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At least 127 records · Page 7Linked to original sources
PubMed2006

Monitoring the referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the district hospital.

BACKGROUND: The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger. METHODS: Strict and controlled application of existing clinical decision trees in a sample of rural health centres allowed the estimation of the corresponding need for and characteristics of curative referrals in rural Niger. Compliance of referral was monitored as well. Need was matched against actual referral in 11 rural districts. The referral patterns were registered so as to get an idea on the types of pathology referred. RESULTS: The referral rate benchmark was set at 2.5 % of patients consulting at the health centre for curative reasons. Niger's rural districts have a referral rate of less than half this benchmark. Acceptability of referrals is low for the population and is adding to the deficient referral system in Niger. Mortality because of under-referral is highest among young children. CONCLUSION: Referral patterns show that the present programme approach to deliver health care leaves a large amount of unmet need for which only comprehensive first and second line health services can provide a proper answer. On the other hand, the benchmark suggests that well functioning health centres can take care of the vast majority of problems patients present with.

Adolescent↗
PubMed2004

Essence of Care: Implementing continence benchmarks in primary care.

'Essence of Care' is a national programme which was launched in 2001. The document provides a set of national benchmarks which are evidence based. The benchmarks focus on basic care as identified in a First Class Service (DH, 1998). The programme has been implemented widely by acute services, however with community and primary care services, the take up appeared to have been spasmodic. A conference in 2003 'Implementing Essence of Care in Primary Care' described the implementation of Essence of Care in Primary Care as a 'challenge'. This article identifies the implementation of the continence benchmark within a PCT. The article details the process and the difficulties encountered within primary care, but also details the benefits of utilising the model despite a labour intensive process. In particular the article suggests the importance of incorporating the benchmarks into current systems within the PCT in order to avoid duplication and extra layers of groups and meetings. Finally the article highlights some of the benefits which the PCT consider the process has achieved to the continence service.

Benchmarking↗
PubMedDate not supplied

Pressure ulcer benchmarking within a primary care setting.

Patient-focused benchmarking was initially launched by the Department of Health. This article examines how the tissue viability service of Camden and Islington primary care trusts implemented the pressure of ulcer benchmarking process within the nursing teams of these trusts. This was achieved by: agreeing best practice through examination of local and national guidelines; developing a suitable audit tool for nursing teams to assess their clinical areas against this best practice; nursing teams producing core action plans to facilitate movement towards best practice; disseminating results; reauditing. The results of the audits carried out in October 2003 and February 2004 are presented. A plan for future work is described including: the involvement of other members of the multidisciplinary team and the Patient Advice Liaison Service; linking pressure ulcer benchmarking to the benchmarks of communication, privacy and dignity and record keeping.

Benchmarking↗
PubMed2003

Management of hyperbilirubinemia in newborns: measuring performance by using a benchmarking model.

BACKGROUND: Accreditors hold hospitals accountable for harm from serious newborn hyperbilirubinemia, yet standards for evaluating performance in prevention are lacking. OBJECTIVE: We confirmed prognostic variables for newborn hyperbilirubinemia and developed a benchmarking model for self-evaluation of hyperbilirubinemia management. METHODS: We conducted a 3-year prospective cohort study in the Henry Ford Health System (HFHS) on 5507 healthy newborns of >or=35 weeks' gestational age. HFHS follows a rigorous protocol for hyperbilirubinemia management. Defining hyperbilirubinemia as age-specific levels of total serum bilirubin exceeding American Academy of Pediatrics criteria for considering phototherapy and severe hyperbilirubinemia as total serum bilirubin >or=20 mg/dL, we used logistic and Poisson regressions to determine predictors and estimate parameters for a benchmarking model. We compared incidence rates for severe hyperbilirubinemia from HFHS to aggregate data from 11 hospitals reported to have less rigorous management. RESULTS: Newborns were 52.9% black, 14.4% white, 24.3% Latino, and 2.4% Asian; 30% were exclusively and 28% partially breastfed. Regression analyses revealed associations for hyperbilirubinemia and severe hyperbilirubinemia with black mothers (negative) and exclusive or partial breastfeeding and younger gestational age (positive). Male newborns and older mothers were also associated with severe hyperbilirubinemia. For all 5 variables, we found a lower risk for severe hyperbilirubinemia at HFHS than in the comparison hospital group. To compare hospitals, we developed a benchmarking model for incidence of hyperbilirubinemia adjusting for race, feeding method, and gestational age. CONCLUSIONS: Hospitals with access to newborns' inpatient and postdischarge data can use our benchmarking model to compare their management of hyperbilirubinemia with a reference population that received rigorous care.

