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PubMed2006

Associations between CMS's Clinical Performance Measures project benchmarks, profit structure, and mortality in dialysis units.

Prior studies observing greater mortality in for-profit dialysis units have not captured information about benchmarks of care. This study was undertaken to examine the association between profit status and mortality while achieving benchmarks. Utilizing data from the US Renal Data System and the Centers for Medicare & Medicaid Services' end-stage renal disease (ESRD) Clinical Performance Measures project, hemodialysis units were categorized as for-profit or not-for-profit. Associations with mortality at 1 year were estimated using Cox regression. Two thousand six hundred and eighty-five dialysis units (31,515 patients) were designated as for-profit and 1018 (15,085 patients) as not-for-profit. Patients in for-profit facilities were more likely to be older, black, female, diabetic, and have higher urea reduction ratio (URR), hematocrit, serum albumin, and transferrin saturation. Patients (19.4 and 18.6%) in for-profit and not-for-profit units died, respectively. In unadjusted analyses, profit status was not associated with mortality (hazard ratio (HR)=1.04, P=0.09). When added to models with profit status, the following resulted in a significant association between profit status (for-profit vs not-for-profit) and increasing mortality risk: URR, hematocrit, albumin, and ESRD Network. In adjusted models, patients in for-profit facilities had a greater death risk (HR 1.09, P=0.004). More patients in for-profit units met clinical benchmarks. Survival among patients in for-profit units was similar to not-for-profit units. This suggests that in the contemporary era, interventions in for-profit dialysis units have not impaired their ability to deliver performance benchmarks and do not affect survival.

Ambulatory Care Facilities↗
PubMed1999

A national day only surgery benchmarking basket.

The efficient management of day surgery facilities benefits both patients and health administrators. Patients can benefit through minimisation of hospital stay while day surgery has the potential to increase elective surgery throughput and to reduce waiting times. This paper explores whether routinely collected morbidity data from Queensland public hospitals can be used to benchmark levels of day only surgery between hospitals. Thirteen procedures were identified that met criteria for inclusion in a day only surgery benchmarking basket. Queensland public hospitals and individual procedures were benchmarked against one another and analysed to determine whether hospitals performing the 13 procedures demonstrate the same rates of day only surgery. With the development of a clinically meaningful and administratively simple tool for comparing hospital day surgery rates using routinely collected morbidity data, the opportunity now exists for health services to compare the performance of clinical services both within and between hospitals. It is also suggested that the basket of procedures identified in this study could form the basis of a national day only surgery benchmarking process.

Ambulatory Surgical Procedures↗
PubMed2000

Benchmarking in health-system pharmacy: experience at Glens Falls Hospital.

The experience of Glens Falls Hospital (GFH) with the Benchmarking Program coordinated by The Clinical Pharmacokinetics Laboratory at Millard Fillmore Hospital is described. GFH, a community hospital in upstate New York with 442 licensed beds, serves a patient population drawn from a five-county area. In 1998, GFH developed a multidisciplinary pharmacy task force charged with generating strategic initiatives for curtailing drug costs. Proposals for various programs, including specific goals, were developed with the aid of trends reported in the individual hospital reports provided by the Benchmarking Program. The data obtained through these reports helped GFH's pharmacy staff establish goals for the appropriate use of many agents, including vancomycin, and allowed GFH to assess the impact of its initiatives through comparisons with similar hospitals across the United States. In 1995, vancomycin expenditures at GFH substantially exceeded those for benchmark hospitals of similar types, but, with the implementation of new vancomycin guidelines aimed at reducing inappropriate use in 1996, the difference was eliminated. The individual hospital reports generated by the Benchmarking Program provide valuable data that can be used to assess pharmacy performance, set drug expenditure goals, and design programs to reduce antimicrobial resistance.

Benchmarking↗
PubMed2000

Benchmarking in health-system pharmacy: experience at MeritCare Medical Center.

