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PubMed2003

Pediatric emergency department directors' benchmarking survey: fiscal year 2001.

OBJECTIVES: To answer basic questions, using precise definitions, regarding emergency department (ED) utilization, wait times, services, and attending physician staffing of representative pediatric EDs (PEDs). METHODS: Ten questions with precise definitions were developed and sent to members of the Ambulatory Pediatric Association's PED Directors' Special Interest Group in November of 2001, with two repeated requests 3 and 6 months later. RESULTS: Twenty-one PEDs from 14 states, the District of Columbia, and Canada responded (41%). The average PED has 48,000 patient visits per year (range, 25,000-97,000). Two thirds have urgent care or fast track areas to see nonurgent patients, while only 29% have 23-hour treatment units. The average admission rate is 13.2% (range, 6.8-20.8%). The average rate of patients who leave without being seen is 1.6%. The average patient waits 1 hour to see a physician and spends a total of 3 hours in the PED. The majority of attending staffing is by pediatric emergency medicine (PEM) Board-certified/eligible physicians (73%), although a few PEDs are staffed only by PEM specialists. Attending staffing is 2.8 patients per attending per hour, or 0.36 hours per patient, with more staffing for PEDs with higher admission rates or acuity. The average entry-level base salary for PED physicians in 2000 was 117,250 dollars (range, 98,000 dollars-145,000 dollars). CONCLUSIONS: Benchmarking of PEM staffing and performance indicators by PEM directors yields important administrative data. PEDs have higher census and admission rates compared with information from all EDs, while their attending staffing, wait times, and rate of patients who leave without being seen are comparable to those of general EDs.

Benchmarking↗

PubMed2000

Benchmarking in rehabilitation: comparing physiotherapy services.

This report presents outcome data from 3,176 consecutive prospective patients referred to physiotherapy for the treatment of soft tissue injuries. The results detailed here are part of a larger study collecting data from different NHS trusts in a benchmarking study. The Therapy Outcome Measure was used to collect data on each patient in four domains: Impairment, Disability/activity, Handicap/participation, and Distress/wellbeing on the entry and the exit from physiotherapy. The study concludes that patients do not have equal opportunity of accessing therapy for their specific condition according to their abilities and needs. Therapy provided in the Trusts did not produce similar changes in the patients' abilities and some dimensions appeared to improve more significantly in some locations. Furthermore this study would suggest that there are no common criteria for discharge of patients with similar conditions from physiotherapy across the Trusts as measured by the Therapy Outcome Measure.

Age Factors↗

PubMed2001

Comparison of the EU T25 single point estimate method with benchmark dose response modeling for estimating potency of carcinogens.

The T25 single-point estimate method of evaluating the carcinogenic potency of a chemical, which is currently used by the European Union (EU) and is denoted the EU approach, is based on the selection of a single dose in a chronic bioassay with an incidence rate that is significantly higher than the background rate. The T25 is determined from that single point by a linear extrapolation or interpolation to the chronic dose (in mg/kg/day), at which a 25% increase in the incidence of the specified tumor type is expected, corrected for the background rate. Another method used to obtain a carcinogenic potency value based on a 25% increase in incidence above the background rate is the estimation of a T25 derived from a benchmark dose (BMD) response model fit to the chronic bioassay data for the specified tumor type. A comparison was made between these two methods using 276 chronic bioassays conducted by the National Toxicology Program. In each of the 2-year bioassays, a tumor type was selected based on statistical and biological significance, and both EU T25 and BMD T25 estimates were determined for that end point. In addition, simulations were done using underlying cumulative probability distributions to examine the effect of dose spacing, the number of animals per dose group, the possibility of a dose threshold, and variation in the background incidence rates on the EU T25 and BMD estimates. The simulations showed that in the majority of cases the EU T25 method underestimated the true T25 dose and overestimated the carcinogenic potency. The BMD estimate is generally less biased and has less variation about the true T25 value than the EU estimate.