Benchmarking↗
PubMed2005

Applications of disease benchmarks and case presentations.

A large dataset of integrated pharmacy and medical claims, extracted from independent third-party databases, is being combined with disease benchmarking technology to facilitate analysis of inpatient, outpatient, ancillary services, and pharmaceutical utilization and costs. The Disease Benchmarks Program was developed to create opportunities for health care decision makers to evaluate the entire health care continuum in a disease-specific fashion. The Benchmarks program is valuable because of its flexibility and because it depicts what is occurring in clinical practice. It can be customized and also show regional variations in treatment. The possible applications of benchmarking applications are discussed in the case presentations of otitis externa, acute otitis media with tympanostomy tubes, and Sjorgren's syndrome.

Benchmarking↗
PubMed2006

WWTP dynamic disturbance modelling--an essential module for long-term benchmarking development.

Intensive use of the benchmark simulation model No. 1 (BSM1), a protocol for objective comparison of the effectiveness of control strategies in biological nitrogen removal activated sludge plants, has also revealed a number of limitations. Preliminary definitions of the long-term benchmark simulation model No. 1 (BSM1_LT) and the benchmark simulation model No. 2 (BSM2) have been made to extend BSM1 for evaluation of process monitoring methods and plant-wide control strategies, respectively. Influent-related disturbances for BSM1_LT/BSM2 are to be generated with a model, and this paper provides a general overview of the modelling methods used. Typical influent dynamic phenomena generated with the BSM1_LT/BSM2 influent disturbance model, including diurnal, weekend, seasonal and holiday effects, as well as rainfall, are illustrated with simulation results. As a result of the work described in this paper, a proposed influent model/file has been released to the benchmark developers for evaluation purposes. Pending this evaluation, a final BSM1_LT/BSM2 influent disturbance model definition is foreseen. Preliminary simulations with dynamic influent data generated by the influent disturbance model indicate that default BSM1 activated sludge plant control strategies will need extensions for BSM1_LT/BSM2 to efficiently handle 1 year of influent dynamics.

Benchmarking↗
PubMed2001

Benchmarking can facilitate the sharing of information on outcomes of care.

Recent restructuring in the national health service (NHS) aimed to effect cultural and organisation changes that would ensure fair and equal access for service users to effective and efficient services. Clinical governance has been introduced as a means of delivering quality improvement. One element of this is the use of benchmarking to assess current process and outcome and to use comparative information to inform about current and best practice. The use of the Therapy Outcome Measure (TOM) (Enderby and John 1997) was investigated as an indicator to benchmark the outcomes of treatment for different client-groups and compare patterns of outcomes from different speech and language therapy (SLT) services. The study recruited eight SLT trust sites and ran for eighteen months. The TOM data was analysed to note similarities and differences in cases entering treatment, in the direction of change resulting from treatment, and on completing treatment. Variation was found on these points between cases with different disorders and across the trusts. TOM data could be used to provide a benchmark for a disorder against which services could make comparisons. However, for benchmarking to succeed there is a need for support and commitment from every level of an organisation.

Benchmarking↗
PubMed2006

Using a health promotion model to promote benchmarking.

The North East (England) Neonatal Benchmarking Group has been established for almost a decade and has researched and developed a substantial number of evidence-based benchmarks. With no firm evidence that these were being used or that there was any standardisation of neonatal care throughout the region, the group embarked on a programme to review the benchmarks and determine what evidence-based guidelines were needed to support standardisation. A health promotion planning model was used by one subgroup to structure the programme; it enabled all members of the sub group to engage in the review process and provided the motivation and supporting documentation for implementation of changes in practice. The need for a regional guideline development group to complement the activity of the benchmarking group is being addressed.