The experience of MeritCare Medical Center (MMC) with the Benchmarking Program coordinated by The Clinical Pharmacokinetics Laboratory at Millard Fillmore Hospital is described. MMC is a community-based teaching institution in Fargo, North Dakota, that serves patients in North Dakota, South Dakota, and Minnesota. MeritCare began participating in the Benchmarking Program in 1997. Data from the individual hospital report raised concern about the high cost of antimicrobials at MMC relative to peer-group institutions. The staff conducted an evaluation of antimicrobial prophylaxis for noncardiovascular surgery, concluded that cefazolin use was suboptimal, and attempted to encourage more cost-effective utilization. MMC's participation in the Benchmarking Program also prompted more appropriate use of various other antimicrobial agents, including i.v. and oral ciprofloxacin. An i.v.-to-oral switching program was begun for various agents. Preliminary analysis after 15 months demonstrated direct cost savings for drug acquisition of $60,000 to $80,000 per year and a reduced length of stay. Initiatives undertaken by MeritCare on the basis of data obtained through the Benchmarking Program resulted in substantial estimated savings in drug acquisition costs.

Anti-Bacterial Agents↗
PubMed2025

DARKIN: a zero-shot benchmark for phosphosite-dark kinase association using protein language models.

MOTIVATION: Protein language models (pLMs) have emerged as powerful tools for capturing the intricate information encoded in protein sequences, facilitating various downstream protein prediction tasks. With numerous pLMs available, there is a critical need for diverse benchmarks to systematically evaluate their performance across biologically relevant tasks. Here, we introduce DARKIN, a zero-shot classification benchmark designed to assign phosphosites to understudied kinases, termed dark kinases. Kinases, which catalyze phosphorylation, are central to cellular signaling pathways. While phosphoproteomics enables the large-scale identification of phosphosites, determining the cognate kinase responsible for the phosphorylation event remains an experimental challenge. RESULTS: In DARKIN, we prepared training, validation, and test folds that respect the zero-shot nature of this classification problem, incorporating stratification based on kinase groups and sequence similarity. We evaluated multiple pLMs using two zero-shot classifiers: a novel, training-free k-NN-based method, and a bilinear classifier. Our findings indicate that ESM, ProtT5-XL, and SaProt exhibit superior performance on this task. DARKIN provides a challenging benchmark for assessing pLM efficacy and fosters deeper exploration of under-characterized (dark) kinases by offering a biologically relevant test bed. AVAILABILITY AND IMPLEMENTATION: The DARKIN benchmark data and the scripts for generating additional splits are publicly available at: https://github.com/tastanlab/darkin.

Protein Kinases↗
PubMed2003

Benchmarking as everyday functional assessment in stroke recovery.

OBJECTIVES: Functional assessment in stroke recovery extends beyond formal testing and evaluation. Stroke survivors themselves continuously engage in the process of reckoning their functional capacities as they go about their everyday lives. This process is called benchmarking. The aim of this article is to discuss and illustrate how it operates in three areas of experience--self-definition, comorbidity and age, and the tasks of daily life. METHODS: Benchmarking data are drawn from in-depth qualitative interviews with male stroke survivors of various ages and from three ethnic groups (Hispanic, African American, and non-Hispanic White). RESULTS: The results show that the benchmarking process is evident in all social categories in which survivors fall, but specific kinds of benchmarks may be more prominent in some categories than others. DISCUSSION: The lessons provided by everyday functional assessment for understanding the stroke experience, as well as directions for further study, are discussed in the conclusion.

Activities of Daily Living↗
PubMedDate not supplied

Benchmarking: your performance measurement and improvement tool.

Many respected professional healthcare organizations and societies today are seeking to establish data-driven performance measurement strategies such as benchmarking. Clinicians are, however, resistant to "benchmarking" that is based on financial data alone, concerned that it may be adverse to the patients' best interests. Benchmarking of clinical procedures that uses physician's codes such as Current Procedural Terminology (CPTs) has greater credibility with practitioners. Better Performers, organizations that can perform procedures successfully at lower cost and in less time, become the "benchmark" against which other organizations can measure themselves. The Better Performers' strategies can be adopted by other facilities to save time or money while maintaining quality patient care.

Benchmarking↗
PubMedDate not supplied

The development of a benchmarking system for a cancer patient population.

Benchmarking, while a useful way to compare outcomes among health care institutions, has been less useful for institutions dealing with specialty patient populations such as cancer, rehabilitation, or psychiatry. Because of regulatory requirements mandating the use of benchmarking for accreditation and performance improvement purposes, a group of comprehensive cancer centers developed a specialized database for benchmarking outcomes for cancer patients. This article describes the development of the database and some of the obstacles encountered by the group. It also outlines solutions to the obstacles. Key words: benchmarking, cancer, quality

Benchmarking↗
PubMed1998

Using videotaped benchmarks to improve the self-assessment ability of family practice residents.