Benchmarking↗

PubMed2004

A comparison of three methods for calculating confidence intervals for the benchmark dose.

Various methods exist to calculate confidence intervals for the benchmark dose in risk analysis. This study compares the performance of three such methods in fitting nonlinear dose-response models: the delta method, the likelihood-ratio method, and the bootstrap method. A data set from a developmental toxicity test with continuous, ordinal, and quantal dose-response data is used for the comparison of these methods. Nonlinear dose-response models, with various shapes, were fitted to these data. The results indicate that a few thousand runs are generally needed to get stable confidence limits when using the bootstrap method. Further, the bootstrap and the likelihood-ratio method were found to give fairly similar results. The delta method, however, resulted in some cases in different (usually narrower) intervals, and appears unreliable for nonlinear dose-response models. Since the bootstrap method is more time consuming than the likelihood-ratio method, the latter is more attractive for routine dose-response analysis. In the context of a probabilistic risk assessment the bootstrap method has the advantage that it directly links to Monte Carlo analysis.

Animals↗

PubMed2004

Nurse staffing levels and budgeted expenditure in acute mental health wards: a benchmarking study.

This paper describes benchmarking research undertaken within one former National Health Service Executive region examining acute ward funded and actual staffing establishments and funded expenditure for mental health nursing staff. Staffing establishment data were obtained for all 73 acute wards within the region. Of the established posts for trained mental health nurses across these wards, it was identified that there were 12% vacancies (117.99 whole time equivalent) at the time of the study. While some of the shortfall was dealt with by recruiting untrained nursing staff above funded establishments, there remained an overall shortfall in the total nursing workforce across the system of acute wards in the region. Although most of the provider trusts in the region were in development or experiencing major organizational change at the time of the study, considerable variation existed within and between trusts. Variations were identified in funded and actual nursing establishments and cost per bed, raising significant issues for trusts and their local mental health economies. Variations based on mixed- and single-sex wards were also noted. Findings are discussed in respect of the issues raised for the development of wards, provider trusts and their local systems. The utility of the methodology developed in this work is also discussed.

Acute Disease↗

PubMedDate not supplied

A collaborative effort to establish a long-term care benchmark process.

Several long-term care facilities in the Rochester, NY, area developed a benchmark process that was customer driven, analytical in its approach to problem-solving, measurable, and flexible enough to be applicable to any area of care within the facilities. The facilities benefited by gaining a process that improves their operations and has a positive impact on residents' quality of life.

Aged↗

PubMedDate not supplied

Hospital nursing benchmarks: the California Nursing Outcomes Coalition project.

The California Nursing Outcomes Coalition (CalNOC) project is an initiative that has become the largest ongoing nursing quality measurement repository in the nation. Launched in 1996 by California nursing leaders concerned with trends in hospital care, CalNOC has created reliable quality benchmark data to define patient safety thresholds in California. This article describes CalNOC's effort, which aligns with the strategy of the National Quality Forum for measuring and reporting healthcare quality. By tracing the evolution of the CalNOC project and its future potential, we hope to encourage other grassroots efforts to build the database repositories needed for healthcare quality measurement in the 21st century.

American Nurses' Association↗

PubMed2005

Benchmarking analytical calculations of proton doses in heterogeneous matter.

