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PubMed1996

Benchmarking the US physician workforce. An alternative to needs-based or demand-based planning.

OBJECTIVE: To propose population-based benchmarking as an alternative to needs- or demand-based planning for estimating a reasonably sized, clinically active physician workforce for the United States and its regional health care markets. DESIGN: Cross-sectional analysis of 1993 American Medical Association and American Osteopathic Association physician masterfiles. POPULATION: The resident population of the 306 hospital referral regions in the United States. MAIN OUTCOME MEASURES: Per capita number of clinically active physicians by specialty adjusted for age and sex population differences and out-of-region health care utilization. The measured physician workforce was compared with 4 benchmarks: the staffing within a large (2.4 million members) health maintenance organization (HMO), a hospital referral region dominated by managed care (Minneapolis, Minn), a hospital referral region dominated by fee-for-service (Wichita, Kan), and the proposed "balanced" physician supply (50% generalists). RESULTS: The proportion of the US population residing in hospital referral regions with a higher per capita generalist workforce than the benchmark was 96% for the HMO benchmark, 60% for Wichita, and 27% for Minneapolis. The specialist workforce exceeded all 3 benchmarks for 74% of the population. The per capita workforce of generalists was not related to the proportion of generalists among regions (Pearson correlation coefficient=0.06; P=.26). CONCLUSIONS: Population-based benchmarking offers practical advantages to needs- or demand-based planning for estimating a reasonably sized per capita workforce of clinically active physicians. The physician workforce within the benchmarks of an HMO and health care markets indicates the varying opportunities for regional physician employment and services. The ratio of generalists to specialists does not measure the adequacy of the supply of the generalist workforce either nationally or for specific regions. Research measuring the relationship between physician workforces of different sizes and population outcomes will guide the selection of future regional benchmarks.

Catchment Area, Health↗
PubMed1996

Quantalization of continuous data for benchmark dose estimation.

Benchmark doses corresponding to low levels of noncancer disease risk have been proposed to replace the no-observed-adverse-effect level for establishing allowable daily intakes or reference doses. For quantal data each animal is classified with or without a disease. The proportion of animals with an adverse effect (risk) is observed as a function of dose of a toxic substance. The calculation of a benchmark dose is relatively straightforward. For continuous data a somewhat more complicated designation of risk is required. Because of the more direct procedures with quantal data, consideration could be given to converting continuous data to quantal data before estimating benchmark doses. The purpose of this paper is to compare the precision of the two approaches (use of continuous or quantalized data) for a number of sublinear dose-response curves ranging from low to high probabilities of risk at the highest dose. In these studies, five animals per dose were generally satisfactory to estimate the benchmark dose for continuous data, whereas the corresponding quantalized data generally do not perform as well even with 10 to 20 animals per dose. For quantalized data, the lower 95% confidence limits on the estimates of the benchmark dose were generally a factor of 3 to 4 below the true benchmark dose, whereas the confidence limits using the continuous data were generally within a factor of 2 of the true benchmark dose. Although the use of quantalized data for the estimation of risk is more direct, estimates of benchmark doses using the continuous data were more precise. Based on this study, converting continuous data to quantal data is not recommended.

Animals↗
PubMedDate not supplied

Benchmarking in healthcare: evaluating data and transforming it into action.

After the benchmarking team has accumulated data for the development of comparisons, it must be validated for completeness and consistency. Various factors can skew the analysis and should be watched: Subjective interpretations of survey questions. Lack of common definitions. Composition of input data. External factors and extraordinary events. After verifying consistency of data gathered from benchmarking partners, calculate appropriate statistics for the performance metric. Typical data tabulations are: mean, median, ratio, minimum and maximum value, normal operating range, standard deviation and correlation coefficient. Statistics derived from the data produce the benchmark against which you will measure your institution's performance. Gap analysis establishes the difference between your internal operation's performance and that of the benchmark. Information developed from properly collected data will help you determine reasons for the gap between your performance and the benchmark and project future trends. The next step is to develop an action plan based on what has been learned from benchmarking and targeted to improving performance in areas that further the strategic goals of the institution. In addition to determining performance goals, you must analyze the decision-making process involved in making changes that will move you toward those goals. Since the goal of benchmarking is to improve the organization, the team must present its analysis to those members of management who can approve an action plan. Changes resulting from benchmarking can range from incremental improvement of existing practices all the way to reenginering. Action plans are designed to effect change at levels that will vary according to the goals that have been set. The more incremental the change, the easier the implementation. The more radical the change, the greater the reward.

