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Benchmarking in health care: using the Internet to identify resources.

Benchmarking is a quality improvement tool that is increasingly being applied to the health care field and to the libraries within that field. Using mostly resources assessible at no charge through the Internet, a collection of information was compiled on benchmarking and its applications. Sources could be identified in several formats including books, journals and articles, multi-media materials, and organizations.

Computer Communication Networks↗

A community resource benchmarking predictions of peptide binding to MHC-I molecules.

Recognition of peptides bound to major histocompatibility complex (MHC) class I molecules by T lymphocytes is an essential part of immune surveillance. Each MHC allele has a characteristic peptide binding preference, which can be captured in prediction algorithms, allowing for the rapid scan of entire pathogen proteomes for peptide likely to bind MHC. Here we make public a large set of 48,828 quantitative peptide-binding affinity measurements relating to 48 different mouse, human, macaque, and chimpanzee MHC class I alleles. We use this data to establish a set of benchmark predictions with one neural network method and two matrix-based prediction methods extensively utilized in our groups. In general, the neural network outperforms the matrix-based predictions mainly due to its ability to generalize even on a small amount of data. We also retrieved predictions from tools publicly available on the internet. While differences in the data used to generate these predictions hamper direct comparisons, we do conclude that tools based on combinatorial peptide libraries perform remarkably well. The transparent prediction evaluation on this dataset provides tool developers with a benchmark for comparison of newly developed prediction methods. In addition, to generate and evaluate our own prediction methods, we have established an easily extensible web-based prediction framework that allows automated side-by-side comparisons of prediction methods implemented by experts. This is an advance over the current practice of tool developers having to generate reference predictions themselves, which can lead to underestimating the performance of prediction methods they are not as familiar with as their own. The overall goal of this effort is to provide a transparent prediction evaluation allowing bioinformaticians to identify promising features of prediction methods and providing guidance to immunologists regarding the reliability of prediction tools.

Animals↗

Distance-restrained docking of rifampicin and rifamycin SV to RNA polymerase using systematic FRET measurements: developing benchmarks of model quality and reliability.

We are developing distance-restrained docking strategies for modeling macromolecular complexes that combine available high-resolution structures of the components and intercomponent distance restraints derived from systematic fluorescence resonance energy transfer (FRET) measurements. In this article, we consider the problem of docking small-molecule ligands within macromolecular complexes. Using simulated FRET data, we have generated a series of benchmarks that permit estimation of model accuracy based on the quantity and quality of FRET-derived distance restraints, including the number, random error, systematic error, distance distribution, and radial distribution of FRET-derived distance restraints. We find that expected model accuracy is 10 A or better for models based on: i), > or =20 restraints with up to 15% random error and no systematic error, or ii), > or =20 restraints with up to 15% random error, up to 10% systematic error, and a symmetric radial distribution of restraints. Model accuracies can be improved to 5 A or better by increasing the number of restraints to > or =40 and/or by optimizing the distance distribution of restraints. Using experimental FRET data, we have defined the positions of the binding sites within bacterial RNA polymerase of the small-molecule inhibitors rifampicin (Rif) and rifamycin SV (Rif SV). The inferred binding sites for Rif and Rif SV were located with accuracies of, respectively, 7 and 10 A relative to the crystallographically defined binding site for Rif. These accuracies agree with expectations from the benchmark simulations and suffice to indicate that the binding sites for Rif and Rif SV are located within the RNA polymerase active-center cleft, overlapping the binding site for the RNA-DNA hybrid.

Binding Sites↗

Benchmark data for elderly, vascular trans-tibial amputees after rehabilitation.

Benchmark data for lower limb amputees is often limited to young subjects who have had their amputations as the result of trauma. The majority of trans-tibial amputees rehabilitated are, however, elderly vascular amputees who may have different gait characteristics than their younger counterparts. Without biomechanical analyses to provide such benchmark data for this group it is not possible to compare the effects of different rehabilitation programmes, gait training regimens, or prosthetic devices. Twenty elderly vascular trans-tibial amputees rehabilitated at The Queen Elizabeth Centre, Ballarat, Australia and at least six months post-amputation were measured in respect of kinetic and kinematic parameters, and relationships between gait speed, consistency, and function were demonstrated. Further, an unexplained vertical ground reaction force pattern was demonstrated in faster, more functional amputees.

Aged↗

Women's aging benchmarks in relation to their health habits and concerns.