A proton dose computational algorithm, performing an analytical superposition of infinitely narrow proton beamlets (ASPB) is introduced. The algorithm uses the standard pencil beam technique of laterally distributing the central axis broad beam doses according to the Moliere scattering theory extended to slablike varying density media. The purpose of this study was to determine the accuracy of our computational tool by comparing it with experimental and Monte Carlo (MC) simulation data as benchmarks. In the tests, parallel wide beams of protons were scattered in water phantoms containing embedded air and bone materials with simple geometrical forms and spatial dimensions of a few centimeters. For homogeneous water and bone phantoms, the proton doses we calculated with the ASPB algorithm were found very comparable to experimental and MC data. For layered bone slab inhomogeneity in water, the comparison between our analytical calculation and the MC simulation showed reasonable agreement, even when the inhomogeneity was placed at the Bragg peak depth. There also was reasonable agreement for the parallelepiped bone block inhomogeneity placed at various depths, except for cases in which the bone was located in the region of the Bragg peak, when discrepancies were as large as more than 10%. When the inhomogeneity was in the form of abutting air-bone slabs, discrepancies of as much as 8% occurred in the lateral dose profiles on the air cavity side of the phantom. Additionally, the analytical depth-dose calculations disagreed with the MC calculations within 3% of the Bragg peak dose, at the entry and midway depths in the phantom. The distal depth-dose 20%-80% fall-off widths and ranges calculated with our algorithm and the MC simulation were generally within 0.1 cm of agreement. The analytical lateral-dose profile calculations showed smaller (by less than 0.1 cm) 20%-80% penumbra widths and shorter fall-off tails than did those calculated by the MC simulations. Overall, this work validates the usefulness of our ASPB algorithm as a reasonably fast and accurate tool for quality assurance in planning wide beam proton therapy treatment of clinical sites either composed of homogeneous materials or containing laterally extended inhomogeneities that are comparable in density and located away from the Bragg peak depths.

Air↗

PubMed2006

An audit of thrombophilia screens: results from the National Pathology Alliance benchmarking review.

AIMS: The National Pathology Alliance benchmarking review has completed six years of data collection and analysis of the workload and organisation of haematology laboratories in the UK. This study audits national practice of routine thrombophilia screening against the current standards, as set out in the British committee for standards in haematology (BCSH) guidelines on investigation of heritable thrombophilia. METHODS: Each laboratory completed a standard data collection questionnaire about the number of routine thrombophilia assays performed each year. Information was collected on which thrombophilia tests were performed as part of a routine thrombophilia screen. These results were then compared against the BCSH guidelines on investigation of heritable thrombophilia. RESULTS: Of the 57 National Health Service trusts that submitted data for review in 2002/2003, 47 performed a routine thrombophilia screen. Ten laboratories complied with the guidelines but 37 laboratories did not. CONCLUSION: There was variation in practice in the tests used in routine thrombophilia screens. There is evidence that some laboratories deviate from what may be regarded as "evidence based practice". The lack of compliance with the guidelines was in general associated with the performance of additional tests not recommended in the guideline. In a minority of laboratories, a clinically significant diagnosis would be missed by the failure to include one or more tests in a thrombophilia screen.

Benchmarking↗

PubMed2003

Red cell or serum folate? Results from the National Pathology Alliance benchmarking review.

AIMS: The National Pathology Alliance benchmarking review has completed five years of data collection and analysis of the workload and organisation of haematology laboratories in the UK. This study analyses variation in practice in how laboratories respond to a request to determine whether or not a patient has folate deficiency. METHODS: A three year analysis of workload data on the number of serum/plasma folate and red cell folate assays performed on an annual basis for the period 1 April 1999 to 31 March 2002. RESULTS: Three diagnostic testing strategies were found, namely: serum/plasma folate only, red cell folate only, and both serum/plasma folate and red cell folate. CONCLUSION: Evidence from the literature indicates that serum folate measurements provide equivalent information to red cell folate measurements when attempting to determine whether folate deficiency is present. There seems to be no basis for the routine testing of all samples for serum/plasma folate and a red cell folate.

Benchmarking↗

PubMed2006

Recognition of transmembrane segments in proteins: review and consistency-based benchmarking of internet servers.

Membrane proteins perform a number of crucial functions as transporters, receptors, and components of enzyme complexes. Identification of membrane proteins and prediction of their topology is thus an important part of genome annotation. We present here an overview of transmembrane segments in protein sequences, summarize data from large-scale genome studies, and report results of benchmarking of several popular internet servers.