Data Display↗
PubMed2001

Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial.

CONTEXT: Performance feedback and benchmarking, common tools for health care improvement, are rarely studied in randomized trials. Achievable Benchmarks of Care (ABCs) are standards of excellence attained by top performers in a peer group and are easily and reproducibly calculated from existing performance data. OBJECTIVE: To evaluate the effectiveness of using achievable benchmarks to enhance typical physician performance feedback and improve care. DESIGN: Group-randomized controlled trial conducted in December 1996, with follow-up through 1998. SETTING AND PARTICIPANTS: Seventy community physicians and 2978 fee-for-service Medicare patients with diabetes mellitus who were part of the Ambulatory Care Quality Improvement Project in Alabama. INTERVENTION: Physicians were randomly assigned to receive a multimodal improvement intervention, including chart review and physician-specific feedback (comparison group; n = 35) or an identical intervention plus achievable benchmark feedback (experimental group; n = 35). MAIN OUTCOME MEASURE: Preintervention (1994-1995) to postintervention (1997-1998) changes in the proportion of patients receiving influenza vaccination; foot examination; and each of 3 blood tests measuring glucose control, cholesterol level, and triglyceride level, compared between the 2 groups. RESULTS: The proportion of patients who received influenza vaccine improved from 40% to 58% in the experimental group (P<.001) vs from 40% to 46% in the comparison group (P =.02). Odds ratios (ORs) for patients of achievable benchmark physicians vs comparison physicians who received appropriate care after the intervention, adjusted for preintervention care and nesting of patients within physicians, were 1.57 (95% confidence interval [CI], 1.26-1.96) for influenza vaccination, 1.33 (95% CI, 1.05-1.69) for foot examination, and 1.33 (95% CI, 1.04-1.69) for long-term glucose control measurement. For serum cholesterol and triglycerides, the achievable benchmark effect was statistically significant only after additional adjustment for physician characteristics (OR, 1.40 [95% CI, 1.08-1.82] and OR, 1.40 [95% CI, 1.09-1.79], respectively). CONCLUSION: Use of achievable benchmarks significantly enhances the effectiveness of physician performance feedback in the setting of a multimodal quality improvement intervention.

Aged↗
PubMed1999

Application of legal and regulatory rules and policies to benchmarking systems.

Although there are few federal or state laws that address benchmarking systems, there are legal issues of which those who develop or use benchmarking system should be aware. Benchmarks may be used as standards of care in tort or professional discipline actions. Use of benchmark data to set fees or exclude providers may raise antitrust concerns. Payers may use benchmark data to set coverage policies or payment rates. Which data are included in benchmarking systems and who has access to those data raise issues of confidentiality. Lastly, benchmarking system developers may want to protect their intellectual property rights and may need to consider medical device laws if they claim that the systems may be used in patient management.

Antitrust Laws↗
PubMed1995

Application of the benchmark method to risk assessment of trichloroethene.

An alternative approach for risk assessment of nongenotoxic substances, the benchmark method, has been evaluated and applied to trichloroethene as a test case. The benchmark dose is the dose that corresponds to a specific increase in risk, normally 1 or 10%. Experimental data from the literature on trichloroethene were used for these calculations. Eighty sets of data on effects on liver, kidney, the central nervous system, and tumors were analyzed. All non-observed-effect levels (NOELs) were higher than the benchmark dose corresponding to 1% extra risk, and 42% of the NOELs and 93% of the lowest-observed-effect levels (LOELs) were higher than the benchmark dose corresponding to 10% extra risk. The present study confirms that the benchmark methodology gives a more detailed picture of dose-response relationships than risk assessment using the NOEL/LOEL approach and facilitates comparison between various toxicity studies. However, the polynomial regression models used in the present study quite often failed to fit the experimental data. Despite the advantages with the benchmark approach, several factors must be considered in the risk assessment process. In the case of trichloroethene, a revised risk assessment using the benchmark approach would lead to a similar guideline value as the traditional NOEL/LOEL approach.