PURPOSE: To address methodologic and statistical problems of previous studies of self-assessment by exposing participants to relevant standards, anchoring rating scales, and providing practice in the use of the assessment tool. METHOD: Fifty first- and second-year family practice residents performed a ten-minute patient interview with a difficult communication problem. Following each interview, the resident and two experts independently evaluated the resident's communication skills. The resident was then shown a videotape of four performances (ranging in quality from poor to good) of the same scenario. The resident evaluated the communication skills displayed in each performance and then reevaluated his or her own performance. RESULTS: The correlation between experts' evaluations and residents' self-evaluations was moderate immediately after the interview (r = 0.38) but increased significantly after the residents viewed the videotape (r = 0.52). This effect was more pronounced for first-year residents (0.22 to 0.45) than for second-year residents (0.53 to 0.65), although the difference was not significant. Post-hoc analysis revealed that neither initial nor post-benchmark self-assessment ability was related to the ability to accurately evaluate the benchmarks in a manner consistent with the experts. CONCLUSIONS: The ability to self-assess does not seem strongly tied to the ability to assess the performances of others on the same task. Nonetheless, providing a set of benchmarks against which trainees can compare their own performances improves their ability to self-evaluate even if the qualities of the benchmarks are not explicitly identified.

Adult↗
PubMedDate not supplied

Rationale and design of the National Benchmarking and Evidence-based National Clinical Guidelines for Chronic Heart Failure Management Programs Study.

OBJECTIVES: The National Benchmarks and Evidence-Based National Clinical Guidelines for Heart Failure Management Programs Study is a national, multicenter study designed to determine the nature, range, and effect of interventions applied by chronic heart failure management programs (CHF-MPs) throughout Australia on patient outcomes. Its primary objective is to use these data to develop national benchmarks and evidence-based clinical guidelines and optimize their cost-effective application by reducing quality and outcome variability. DATA SOURCES/STUDY SETTING: Primary data will be collected from CHF-MP coordinators and CHF patients enrolled in these programs on a national basis. Secondary outcome data will be collected from a national morbidity record and from patients' medical records. STUDY DESIGN: Stage I of the study involves a prospective clinical audit of all CHF-MPs throughout Australia (n = 45) to determine the extent of variability in programs currently. Stage II is a prospective cross-sectional survey design enrolling 1,500 patients (average of 40 patients per program) to firstly determine the typical profile of patients being managed via a CHF-MP in Australia and, secondly, the subsequent morbidity and mortality during the 6-month follow-up. Outcome data will be subject to multivariate analysis to determine the key components of care in this regard. All study data will be then examined in the final stage of the study (III) to develop national benchmarks for the application and auditing of CHF-MPs in Australia. CONCLUSION: Variability in patient outcomes is a product of heterogeneity among CHF-MPs. The development of national benchmarks will minimize such heterogeneity and will provide a greater level of evidence for their cost-effective application.

Australia↗
PubMed2005

Leveraging nurse-related dashboard benchmarks to expedite performance improvement and document excellence.

Using nursing quality benchmarks in operational dashboards and translating those data to drive performance excellence is a strategic imperative. Since access to unit-level, hospital-generated nurse-related benchmarks is an emerging arena, the authors provide an overview of aggregated trends and benchmarks gleaned from the California Nursing Outcome Coalition acute care database for 2 established nurse-related quality indicators-patient falls incidence and hospital-acquired pressure ulcer prevalence. Integrating these acute care benchmarks into clinical dashboards can be invaluable to clinicians, administrators, and policy makers who share a common commitment to expediting evidence-based improvement in patient care safety, outcomes, and excellence.

Accidental Falls↗
PubMed2001

Cross-industry benchmarking: is it applicable to the operating room?

The use of benchmarking has been growing in nonmedical industries. This concept is being increasingly applied to medicine as the industry strives to improve quality and improve financial performance. Benchmarks can be either internal (set by the institution) or external (use other's performance as a goal). In some industries, benchmarking has crossed industry lines to identify breakthroughs in thinking. In this article, we examine whether the airline industry can be used as a source of external process benchmarking for the operating room.

Aviation↗
PubMedDate not supplied

The 1999 National Pressure Ulcer Prevalence Survey: a benchmarking approach.

