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Benchmarking stresses the importance of rate, not absolute numbers. Facility goes from dead last to first in just a few quarters. Sustaining change is much more difficult than achieving change.
Regional block (RB) anesthesia for carotid surgery offers the advantage of continuously monitoring the awake patient's neurologic status during carotid cross-clamping. We retrospectively studied our experience with RB for carotid endarterectomy (CEA) procedures performed during the period January 1, 1995 through December 31, 2001. A total of 388 consecutive CEA procedures were performed; RB was used in 314 and general anesthesia (GA) in 74. Three patients required conversion from RB to GA. GA was used only in patients who could not tolerate a block or needed combined coronary artery bypass grafting (CABG) and carotid surgery. New ipsilateral stroke did not occur in RB patients; one patient extended a previous stroke. Three in-hospital deaths occurred; these were all cardiac-related. In GA patients undergoing CEA without CABG (CEA only, n = 58), one stroke and no deaths occurred. The combined stroke and mortality rate for all CEA-only patients was 1.3 per cent (five of 372). RB allows 90 per cent of procedures to be performed without shunting, thus facilitating endarterectomy and patch angioplasty. CEA performed under RB is similar to carotid stenting because both procedures allow monitoring of the awake patient's neurologic status. The very low procedural complication rate in this study warrants the consideration of carotid surgery under regional block as a benchmark for future carotid angioplasty and stenting studies.
The latest benchmarking data reveal both old trends and some surprises. Once again, hospitals in high managed care markets outperformed those in low managed care markets in profitability measures, such as total margin and return on equity. However, hospitals in areas with low managed care penetration had a lower percentage of bad-debt expense and significantly fewer days in accounts receivable and more days cash on hand.
To show the impact of sensor behaviour on the control result, four strategies for aeration control are tested using different sensor characteristics. It is demonstrated, on the one hand, how an increasing response time will limit the achievable control quality and, on the other hand, how a given sensor characteristic can be taken into account for the controller design. The presented tests show that an improvement potential by control for WWTPs is available but this potential is limited compared to proper DO control with fixed set-points. To activate this control potential, sufficient control authority must be available and a careful control design is required. It can be shown that using feedback control, sensors with a small response time have significant advantages compared to conventional sensors. Using feed forward control, the improvement potential by control is considerably higher and additionally, the sensor delay can be integrated into the controller design. The presented discussion is based on simulation studies performed on a standardised benchmark case. For these tests it was necessary to include sensor models into the simulation model. It can be stated that the usage of sensor models is necessary for the application of dynamic simulation for the design and evaluation of WWTP control and in general to achieve realistic results.
For many, fiscal responsibility is a key component of quality. Cost, quality, speed of service comprise "three-legged stool" of performance. Benchmarking helpful in pointing out institutional differences as well as similarities.
A need was seen for uniform data sets, identification of best practices. Benchmarking project helps reveal department's strengths and weaknesses. Using an outside consultant helped ensure objectivity.
Reducing practice variation in clinically complex patient populations is one of the biggest challenges in medicine. Paidos Health Management Services has released a fascinating nationwide review of more than 13,000 premature and other medically complex newborns. The report--an invaluable benchmarking tool--demonstrates that variation often leads to less-than-optimal outcomes for newborns and unnecessary costs to the health care system.
Data from five different Institution of Pathological Anatomy Hospital Services are presented in order to show one (the benchmark) of the multiple existing ways to approach the budget problem and the macroeconomic management of our Services. The aim of this work is not to show the "best" way to work in terms of cost-efficacy but only a methods to compare our results with others. Nevertheless from this study is possible also to make some considerations about medical and technical workload in different services with different habits.
A benchmark study of home care institutions in the Netherlands evaluated them principally in terms of efficiency and client and staff surveys. Efficiency was measured on the basis of production and expenditure data. Those chosen as "best-practice" agencies tend to focus on their core duties and perform fewer ancillary services, have smaller care teams and operate with fewer hierarchical levels.
The number of hip fractures worldwide is expected to more than triple by 2050. A World Health Organization document serves as a data benchmark for more than 150 conditions. Major focus of U.S. efforts are on awareness and research funding.