Animals↗
PubMed2025

A complete diploid human genome benchmark for personalized genomics.

Human genome resequencing typically involves mapping reads to a reference genome to call variants; however, this approach suffers from both technical and reference biases, leaving many duplicated and structurally polymorphic regions of the genome unmapped. Consequently, existing variant benchmarks, generated by the same methods, fail to assess these complex regions. To address this limitation, we present a telomere-to-telomere genome benchmark that achieves near-perfect accuracy (i.e. no detectable errors) across 99.4% of the complete, diploid HG002 genome. This benchmark adds 701.4 Mb of autosomal sequence and both sex chromosomes (216.8 Mb), totaling 15.3% of the genome that was absent from prior benchmarks. We also provide a diploid annotation of genes, transposable elements, segmental duplications, and satellite repeats, including 39,144 protein-coding genes across both haplotypes. To facilitate application of the benchmark, we developed tools for measuring the accuracy of sequencing reads, phased variant call sets, and genome assemblies against a diploid reference. Genome-wide analyses show that state-of-the-art de novo assembly methods resolve 2-7% more sequence and outperform variant calling accuracy by an order of magnitude, yielding just one error per 100 kb across 99.9% of the benchmark regions. Adoption of genome-based benchmarking is expected to accelerate the development of cost-effective methods for complete genome sequencing, expanding the reach of genomic medicine to the entire genome and enabling a new era of personalized genomics.

Journal Article↗
PubMed1995

Benchmarking reference services: an introduction.

Benchmarking is based on the common sense idea that someone else, either inside or outside of libraries, has found a better way of doing certain things and that your own library's performance can be improved by finding out how others do things and adopting the best practices you find. Benchmarking is one of the tools used for achieving continuous improvement in Total Quality Management (TQM) programs. Although benchmarking can be done on an informal basis, TQM puts considerable emphasis on formal data collection and performance measurement. Used to its full potential, benchmarking can provide a common measuring stick to evaluate process performance. This article introduces the general concept of benchmarking, linking it whenever possible to reference services in health sciences libraries. Data collection instruments that have potential application in benchmarking studies are discussed and the need to develop common measurement tools to facilitate benchmarking is emphasized.

Efficiency, Organizational↗
PubMed1995

Where does benchmarking fit? Crafting a role for sharing best practices.

Benchmarking strategy alone may get you started, but the development of a sustainable program becomes the key to success. That development involves characteristics such as educating and nurturing appropriate benchmarking behaviors, building a best practice network to share learning and developing a continuous updating mechanism. With clear direction and these supporting systems in place, benchmarking can be a powerful tool to help you innovate today and stay on the right track for tomorrow. A thorough understanding of the benchmarking can avoid the "Benchmarks are great," "More benchmarks are always better," and "Why do I have so much trouble innovating?" cycle that has plagued many who embraced this idea without first seeing its risks to culture and improvement. With the proper program, benchmarks can add the critical shared learning and best practice role that successful change initiatives need.

Creativity↗
PubMed1999

Benchmarking pathology services: implementing a longitudinal study.

This paper details the benchmarking process and its application to the activities of pathology laboratories participating in a benchmark pilot study [the Royal College of Pathologists of Australasian (RCPA) Benchmarking Project]. The discussion highlights the primary issues confronted in collecting, processing, analysing and comparing benchmark data. The paper outlines the benefits of engaging in a benchmarking exercise and provides a framework which can be applied across a range of public health settings. This information is then applied to a review of the development of the RCPA Benchmarking Project. Consideration is also given to the nature of the preliminary results of the project and the implications of these results to the on-going conduct of the study.

Australia↗
PubMed1999

Benchmarking patient relations within ambulatory care: lessons from a high-risk pregnancy program.

