accessible information; they also agree on scoring rules for evaluating the diverse changes in the indicators. In contrast to a comprehensive index that aggregates all measured changes into a single evaluation or rank, the pattern of changes revealed by the benchmarks is used to inform policy deliberation aboutwhich aspects of the reforms have been successfully implemented, and it also allows for improvements to be made in the reforms. This approach permits useful evidence about reform to be gathered in settings where existing information is underused and where there is a weak information infrastructure. Brief descriptions of early results from Cameroon, Ecuador, Guatemala, Thailand and Zambia demonstrate that the method can produce results that are useful for policy and reveal the variety of purposes to which the approach can be put. Collaboration across sites can yield a catalogue of indicators that will facilitate further work.
Benchmarking has been adopted by educational institutions as a potentially sensitive tool for improving learning and teaching. To date there has been limited application of benchmarking methodology in the Discipline of Nutritional Science. The aim of this survey was to define core elements and outstanding practice in Nutritional Science through collaborative benchmarking. Questionnaires that aimed to establish proposed core elements for Nutritional Science, and inquired about definitions of " good" and " outstanding" practice were posted to named representatives at eight Australian universities. Seven respondents identified core elements that included knowledge of nutrient metabolism and requirement, food production and processing, modern biomedical techniques that could be applied to understanding nutrition, and social and environmental issues as related to Nutritional Science. Four of the eight institutions who agreed to participate in the present survey identified the integration of teaching with research as an indicator of outstanding practice. Nutritional Science is a rapidly evolving discipline. Further and more comprehensive surveys are required to consolidate and update the definition of the discipline, and to identify the optimal way of teaching it. Global ideas and specific regional requirements also need to be considered.
In an ideal world, benchmarking performance in the clinical laboratory would improve performance, quality, and overall patient satisfaction. However, there is a reason why laboratory managers continue to be on the lookout for the perfect benchmarking product--it doesn't exist. As a result, benchmarking performance in the laboratory is inherently flawed. Here is why.
The Benchmark intra-aortic balloon counterpulsation (IABC) registry maintains prospectively gathered clinical information on a large cohort of IABC patients. The purpose of the present report is to compare in-hospital outcomes and complications in patients treated with the newer 8 vs. 9.5 Fr size catheters. Between January 1997 and August 2000, data on 7,078 9.5 Fr and 2,254 8 Fr IABC insertions were submitted to Benchmark. This was not a randomized comparison but rather a posthoc analysis of prospectively gathered data. There was less limb ischemia with the 8 Fr IABC size catheter. There were no significant differences in bleeding or mortality between the two groups. Smaller IABC catheter size is associated with significantly less limb ischemia, especially in higher-risk patients. The large, population-based, ongoing Benchmark registry provides a useful vehicle for outcomes research concerning the evolving practice of IABC.
We have computed a state-of-the-art benchmark potential energy surface (PES) for the archetypal oxidative addition of the ethane C-C bond to the palladium atom and have used this to evaluate the performance of 24 popular density functionals, covering LDA, GGA, meta-GGA, and hybrid density functionals, for describing this reaction. 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 five Gaussian-type basis sets, up to g polarization. Relativistic effects are taken into account either through a relativistic effective core potential for palladium or through a full four-component all-electron approach. Our best estimate of kinetic and thermodynamic parameters is -10.8 (-11.3) kcal/mol for the formation of the reactant complex, 19.4 (17.1) kcal/mol for the activation energy relative to the separate reactants, and -4.5 (-6.8) 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 1.5 to 2.5 kcal/mol and errors in activation energies ranging from -0.2 to -3.2 kcal/mol. Interestingly, the well-known BLYP functional compares very reasonably with a slight underestimation of the overall barrier by -0.9 kcal/mol. For comparison, with B3LYP we arrive at an overestimation of the overall barrier by 5.8 kcal/mol. On the other hand, B3LYP performs excellently for the central barrier (i.e., relative to the reactant complex) which it underestimates by only -0.1 kcal/mol.