Algorithms↗

PubMed2006

Performance benchmarks for screening mammography.

PURPOSE: To retrospectively evaluate the range of performance outcomes of the radiologist in an audit of screening mammography by using a representative sample of U.S. radiologists to allow development of performance benchmarks for screening mammography. MATERIALS AND METHODS: Institutional review board approval was obtained, and study was HIPAA compliant. Informed consent was or was not obtained according to institutional review board guidelines. Data from 188 mammographic facilities and 807 radiologists obtained between 1996 and 2002 were analyzed from six registries from the Breast Cancer Surveillance Consortium (BCSC). Contributed data included demographic information, clinical findings, mammographic interpretation, and biopsy results. Measurements calculated were positive predictive values (PPVs) from screening mammography (PPV(1)), biopsy recommendation (PPV(2)), biopsy performed (PPV(3)), recall rate, cancer detection rate, mean cancer size, and cancer stage. Radiologist performance data are presented as 50th (median), 10th, 25th, 75th, and 90th percentiles and as graphic presentations by using smoothed curves. RESULTS: There were 2 580 151 screening mammographic studies from 1 117 390 women (age range, <30 to >/=80 years). The respective means and ranges of performance outcomes for the middle 50% of radiologists were as follows: recall rate, 9.8% and 6.4%-13.3%; PPV(1), 4.8% and 3.4%-6.2%; and PPV(2), 24.6% and 18.8%-32.0%. Mean cancer detection rate was 4.7 per 1000, and the median [corrected] mean size of invasive cancers was 13 mm. The range of performance outcomes for the middle 80% of radiologists also was presented. CONCLUSION: Community screening mammographic performance measurements of cancer outcomes for the majority of radiologists in the BCSC surpass performance recommendations. Recall rate for almost half of radiologists, however, is higher than the recommended rate.

Adult↗

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↗

PubMed2003

Benchmarking as a tool for the improvement of health services' supply departments.

This paper presents a benchmarking study carried out on the supply departments of Quebec's health services. The paper begins with the definition of a methodology to collect the information needed, both environmental (to enable institutions to be sorted into homogenous groups) and performance related. The analysis of indicators and the data envelopment analysis (DEA) models allowed classification of each hospital's performance and explained the operational approaches used, either at a general level or for each subprocess of the supply chain. It was observed that important economies of scale may be achieved with better co-ordination and with the regrouping of the supplying activities, both for purchasing management and central store management. The study showed that the best performance of central store services comes with flexible administrative structures, by receiving packages as small as possible and by using employees from the lowest range of the hierarchy. Purchasing services should employ highly qualified and well-paid staff. Although such services are relatively small with respect to their purchase volume, they show a higher activity rate. As a result of the discovered performing strategies, the possible economies range from 20% to 30% of the actual supply-chain management cost.

Benchmarking↗

PubMed2003

Southwest Regional Genitourinary Physicians' Audit Group: setting regional benchmarks for patient satisfaction.

The Southwest Regional Genitourinary Physicians' Audit Group conducted a survey to determine regional benchmarks for patient satisfaction with quality of care received in genitourinary medicine (GUM) clinics. Eight clinics participated, producing 1747 responses. Most patients were very satisfied with the standard of care in southwest GUM clinics resulting in high regional averages (74-90% very satisfied--score 5 on linear analogue scale 1-5). Revalidation/appraisal guidance suggests that physicians should actively participate in validated surveys relevant to their practice to provide evidence of relationships with patients. This questionnaire (with suggested improvements) may be used as part of that monitoring process.

Ambulatory Care Facilities↗

PubMed2004

Application of benzo(a)pyrene and coal tar tumor dose-response data to a modified benchmark dose method of guideline development.