OBJECTIVES: To identify aging benchmarks for women and to examine relationships between women's perceptions of aging and their health behaviors and concerns. METHODS: More than 1000 primarily white women completed paper-and-pencil and Internet surveys of demographic, attitudinal, and health-behavior information. RESULTS: Aging benchmarks correlated significantly with women's education and employment levels, reported health status, and health behaviors including exercise, dieting, and breast augmentation surgery. Those who worried about aging were significantly more likely to diet but not more likely to exercise. CONCLUSION: More research is needed to understand how perceptions influence women's ability to impact the aging process.

Adolescent↗

Using benchmarking to improve practice.

Benchmarking is a relatively new addition to NHS quality initiatives. This article describes how a group of paediatric nurses set up a project to introduce benchmarking across units in the north west of England, and explores the benefits and disadvantages of this approach for nursing in general.

Child↗

Benchmark matrix and guide: Part III.

The final article in the "Benchmark Matrix and Guide" series developed by Headquarters Air Force Logistics Command completes the discussion of the last three categories that are essential ingredients of a successful total quality management (TQM) program. Detailed behavioral objectives are listed in the areas of recognition, process improvement, and customer focus. These vertical categories are meant to be applied to the levels of the matrix that define the progressive stages of the TQM: business as usual, initiation, implementation, expansion, and integration. By charting the horizontal progress level and the vertical TQM category, the quality management professional can evaluate the current state of TQM in any given organization. As each category is completed, new goals can be defined in order to advance to a higher level. The benchmarking process is integral to quality improvement efforts because it focuses on the highest possible standards to evaluate quality programs.

Employee Performance Appraisal↗

Benchmarking cardiac surgery: a regional initiative to improve outcomes. Interview by Reggi Veatch.

Many of the clinical benchmarking projects featured in the Lead Story are designed to produce quick results. The Northern New England Cardiovascular Disease Study Group (NNE), by contrast, is a long-term effort to improve patients' functional health status. Formed in 1987, NNE is a voluntary consortium comprising all providers of open heart surgery in Maine, New Hampshire, and Vermont--five facilities and 28 surgeons. Although NNE is just beginning to focus on best practices within the region, its early benchmarking efforts have produced a collaborative environment in which clinical information is now readily shared. Because of this, its accomplishments have been striking: the creation of a database that includes information on more than 18,000 patients; the development of a highly accurate mortality prediction tool for patients facing coronary bypass surgery; and a 24 percent decrease in regional operative mortality following coronary artery bypass graft (CABG) surgery.

Cardiology Service, Hospital↗

Benchmarking in healthcare organizations: an introduction.

Business survival is increasingly difficult in the contemporary world. In order to survive, organizations need a commitment to excellence and a means of measuring that commitment and its results. Benchmarking provides one method for doing this. As the author describes, benchmarking is a performance improvement method that has been used for centuries. Recently, it has begun to be used in the healthcare industry where it has the potential to improve significantly the efficiency, cost-effectiveness, and quality of healthcare services.

Commerce↗

Benchmarking can add up for healthcare accounting.

In 1993, a healthcare accounting and finance benchmarking survey of hospital and nonhospital organizations gathered statistics about key common performance areas. A low response did not allow for statistically significant findings, but the survey identified performance measures that can be used in healthcare financial management settings. This article explains the benchmarking process and examines some of the 1993 study's findings.

Accounting↗

Improving cash flow through benchmarking.

Healthcare organizations can use two benchmarking techniques to improve their accounts receivable departments' performance: 1) studying the accounts receivable statistics of model healthcare organizations, and 2) visiting these model organizations in order to get a first-hand look at how they do business. Employing these two benchmarking techniques can help healthcare organizations reduce gross days revenue outstanding, bad debt, the length of time between the date a patient is discharged and the date a bill is mailed, the total percentage of receivables more than 90 days old, and general business office expenses related to collection.

Accounts Payable and Receivable↗

Seeking improvements through laboratory benchmarking. The Western North Carolina Collaborative Group.

The laboratory departments at six North Carolina hospitals have formed an ongoing benchmarking team that has been meeting on a regular basis for more than 2 years. This article describes how the laboratory managers on this multihospital team have learned the benchmarking process, standardized procedural cost accounting in the group, compared and reduced costs, improved quality and efficiency, and created networking channels with other health-care professionals. The team members have quantified and reported significant savings and increased revenue for their laboratories as a direct result of their participation in this project.