OBJECTIVE: Health care professionals are faced with the ongoing challenge of improving performance. From physicians and nurses to process improvement experts, health care professionals are discovering new approaches to increasing the overall effectiveness of procedures used in clinical areas. One way to collect data useful for benchmarking specific clinical practices is through the use of prevalence studies. DESIGN: A 1-day pressure ulcer prevalence survey was performed in March 1999. Acute care facilities across the United States volunteered to participate in the data collection process. Patients' demographic information, pressure ulcer stages, locations, and support surfaces were noted. SETTING: 356 acute care facilities. PARTICIPANTS: 42,817 patients. RESULTS: The overall pressure ulcer prevalence was 14.8%, with a nosocomial pressure ulcer prevalence of 7.1%. CONCLUSIONS: Benchmarking is one of the tools that enables health care professionals to measure and identify inconsistencies in patient care practices. Understanding these inconsistencies enables the health care team to develop processes that are innovative and efficient. National pressure ulcer prevalence surveys provide a benchmark to evaluate an individual facility's care and treatment of patients at risk for pressure ulcer development. Success, however, lies in the health care professional's ability to take the information and apply it to clinical practice. Through the use of a benchmarking approach, performance gaps can be identified, processes can be put into place, and improved patient outcomes can be monitored and maintained.

Adolescent↗
PubMed2005

Infra-inguinal revascularization surgical site infections: Australasian benchmark.

BACKGROUND: Infra-inguinal revascularization surgery remains one of the most commonly performed major vascular procedures in contemporary practice. Surgical site infections (SSI) are a common cause of morbidity in this patient cohort and generate high rates of limb loss and mortality when vascular graft involvement occurs. An overall reduction in North American SSI has been attributed to the establishment of national benchmarks. A comparable Australasian benchmark does not exist. The purpose of the present study was to assess the methods used by Australasian vascular units to determine SSI rates and to instigate the development of an acceptable benchmark. METHODS: A structured questionnaire pertaining to SSI after infra-inguinal revascularization surgery was sent to 26 Australasian vascular units. Data requested included the number and type of lower extremity revascularization procedures performed. Units were also asked to report the methods employed for defining and detecting wound infections and to document their SSI rate. The incidence of SSI causation by methicillin-resistant Staphylococcus aureus (MRSA) was also sought. RESULTS: The total number of revascularizations performed annually varied from 28 to 179 between units. The SSI rates ranged from 0 to 38%. The incidence of MRSA involvement varied from <1% to 56%. The SSI surveillance methodology varied considerably between units. CONCLUSIONS: The present study confirms the significant incidence of SSI after infra-inguinal revascularization surgery in contemporary vascular practice. Standardized definitions and surveillance protocols are required to facilitate inter- and intrahospital comparisons. A possible benchmark infection rate may be 10-20%.

Australia↗
PubMed2005

[Results of a benchmarking exercise for primary care teams in Barcelona, Spain].

OBJECTIVE: To identify primary care teams (PCT) with the best overall performance and compare these with other PCT with benchmarking methods. DESIGN: Descriptive, cross-sectional study of a set of indictors for the year 2002. SETTING: City of Barcelona (northeastern Spain). PARTICIPANTS: Thirteen seven PCT with more than 2 years' experience, and 771,811 inhabitants in the catchment area. MAIN MEASURES: Indicators were chosen from among those proposed by an advisory group, depending on feasibility of obtaining information. A total of 17 indicators in 4 dimensions were studied: accessibility, clinical effectiveness, case management capacity, and cost-efficiency. Each PCT was scored for each indicator based on the percentile group in the distribution of scores, and for each dimension based on the mean score for all indicators in a given dimension. Overall score for PCT performance was calculated as the weighted sum of the scores for each dimension. As descriptive variables we analyzed time operating under the revised administrative system, patient visits per population served, the population's economic capacity and age of the population. RESULTS. Nine PCT were identified as the benchmark group. Teams in this group had been operating under the revised administrative system for significantly longer than other PCT. In comparison to other PCT, the benchmark group obtained higher scores on all four dimensions, better results on 14 separate indicators, the same results for 1 indicator, and worse results for 2 indicators. CONCLUSIONS. Benchmarking made it possible to identify PCT with the best performance, and to identify areas in need of improvement. This approach is a potentially useful tool for self-evaluation and for stimulating a dynamic for improvement in primary care providers.

Benchmarking↗
PubMed2001

The ICCD benchmarks for clubhouses: a practical approach to quality improvement in psychiatric rehabilitation.