Ambulatory care providers are being challenged to deliver high-quality care at low cost with easy access. Patient satisfaction with services hinges on the ability of providers to meet these often elusive benchmarks. This article focuses on the barriers to benchmarking patient relations in ambulatory care organizations and strategies for improving patient relations through internal benchmarking that encourages service innovation and performance emphasis. A case study of programmatic benchmarking in the Lovelace Health System is used to illustrate how patient relations can benefit from establishing internal performance thresholds that guide service delivery. Examples from Lovelace's High Risk Pregnancy Program demonstrate the value of benchmarking efforts. The implications for patient relations benchmarking in other ambulatory care settings are discussed.

Ambulatory Care↗
PubMed2001

Benchmarking and the laboratory.

This article describes how benchmarking can be used to assess laboratory performance. Two benchmarking schemes are reviewed, the Clinical Benchmarking Company's Pathology Report and the College of American Pathologists' Q-Probes scheme. The Clinical Benchmarking Company's Pathology Report is undertaken by staff based in the clinical management unit, Keele University with appropriate input from the professional organisations within pathology. Five annual reports have now been completed. Each report is a detailed analysis of 10 areas of laboratory performance. In this review, particular attention is focused on the areas of quality, productivity, variation in clinical practice, skill mix, and working hours. The Q-Probes scheme is part of the College of American Pathologists programme in studies of quality assurance. The Q-Probes scheme and its applicability to pathology in the UK is illustrated by reviewing two recent Q-Probe studies: routine outpatient test turnaround time and outpatient test order accuracy. The Q-Probes scheme is somewhat limited by the small number of UK laboratories that have participated. In conclusion, as a result of the government's policy in the UK, benchmarking is here to stay. Benchmarking schemes described in this article are one way in which pathologists can demonstrate that they are providing a cost effective and high quality service.

Benchmarking↗
PubMed1999

Can data-driven benchmarks be used to set the goals of healthy people 2010?

OBJECTIVES: Expert panels determined the public health goals of Healthy People 2000 subjectively. The present study examined whether data-driven benchmarks provide a better alternative. METHODS: We developed the "pared-mean" method to define from data the best achievable health care practices. We calculated the pared-mean benchmark for screening mammography from the 1994 National Health Interview Survey, using the metropolitan statistical area as the "provider" unit. Beginning with the best-performing provider and adding providers in descending sequence, we established the minimum provider subset that included at least 10% of all women surveyed on this question. The pared-mean benchmark is then the proportion of women in this subset who received mammography. RESULTS: The pared-mean benchmark for screening mammography was 71%, compared with the Healthy People 2000 goal of 60%. CONCLUSIONS: For Healthy People 2010, benchmarks derived from data reflecting the best available care provide viable alternatives to consensus-derived targets. We are currently pursuing additional refinements to the data-driven pared-mean benchmark approach.

Benchmarking↗
PubMedDate not supplied

Occupational therapy benchmarks within orthopedic (hip) critical pathways.

OBJECTIVE: This study examined patient performance benchmarks for occupational therapy within orthopedic (hip) critical pathways. METHOD: Eight orthopedic (hip) critical pathways gathered from occupational therapy practitioners working in hospital and rehabilitation settings were examined to determine commonalities and differences of occupational therapy benchmarks, disciplines involved, and identified allowable variances. A comparison and contrast matrix was developed to provide a visual means of reviewing the data. RESULTS: Nursing, physical therapy, and occupational therapy were disciplines consistently involved in the pathways. Activities of daily living related to self-care were the most consistently used occupational therapy benchmark within the sample pathways, and functional transfers were the second most-used benchmark. The remaining occupational therapy benchmarks varied, and little commonality was found in their use. Frequency of use also varied among the eight pathways. Five of eight pathways specifically coded variances, with the remaining three providing space for explanation of the variance. CONCLUSION: Although these eight orthopedic (hip) critical pathways included occupational therapy benchmarks, further development and definition of the role of occupational therapy within subsequent orthopedic (hip) critical pathways is needed.

Benchmarking↗
PubMed1994

Calculation of benchmark doses from teratology data.