Benchmarking↗
PubMed1998

Clinical buy-in is key to benchmarking success.

The effectiveness of benchmarking as a tool for improving the quality of healthcare services and reducing costs depends on the completeness of the data and physician acceptance of the findings. Benchmarking analyses based on cost-center data, for example, do not account for many of the actual costs of performing a procedure and, therefore, may be of limited value. Benchmarking studies should use data that provide a complete, detailed picture of what each procedure entails to facilitate consistent comparisons among actual physician practices so that physicians can see clearly how their practices relate to best practices. The current procedural terminology (CPT) coding system can provide an excellent basis for assembling benchmark data.

Abstracting and Indexing↗
PubMed2000

Benchmarks of fairness for health care reform: a policy tool for developing countries.

Teams of collaborators from Colombia, Mexico, Pakistan, and Thailand have adapted a policy tool originally developed for evaluating health insurance reforms in the United States into "benchmarks of fairness" for assessing health system reform in developing countries. We describe briefly the history of the benchmark approach, the tool itself, and the uses to which it may be put. Fairness is a wide term that includes exposure to risk factors, access to all forms of care, and to financing. It also includes efficiency of management and resource allocation, accountability, and patient and provider autonomy. The benchmarks standardize the criteria for fairness. Reforms are then evaluated by scoring according to the degree to which they improve the situation, i.e. on a scale of -5 to 5, with zero representing the status quo. The object is to promote discussion about fairness across the disciplinary divisions that keep policy analysts and the public from understanding how trade-offs between different effects of reforms can affect the overall fairness of the reform. The benchmarks can be used at both national and provincial or district levels, and we describe plans for such uses in the collaborating sites. A striking feature of the adaptation process is that there was wide agreement on this ethical framework among the collaborating sites despite their large historical, political and cultural differences.

Benchmarking↗
PubMed2000

Can benchmarking be applied to radiation protection? And is it useful?

PURPOSE: Any program of protection from the ionizing radiations used for health care must ultimately lead to the total prevention of graduated effects and to the limitation of probabilistic effects to acceptable levels. The latter are the more dangerous because they may occur even at very low doses and involve the whole population including unexposed subjects; these effects may appear in the generations to come. The specific protection of the health of operators, patients, and the general population, depends on a series of physical-technical and bureaucratic-administrative factors. These must be known and applied based on precise reference standards, recommended or stated by law, as well as on appropriately regulated and controlled procedures. We chose to apply the benchmarking method to radiation protection in order to standardize and increase the efficacy of prevention and to plan, according to Deming's cycle, the continuous improvement of radiation protection performance. METHOD: Benchmarking is a qualitative intercomparison method widely used in business economics to improve performance referring to best practice and the best in class. When applied in a department where all the partners belong (internal benchmarking), the method features a subdivision into different (sub)processes integrated according to the logic of problem-solving. These stages are: planning: 1) identifying benchmarking issues; 2) identifying the participants; 3) deciding the data collection method; 4) data collection; analysis: 5) measuring the gap; 6) planning future performance; integration: 7) reporting the results; 8) setting the functional goals; action: 9) developing and implementing plans; 10) checking results and resetting the target. The gross subdivision of resources into human and structural permits to check the gap between an actual and an ideal setting separately. Thus, the procedures will give information on the human factor which will be periodically checked in loco relative to all active and passive conducts, while standards will be used to assess the available spaces, facilities and equipment, as well as the relative regular activity. Specific physical-technical and bureaucratic-administrative indices will be needed in both cases. RESULTS AND DISCUSSION: Solving the operators' doubts and consequently decreasing the statistical errors and/or the cases of incorrect performance has resulted in improved rendered quality, which will be further increased after the planned replacement of substandard or unsafe equipment. Meanwhile, the early application of equipment quality controls has helped rationalize and markedly decrease maintenance costs, which results in possible technologic investment to improve emergency imaging. Greater attention to their protection has made patients feel an improvement in received quality and has increased empathy in general. Total quality, as compared with the best practice, has increased thanks to the positive stimulus from standardization, emulation and sharing, and not only to the controls performed. It is difficult to evaluate the management indices, especially the performance efficacy, that is the relationship between radiation protection and results, because the work is in progress and we still lack the actual data on the decrease in accidents at work or occupational diseases of the operators. Moreover, the epidemiological data on radiation-induced conditions will be difficult to collect and interpret, which will make the dynamics of lawsuits for unwarranted or excessive exposure a useful and more readily available piece of information. Finally, relative to economic results, we would like to stress that no additional costs have been necessary to implement safety and quality in a setting involving, directly or indirectly, thousands of people. (ABSTRACT TRUNCATED)