OBJECTIVE: The study evaluated whether the average performance of clubhouses certified by the International Center for Clubhouse Development (ICCD) should be considered valid benchmarks for clubhouse programs. METHODS: A representative sample of clubhouses more than three years old that were based on the Fountain House model participated in a 1998 mail survey. To verify that ICCD certification is a valid indicator of program quality for use in setting benchmark performance rates, 71 certified and 48 noncertified programs were compared on a variety of organizational variables. RESULTS: Even though certified and noncertified clubhouses were similar in organizational structure and resources, findings from a logistic regression analysis confirmed that certified clubhouses provided a wider array of rehabilitation services and achieved higher rates of employment. CONCLUSIONS: The findings suggest that ICCD certification is a valid indicator of program quality. The ICCD has therefore proposed that the average performance of certified U.S. clubhouses in specific domains be adopted as benchmarks for organizational performance. When tailored for programs in particular regions and with specific levels of funding, the ICCD benchmarks for clubhouse performance set fair and reasonable expectations for clubhouse programs and for the design of performance contracts between departments of mental health and ICCD clubhouses.

Benchmarking↗
PubMed2003

Toward benchmarks for tertiary care for adults with severe and persistent mental disorders.

BACKGROUND: Scarce attention has been paid to establishing benchmarks for tertiary care for adults with severe mental disorders. Yet, the availability and efficient utilization of residential resources partly determines the capacity of a comprehensive system of care to avoid clogging ever-shrinking acute care bed facilities. OBJECTIVES: To describe the actual utilization of and projected needs for residential resources, one part of tertiary care, in the catchment area of a psychiatric hospital in east-end Montreal. To compare results obtained against actual utilization and projected needs evaluated in other Canadian provinces and in other countries, with a view to establishing national benchmarks. METHODS: Two surveys were undertaken to establish the number of places in these facilities that were utilized and needed for adults aged 18 to 65 years with severe mental disorders, without a primary diagnosis of mental retardation or organic brain syndrome, and originally from the catchment area. A first survey ascertained the number of places utilized and of those needed for residential care among all long-stay inpatients and all adults in supervised residential facilities. A second survey identified the need for such long-stay hospitalization, nursing homes, and supervised facilities as an alternative or as a complement to hospitalization among acute care inpatients. RESULTS: The actual ratio of places in long-stay hospital units, nursing homes, and supervised residential facilities was 150:100,000 inhabitants. The ideal ratio, according to estimated needs, is 171:100,000. The figure breakdown is as follows: 20:100,000 for long-stay hospital units, 20:100,000 for nursing homes, 40:100,000 for group homes, 40:100,000 for private hostels or foster families, and 51:100,000 for supervised apartments. The needs of this urban, blue-collar population for supervised residential places hovered in the upper range of utilization and standards for European countries and within the proposed standards for Canadian provinces. DISCUSSION: Needs for long-stay hospitalization or for supervised residential facilities cannot be treated as absolute. For example, evaluation conducted in this hospital-led system of psychiatric care may produce higher estimates of institutional care. Comparing actual utilization and projected needs in this urban catchment area with current utilization in other jurisdictions in Canada and Europe should contribute to establishing sound national benchmarks within ranges. CONCLUSIONS: It is possible to establish benchmarks that guide the development of supervised residential settings to best meet the needs of the population of adults with severe and persistent mental disorders. The methods used here to assess needs should serve as guidelines for future research, because they were designed to contain the bias of over- or underprovision of care in the current utilization.

Adolescent↗
PubMedDate not supplied

Benchmarking implementation of a computerized system for long-term care.

The purpose of this study was to apply a benchmarking methodology to identify the most effective approaches used by long-term care facilities in implementing new computerized resident assessment instrument/minimum data set (RAI/MDS) systems and to develop implementation protocols based on these "best practices." Site visits were conducted with 3 long-term care facilities, selected on the basis of a national search. Facility directors, directors of nursing, information system managers, and frontline staff at each facility were targeted, and questionnaires were developed for each to assess factors viewed as important to successful implementation. A convergence was found in recommended action steps reported across sites to facilitate introduction and implementation of new RAI/MDS software. An example of how benchmarking results were used to develop an implementation plan is provided. Benchmarking provided a useful methodology for identifying best practices to guide implementation planing for adoption of a new computerized RAI/MDS system in the current trial. The benchmarking steps described are replicable and can be used to guide implementation of other new systems in the nursing home setting.

Benchmarking↗