Cost Savings↗

Benchmarking in home care.

Recognizing that continuous quality improvement will be imperative for success in the future, six visiting nurse associations of northwestern Pennsylvania used benchmarking as a tool to improve their respective agencies' performance. The agencies benchmarked three areas: continuity of care, patient rehospitalization, and nosocomial infection rate.

Continuity of Patient Care↗

Rehab facility overcomes scarcity of models to make benchmarking pay.

LOCATION: Bryn Mawr Rehab, a 141-bed rehabilitation facility in Malvern, PA. PROBLEM: Scarcity of benchmarkable models. The facility wanted to benchmark an integrated caregiving model that melded the disciplines of therapy and nursing into work teams reporting to the same supervisor. SOLUTION: It did not find a complete model but did glean valuable information from two facilities that had changed parts of the overall organizational structure.

Efficiency, Organizational↗

How to use benchmarking to reduce planning and purchasing costs.

Each year at budget time, the standard question asked of the materiel management group is "Why do you have so many people?" Our answer had been that we do not have enough people. With more people, we could lower total cost and manage inventories better. The inevitable standoff occurs with each side feeling that the other does not understand the need for materiel management services. In early 1993, we decided to be prepared to answer the famous question of Dr. W. Edwards Deming, "How do you know?" We wanted to show people we really did know our business and thus initiated a project to benchmark planning, purchasing, and scheduling services of other companies. This article shares not only the results of the benchmarking efforts, but also the techniques for getting started.

Cost Control↗

Benchmarking hospital laboratory financial and operational performance.

The movement toward more integrated delivery systems requires hospital administrators, medical staffs, and health care network organizations to consider strategies that will meet the future challenges facing laboratory services. Many health care experts predict that the number of hospital inpatient days, staffed acute care beds, and length of stay will continue their precipitous decline, and then stabilize during the next four to five years. Hospitals should carefully evaluate how their laboratories might be affected as a result of the decline in inpatient services and the integration of health care services at all levels. Hospital executive management must find a way to manage staffing levels and technical resources in order to maintain quality patient services in the face of declining test volume. This Special Report discusses relevant benchmarks intended to help hospital administrators and laboratory directors identify "best practices" in hospital laboratories so that comparisons of patterns of care and financial operations can be made. Benchmarking the relative financial and operational performance of hospital laboratories allows health care planners to design the most appropriate laboratory services delivery system for future hospital inpatient and outpatient market demands. Factors influencing financial and operation performance will be investigated, including utilization, testing costs, staffing mix, productivity, and organizational structure. This will be followed by a discussion on the future of laboratories and the trend toward regional laboratories owned by hospital consortiums.

Clinical Laboratory Techniques↗

Establishing benchmarks for ambulatory surgery costs.

The acceleration of managed care activity has made benchmark data on performance especially important. To date, benchmark data on financial and clinical performance in ambulatory surgery have been lacking in both hospital-based and independent, freestanding ambulatory surgery centers. This article discusses tools, empirical data, and strategies to assist financial (and clinical) managers in healthcare organizations critically examine the efficiency of their ambulatory surgery services.

Ambulatory Surgical Procedures↗

Total quality management (TQM) in a hospital library: identifying service benchmarks.

Hospitals are turning to total quality management (TQM) to lower costs of providing care. A hospital library in a TQM environment needs to embrace corporate goals while maintaining its accountability as a contributor to quality patient care. Alliant Health System (AHS) Library at Norton Hospital and Kosair Children's Hospital in Louisville, Kentucky, conducted a study to establish TQM benchmarks and to examine the significance of its role in clinical care. Using a methodology designed to allow both library user and nonuser to respond, 2,091 surveys were distributed to physicians and nursing and allied health personnel. Areas surveyed included frequency of library use, impact of information received on clinical judgments, cognitive value of the information, and satisfaction with library products and services. Results confirm that the library has a substantial clinical role. Eighty-eight percent of reporting physicians agreed that information from the library contributed to higher quality care. Nursing and allied health were less convinced of the importance of the library's clinical role. Sixty-nine percent of nursing personnel and 58% of allied health personnel agreed that the library contributed to higher quality care. Nursing and allied health personnel also used the library less frequently than physicians. With these results as benchmarks, improving the clinical role of the library will take commitment to the TQM process and a willingness to change.

Attitude of Health Personnel↗