Algorithms↗
PubMed2001

Benchmark guideline for urinary 1-hydroxypyrene as biomarker of occupational exposure to polycyclic aromatic hydrocarbons.

Many individual polycyclic aromatic hydrocarbons (PAH) are genotoxic carcinogens. One of the parent PAH, pyrene, undergoes simple metabolism to 1-hydroxypyrene. 1-Hydroxypyrene and its glucuronide are excreted in urine. Biological monitoring of exposure to PAH has rapidly been expanded since urinary 1-hydroxypyrene was suggested as a biological index of dose of pyrene. Since pyrene is always present in PAH mixtures, the biological indicator is not only an indicator of uptake of pyrene, but also an indirect indicator of all PAH. At present, several hundreds of papers reporting on urinary concentrations of 1-hydroxypyrene in workers' urine are available. It appeared that urinary 1-hydroxypyrene is a sound biomarker and that the analytical method is robust and non-laborious. Since epidemiological studies of cancer mortality related to long-term average urinary 1-hydroxypyrene concentration are lacking, a sound health-based limit value of 1-hydroxypyrene in urine cannot be set as yet. Since PAH exposure is widespread and the dermal uptake is substantial among exposed workers, an attempt was made to propose a three-level benchmark guideline for urinary 1-hydroxypyrene. The reference value as a 95th percentile in non-occupational exposed controls is 0.24 micromol mol(-1) creatinine and 0.76 micromol mol(-1) creatinine for non-smokers and smokers, respectively. This is the first level of the benchmark guideline. A no-biological-effect-level of 1-hydroxypyrene in urine of exposed workers was found at 1.4 micromol mol(-1) creatinine. It is the lowest reported level at which no genotoxic effects were found and therefore the estimate for the second level of the benchmark guideline. In two types of industry, coke ovens and primary aluminium production, the regression of airborne PAH concentrations and urinary 1-hydroxypyrene concentrations in exposed workers has been studied. The correlation of airborne concentrations and urinary 1-hydroxypyrene in urine of workers from coke ovens and in the primary aluminium industry was used to estimate the level of urinary 1-hydroxypyrene equal to the present occupational exposure limit (OEL) of PAH. The concentration of 1-hydroxypyrene in urine equal to the OEL is 2.3 micromol mol(-1) creatinine and 4.9 micromol mol(-1) creatinine, respectively, in these two industries. These latter values present the third level of the benchmark guideline.

Benchmarking↗
PubMedDate not supplied

How benchmarking can improve patient nutrition.

Benchmarking is a tool that originated in business to enable organisations to compare their services with industry-wide best practice. Early last year the Department of Health published The Essence of Care, a benchmarking toolkit adapted for use in health care. It focuses on eight elements of care that are crucial to patients' experiences. Nurses and other health care professionals at a London NHS trust have begun a trust-wide benchmarking project. The aim is to improve patients' experiences of health care by sharing and comparing information, and by identifying examples of good practice and areas for improvement. The project began with two of the eight elements of The Essence of Care, with the intention of covering the rest later. This article describes the benchmarking process for nutrition and some of the consequent improvements in care.

Benchmarking↗
PubMedDate not supplied

Benchmarking mental health care in a general hospital.