The benchmark dose approach has several potential advantages over the no observed adverse effect level (NOAEL) as a basis for risk assessment of toxic chemicals, based upon animal toxicity data. The practical use of the benchmark dose has been evaluated by applying dose-response models to an extensive historical database of teratology bioassays. Doses corresponding to 1 and 5% increases in incidence of lesions are calculated and compared to NOAELs. The statistical accuracy of these estimates was determined by calculating confidence intervals. The lower confidence limit on the 5% benchmark dose (LED05) is found to be comparable to the NOAEL for most datasets, and slightly higher on average. Benchmark doses at the 1% level could not be estimated accurately (i.e., they had wide confidence intervals) for a significant fraction of the datasets. LED01 values were lower on average than the NOAEL. Based on these results, it is concluded that benchmark doses for a 5% increases in incidence can be calculated for most datasets, and could be used as a satisfactory basis for risk assessment, e.g., to set reference doses or acceptable daily intakes. An exception occurs when the benchmark dose exceeds the highest dose of the study. This is only likely to occur when the chemical causes a small, but significant, increase in a finding that is uncommon in untreated animals.

Abnormalities, Drug-Induced↗
PubMed1995

Application of benchmark dose risk assessment methodology to developmental toxicity: an industrial view.

The U.S. EPA first signalled its intention to use benchmark dose risk techniques in 1991. Subsequently, publication of draft Guidelines for the Risk Assessment of Reproductive Toxicity data indicated the Agency's intention for wide use of the technique. In developmental toxicity experiments, a number of factors need to be considered before attempting benchmark dose calculations, as compared to the conventional NOAEL approach. For example, care in the assessment of potential litter effects (the litter is the unit of such a study) on the data and whether the data are continuous (e.g. foetal body weight) or discontinuous (e.g. specific or grouped developmental defects where the abnormality is present or absent). Two examples of the use of the benchmark dose approach will be made. First, in the analysis of foetal body weight, where a benchmark dose estimate for an agent producing a 5% decrease in mean foetal weight may be calculated from a shift in the distribution of foetal weights between groups, or by conversion of data to reflect changes in the incidence of 'small' pups (i.e. those towards the extreme of the normal range). The second example involves studies conducted on the developmental toxicity of a triazole antifungal. In the first study, the agent was clearly teratogenic, but a NOAEL was not established and thus necessitated a second study. Analysis of benchmark does estimates (e.g. for % foetuses malformed) from the first study indicated that these were not significantly changed when the data from the second study were combined (i.e. the second study did not aid the risk assessment). The benchmark dose approach has significant scientific and practical advantages over the conventional NOAEL methodology in risk assessments derived from developmental toxicity studies.

Animals↗
PubMed1993

Understanding benchmarking.

In order to meet the challenges facing health care today, organizations are turning to new approaches. Benchmarking is one such approach. Benchmarking is externally driven, encouraging organizations to look outside their own walls to learn from others and achieve exemplar performance. Organizations can benchmark within their own systems, against competitors, against "best-in-class" companies in the same general industry and against "best-in-class" companies in different industries. A four-step approach to benchmarking includes planning, collecting information, analyzing results and adapting and improving. A benchmarking study team composed of the process owner and other users of the process conducts the study. Application of benchmarking to healthcare materiel management is particularly appropriate, since many materiel management processes occur in other industries and, therefore, best practices outside the healthcare industry may be adapted. The practice, through growing in other industries, is still very new in health care.

Data Collection↗
PubMed1995

Benchmarking in healthcare: selecting and working with partners.

The process of selecting a benchmarking partner begins with gathering information to establish industry standards, identifying potential partners and supplying data on the subject to be benchmarked. Suggested sources of information are business and trade publications; investment industry analysts; journalists; trade associations and professional organizations; government research reports; disclosure documents; current and former employees; and product and service providers. Potential partners should be approached only after careful preparation of a project plan that includes information about the benchmarking team's organization and purpose, description of the subject and a statement of benefits for the prospective partner. After obtaining a commitment from the benchmarking partner, relevant comparative data is gathered and analyzed, using some of the following methods: library research, questionnaires, telephone surveys, site visits and consultants. Because benchmarking often involves sharing information with competitors, a code of ethical conduct has been developed by the International Benchmarking Clearinghouse.

Decision Making, Organizational↗