The IWA's Biofilm Modeling Task Group created a multi-species benchmark problem in which heterotrophic bacteria, nitrifying bacteria, and inert biomass coexist in a biofilm. Members of the Task Group submitted solutions from nine different one-dimensional models. The most important distinctions among the models were (1) whether the model required a full numerical solution or was solved with a spreadsheet, and (2) the way the biomass types were distributed in the biofilm. The models that protected the slow-growing species by having them accumulate away from the outer surface always had the largest surface coverage by nitrifiers and inerts, but the heterotroph coverage declined to compensate. Coverage by heterotrophs and removal of substrate COD were most strongly affected by dilution from nitrifiers and inerts near the outer surface. Models that did not allow the nitrifiers and inerts to dilute the heterotrophs significantly in the outer layer predicted more removal of COD than did the other models. The choice of the model to use depends on the user's needs and the relative importance of including protection of slow-growing species and/or dilution of fast-growing species.
In addition to the one-dimensional solutions of a multi-species benchmark problem (BM3) presented earlier (Rittmann et al., 2004), we offer solutions using two-dimensional (2-D) models. Both 2-D models (called here DN and CP) used numerical solutions to BM3 based on a similar mathematical framework of the one-dimensional AQUASIM-built models submitted by Wanner (model W) and Morgenroth (model M1), described in detail elsewhere (Rittmann et al., 2004). The CP model used differential equations to simulate substrate gradients and biomass growth and a particle-based approach to describe biomass division and biofilm growth. The DN model simulated substrate and biomass using a cellular automaton approach. For several conditions stipulated in BM3, the multidimensional models provided very similar results to the 1-D models in terms of bulk substrate concentrations and fluxes into the biofilm. The similarity can be attributed to the definition of BM3, which restricted the problem to a flat biofilm in contact with a completely mixed liquid phase, and therefore, without any salient characteristics to be captured in a multidimensional domain. On the other hand, the models predicted significantly different accumulations of the different types of biomass, likely reflecting differences in the way biomass spread within the biofilm is simulated.
Hospitals have a new set of 15 standardized measures they can use to evaluate the quality of nursing care their staffs provide and benchmark that performance against other institutions.
A relatively simple benchmarking method has paid off in improved quality of care for Alabama diabetes patients.
Providers are well aware that appropriate coding is the key to prompt payment of claims submitted for services. Payers do reserve the right to review payments at a later date, however. The auditing process is costly, time consuming, and often traumatic for practices. This article provides an overview of the coding and payment process. The author suggests that practices audit their own clinical records on a periodic basis and compare the distribution of their codes with national and/or specialty benchmarks. In addition, practices must weigh whether the coding level is supported by appropriate documentation.
For benchmarking hospital supply expense to be meaningful, the healthcare industry needs an accurate and generally agreed-upon definition of "supply expense."
CMS intends to move to a severity-adjusted system for DRGs; number of codes may double. ICD-10 will allow for more specific codes, which could affect benchmark data. Understanding the new codes and data will be critical to uncovering opportunities for improvement.
Transforming the current event-driven reimbursement system into a quality powered marketplace will require clinical evaluation of how care is delivered. The managed care marketplace is evolving in three stages, from an event-driven, cost-avoidance model, to which the concepts of "value" and "quality" are added, with the final addition of a more "public health" focus. Clinical evaluation is a scientific process of outcomes assessment, clinical guidelines, and benchmarking. This process was applied to a hospital-based outpatient wound clinic, leading to a determination that the overall clinic Kaplan-Meier median time to healing could be improved. Two groups of patients were studied, 141 retrospectively from 1993 to 1994 and 57 prospectively in 1995. While there was no significant difference in the percentage healed between the groups, a significant difference in the median times to healing was revealed, which was linked to antibiotic use. Even when antibiotics were used prophylactically, the median times for healing were elevated from those without infections. Introspection led to fewer patients receiving preventive antibiotics. The overall lower median time to healing curve in 1995 can be explained by this change in clinical practice. This quality improvement demonstrates the utility of the clinical evaluation process as the healthcare marketplace evolves.