Recently, most attention on the application of benchmark dose (BMD) techniques to toxicology data has focused on quantal measures of response. Before the advantages of the BMD approach can be exploited in the risk assessment process, it is important that continuous measures of response also be modeled appropriately. In this study, we examined a variety of approaches to estimating BMDs for a change in fetal weight following chemical exposure from a total of 85 developmental toxicity experiments. We modeled the change in the mean fetal weight of a litter in response to treatment using a continuous power model, as well as reductions in the weight of individual fetuses within litters (defined as falling below a preset level) using a log-logistic model which incorporates litter size as a covariable and considers intralitter correlations. For the litter-based approach, several methods of defining a benchmark effect (BME) were considered, including a percentage change in mean litter weight, a change in mean litter weight relative to variability in the control group, and a reduction in the mean litter weight to some point on the control group distribution curve. For the fetus-based approach, we examined several BME options on the cumulative frequency distribution of the control fetuses for defining a low weight fetus and calculated several levels of additional risk. BMDs for four litter-based BMEs (a difference of 5% in mean fetal weight, a decrease to the 25th percentile mean weight of control litters, a decrease in the mean weight by 2 standard errors, and a decrease of 0.5 standard deviation units) and two fetus-based BMEs (a 5% added risk of weighing less than the 5th percentile of control weights and a 10% added risk of weighing less than the 10th percentile) showed strong similarities to each other and to statistically derived NOAELs. In addition to providing comparison with the NOAEL as a reference value, these analyses provided confirmation of the advantages of the BMD approach over the NOAEL in terms of the influence of dose spacing and dose selection. Combined with our previous analyses of quantal endpoints of fetal effects, this information provides a firm basis upon which to implement the benchmark dose concept in developmental toxicity risk assessments.
OBJECTIVES: To determine the ability of the current literature to supply appropriate data for benchmarking admission practice to a multidisciplinary critical care unit. DESIGN: Retrospective review of data collected prospectively on a cohort of 614 patients and a systematic review of the literature. SETTING: A 30-bed multidisciplinary critical care unit at a university teaching hospital. PATIENTS: Consecutive admissions to the critical care unit over a 6-month period. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: For each patient, demographic data and admitting diagnosis were recorded on admission. Information necessary to calculate the Acute Physiology and Chronic Health Evaluation II and Therapeutic Intervention Scoring System (TISS) scores were collected daily. TISS variables were categorized as "active" or "non-active" treatment variables. Patients were then identified on a daily basis as receiving or not receiving active treatment. A review of the literature, using MEDLINE and the search term "Therapeutic Intervention Scoring Index" (as a textword), was conducted to identify studies that had similarly divided their patients. Using the method of benchmarking, the proportion of patients admitted who received active treatment during their stay in the critical care units was compared between the index critical care unit and those in the literature. A greater proportion of the patients admitted to our unit received active treatment (97.7%) when compared to other studies in the literature (20-66%). However, a number of potential confounding factors were present, such as the availability of intermediate care units, overnight recovery room ventilation, and critical care bed availability between the index critical care unit and those described in the literature. CONCLUSIONS: The current literature does not provide adequate data on critical care unit admission practices to allow useful application of the method of benchmarking. There is a need for publicly accessible large databases to allow individual critical care units to determine their level of efficiency when compared to similar institutions.
The outcome of clinical events has become the major focus for quality assurance programs in the United States. Assessment of outcome depends on the availability of accurate benchmark rates appropriate to the clinical situation. Although mortality, length of stay, cost, and other resource utilization measures are important outcome events for review, nosocomial infection is one of the best-studied outcome events for which benchmark rates and distributions of rates are available. To monitor nosocomial infection acquisition, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has proposed indicators for wound infections after clean and clean-contaminated surgical procedures, for pneumonia in intensive care units (ICUs), and for intravascular device infections in ICUs. From the National Nosocomial Infections Surveillance (NNIS) system, we know that the mean rate of surgical wound infections (SWIs) for clean-contaminated wounds is 2.7%. However, the range is too broad and depends on the types of surgical procedures and the patient risk factors in each category. As an example, the SWI rate for appendectomies is 2.2% while for colon surgery it is 7.1%. In addition, the patients should be stratified by underlying risk factors. For example, the NNIS risk index is composed of wound class, duration of surgery, and American Society of Anesthesiology score. Other commonly used severity of illness scores could be used, such as a comorbidity score or APACHE II. Other proposed JCAHO indicators are reviewed. Controlling for case mix and for severity of illness will be necessary for the development of benchmark infection rate distributions if clinical indicators are to be used as reliable quality assurance tools in the 1990s.
A Benchmark test program cannot only be used as a tool in the process of comparing the capabilities of different EDP systems, to make the decision for a new computer. Benchmark tests can serve also as a source of dynamic information on the development of performance and to predict bottlenecks with increasing workload. To gain these advantages each computer center should develop a representative model for its typical computer workload. Criteria for the development of such a Benchmark test program are described, especially for the important simulation of terminal sessions and detailed in an example.