Benchmarking is a tool that allows practitioners to compare and measure their own performance against best practice. Two trusts took a joint approach to benchmarking mental health in a general hospital. They set up a benchmarking comparison group, whose members explored the six elements of the mental health benchmark and identified examples of best practice. The group then scored practice and compared scores. Finally, guidance sheets were produced on assessing and planning care in a general hospital for people with mental health needs. These are included as part of a mental health resource pack for each clinical area in the general hospital.

Benchmarking↗
PubMed2003

A framework for benchmarking hospital performance: application to surgical site infection.

Benchmarking is an approach to quality improvement where practice of leaders are studied to help improve one's own practice. Here, a framework for designing and implementing an information system for benchmarking is proposed. Participating actors are described by Structure, Process, Outcomes and indicators of case mix. The core of the information system consists in a database of actors descriptions, and in an algorithm combining rules and data on Structures, Outcomes and Case mix to identify leaders. Results from the benchmark consist in the Processes of the leaders. An example using data from a surgical site infection surveillance network is provided. Actors were hospital surgical departments. Structure consisted in the type of the hospital, specialty and annual number of interventions. The algorithm for selection of leaders was implemented using a decision tree. Using this framework, benchmarking could be facilitated and more easily accepted by professionals.

Benchmarking↗
PubMed2000

Benchmarking laboratory operations.

OBJECTIVE: Explain why benchmarking is a valued management tool and what ratios or percentages are most useful in benchmarking laboratory operations. Review the major benchmarking subscription products currently available to laboratory managers in the United States. DATA SOURCES: Current literature and Internet sites. CONCLUSIONS: The process of comparing laboratory operations over time with peer groups using statistical tools and benchmarking can provide valuable insights into areas of operation that need improvement.

Administrative Personnel↗
PubMed2003

Benchmarking farmer performance as an incentive for sustainable farming: environmental impacts of pesticides.

Pesticide use in The Netherlands is very high, and pesticides are found across all environmental compartments. Among individual farmers, though, there is wide variation in both pesticide use and the potential environmental impact of that use, providing policy leverage for environmental protection. This paper reports on a benchmarking tool with which farmers can compare their environmental and economic performance with that of other farmers, thereby serving as an incentive for them to adopt more sustainable methods of food production methods. The tool is also designed to provide farmers with a more detailed picture of the environmental impacts of their methods of pest management. It is interactive and available on the internet: www.agriwijzer.nl. The present version has been developed specifically for arable farmers, but it is to be extended to encompass other agricultural sectors, in particular horticulture (bulb flowers, stem fruits), as well as various other aspects of sustainability (nutrient inputs, 'on-farm' biodiversity, etc.). The benchmarking methodology was tested on a pilot group of 20 arable farmers, whose general response was positive. They proved to be more interested in comparative performance in terms of economic rather than environmental indicators. In their judgment the benchmarking tool can serve a useful purpose in steering them towards more sustainable forms of agricultural production. The benchmarking results can also be used by other actors in the agroproduction chain, such as food retailers and the food industry.

Agriculture↗
PubMedDate not supplied

Identifying best practice through benchmarking and outcome measurement.

Collecting and analyzing various types of data are essential to identifying areas for improvement. Data collection and analysis are routinely performed in hospitals and are even required by some regulatory agencies. Realization of the full benefits, which may be achieved through collection and analysis of data, should be actively pursued to prevent a meaningless exercise in paperwork. Internal historical comparison of data may be helpful but does not achieve the ultimate goal of identifying external benchmarks in order to determine best practice. External benchmarks provide a means of comparison with similar facilities, allowing the identification of processes needing improvement. The specialty of ophthalmology presents unique practice situations that are not comparable with other specialties, making it imperative to benchmark against other facilities where quick surgical case time, efficient surgical turnover times, low infection rates, and cost containment are essential and standard operations. Important data to benchmark include efficiency data, financial data, and quality or patient outcome data. After identifying facilities that excel in certain aspects of performance, it is necessary to analyze how their procedures help them achieve these favorable results. Careful data collection and analysis lead to improved practice and patient care.

Benchmarking↗