Assessment of cancer risk from exposure to polycyclic aromatic hydrocarbons (PAHs) has been traditionally conducted by applying the conservative linearized multistage (LMS) model to animal tumor data for benzo(a)pyrene (BaP), considered the most potent carcinogen in PAH mixtures. Because it has been argued that LMS use of 95% lower confidence limits on dose is unnecessarily conservative, that assumptions of low-dose linearity to zero in the dose response imply clear mechanistic understanding, and that "acceptable" cancer risk rests on a policy decision, an alternative cancer risk assessment approach has been developed. Based in part on the emerging benchmark dose (BMD) method, the modified BMD method we used involves applying a suite of conventional mathematical models to tumor dose-response data. This permits derivation of the average dose corresponding to 5% extra tumor incidence (BMD0.05) to which a number of modifying factors are applied to achieve a guideline dose, that is, a daily dose considered safe for human lifetime exposure. Application of the modified BMD method to recent forestomach tumor data from BaP ingestion studies in mice suggests a guideline dose of 0.08 microg/kg/day. Based on this and an understanding of dietary BaP, and considering that BaP is a common contaminant in soil and therefore poses human health risk via soil ingestion, we propose a BaP soil guideline value of 5 ppm (milligrams per kilogram). Mouse tumor data from ingestion of coal tar mixtures containing PAHs and BaP show that lung and not forestomach tumors are most prevalent and that BaP content cannot explain the lung tumors. This calls into question the common use of toxicity equivalence factors based on BaP for assessing risk from complex PAH mixtures. Emerging data point to another PAH compound--H-benzo(c)fluorene--as the possible lung tumorigen.

Animals↗

PubMed2006

Financial benchmarks for Ontario hospitals.

Since the inception of the Hospital Reports in 1998, researchers have focused on three separate but related problems--how to measure performance; how to evaluate performance; and how to transfer knowledge about excellent performance to the field. This article describes a method to address the second problem--how to evaluate performance by benchmarking two indicators of financial performance and condition through three years of recent data for Ontario hospitals.

Benchmarking↗

PubMed2025

Benchmarking with synthetic communities provides a baseline for virus-host inferences from Hi-C proximity linking.

Microbiomes influence diverse ecosystems, and viruses increasingly appear to impose key constraints. While viromics has expanded genomic catalogs, host identification for these viruses remains challenging due to the limitations in scaling cultivation-based approaches and the uncertain reliability and relative low resolution of in silico predictions - particularly for understudied viral taxa. Towards this, Hi-C proximity ligation uses sequenced, cross-linked virus and host genomic fragments to infer virus-host linkages and has now been applied in at least 10 studies. However, its accuracy remains unknown. Here we assess Hi-C performance in recovering virus-host interactions using synthetic communities (SynComs) composed of four marine bacterial strains and nine phages with known interactions and then apply optimized bioinformatic protocols to natural soil samples. In SynComs, standard Hi-C sample preparations and analyses showed poor normalized contact score performance (26% specificity, 100% sensitivity, incorrect matches up to class level) that could be dramatically improved by Z-score filtering (Z ≥ 0.5, 99% specificity), though at reduced sensitivity (62% down from 100%). Detection limits were established as reproducibility was poor below minimal phage abundances of 105 PFU/mL. Applying optimized bioinformatic protocols to natural soil samples, we compared virus-host linkages inferred from proximity-ligated Hi-C sequencing with predictions generated by in silico homology-based and machine learning-based bioinformatic approaches. Prior to Z-score thresholding, agreement was relatively high at the phylum to family levels (72%), but not at the genus (43%) or species (15%) levels. Z-score thresholding reduced sensitivity (only 34% of predictions were retained), with only modest improvements in congruence with bioinformatic methods (48% or 18% at genus or species levels, respectively). Regardless, this led to 79 genus-level-congruent virus-host linkages and 293 new ones revealed by Hi-C alone, i.e., providing many new virus-host interactions to explore in already well-studied climate-critical soils. Overall, these findings provide empirical benchmarks and methodological guidelines to improve the accuracy and reliability of Hi-C for virus-host linkage studies in complex microbial communities.

Benchmarking↗