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PubMed1998

A new model function for continuous data sets in health risk assessment of chemicals using the benchmark dose concept.

The benchmark dose concept is an alternative way to calculate acceptable daily intakes or other low-risk limits of exposure for nongenotoxic compounds. An effective dose that corresponds to a specific change of effect/response, e.g., 10%, over background, on a given model is calculated and a benchmark dose which is the lower confidence bound for the effective dose can be estimated. One problem with this method is that it has not been possible to model "S"-shaped curves for continuous data with the existing commercial computer programs. We present a new mathematical model for continuous data, which can form S-shaped curves. For a number of data sets on the toxicity of trichloroethene, the introduction of this new function significantly increased the possibilities to model continuous data. A new computer package has also been developed to improve and simplify the calculations of benchmark doses.

Benchmarking↗

PubMed2006

[The use of diagnosis-related-groups data for external benchmarking of anesthesia and intensive care services].

Measurement and assessment of the economic efficiency of clinical departments is still an unresolved, yet important problem in hospital management. Benchmarking with other providers can help to evaluate one's own efficacy in anaesthesia and intensive care services. In this article we describe a method for using the diagnosis-related-groups (DRG) cost breakdown data, to achieve a case mix adjusted comparison of own costs for anaesthesia and intensive care services with the average costs in German hospitals. On the basis of 19,401 cases from 10 different surgical departments, we compared our own costs with the German-wide benchmark. Major factors for profit optimisation are discussed. Special attention is given to the close interaction of surgical, anaesthesiological and intensive care process performance and costs and its impact on benchmarking studies.

Anesthesia↗

PubMed2005

Clinical path modeling in XML for a web-based benchmark test system for medication.

Many hospitals have introduced the Clinical Path (Path) to improve medical procedures. A Path is a way to manage care and check lists for a certain disease, providing a useful tool for hospital management. Paths can help hospitals reduce the duration of hospitalization and variations in care of patients while increasing hospital revenue. Nowadays, Paths are made by each hospital and there is no standard format. Benchmark testing between Paths used by different hospitals is important for evaluating medical practices, in order to develop and improve more effective practices. However, as the formats used in Paths are not standardized, benchmark testing of Paths is no easy task. To start benchmark testing of Paths, we compare medication in Paths and introduce description rules of medication in XML. Based on these, we developed a prototype system that enables us to compare the difference of medications in Paths prescribed between multiple of hospitals.

Benchmarking↗

PubMed2006

Effectiveness of cognitive-behavioral therapy for adolescent depression: a benchmarking investigation.

In this study, we examined the effectiveness of cognitive-behavioral therapy (CBT) for adolescent depression. Outcomes of 80 youth treated with CBT in an outpatient depression specialty clinic, the Services for Teens at Risk Center (STAR), were compared to a "gold standard" CBT research benchmark. On average, youths treated with CBT in STAR experienced significantly slower symptom improvement than youths in the CBT benchmark. However, outcomes for STAR teens were more similar to the research benchmark when accounting for differences in referral source (clinical versus advertisement) between the datasets. Results support further efforts to test the effectiveness of CBT in clinically representative community practice settings and samples.

Adult↗

PubMed2006

Use of benchmark dose-volume histograms for selection of the optimal technique between three-dimensional conformal radiation therapy and intensity-modulated radiation therapy in prostate cancer.

PURPOSE: The aim of this study was to develop and validate our own benchmark dose-volume histograms (DVHs) of bladder and rectum for both conventional three-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT), and to evaluate quantitatively the benefits of using IMRT vs. 3D-CRT in treating localized prostate cancer. METHODS AND MATERIALS: During the implementation of IMRT for prostate cancer, our policy was to plan each patient with both 3D-CRT and IMRT. This study included 31 patients with T1b to T2c localized prostate cancer, for whom we completed double-planning using both 3D-CRT and IMRT techniques. The target volumes included prostate, either with or without proximal seminal vesicles. Bladder and rectum DVH data were summarized to obtain an average DVH for each technique and then compared using two-tailed paired t test analysis. RESULTS: For 3D-CRT our bladder doses were as follows: mean 28.8 Gy, v60 16.4%, v70 10.9%; rectal doses were: mean 39.3 Gy, v60 21.8%, v70 13.6%. IMRT plans resulted in similar mean dose values: bladder 26.4 Gy, rectum 34.9 Gy, but lower values of v70 for the bladder (7.8%) and rectum (9.3%). These benchmark DVHs have resulted in a critical evaluation of our 3D-CRT techniques over time. CONCLUSION: Our institution has developed benchmark DVHs for bladder and rectum based on our clinical experience with 3D-CRT and IMRT. We use these standards as well as differences in individual cases to make decisions on whether patients may benefit from IMRT treatment rather than 3D-CRT.

Adult↗

PubMed2005

Variation in treatment of pediatric spleen injury at trauma centers versus nontrauma centers: a call for dissemination of American Pediatric Surgical Association benchmarks and guidelines.

BACKGROUND: American Pediatric Surgical Association consensus guidelines for children with blunt spleen injuries have been defined and validated in children's hospitals, but large administrative data sets indicate that only 10% to 15% of children with blunt spleen injuries are treated at children's hospitals. We sought to identify the frequency and compare the treatment of children with spleen injury in hospitals with and without recognized trauma expertise, with the aim of identifying a meaningful target for dissemination of benchmarks and consensus guidelines. STUDY DESIGN: State health departments' administrative data sets from California, Florida, New Jersey, and New York were analyzed for 2000, 2001, and 2002. All children with head injury or other nonspleen abdominal injuries requiring surgery were excluded. Injury Severity Scores were determined by ICDMAP-90. RESULTS: There were 3,232 patients with blunt spleen injury. Trauma centers had a significantly lower rate of operation for both multiply injured patients (15.3% versus 19.3%, p < 0.001) and those with isolated injury (9.2% versus 18.5%, p < 0.0001) when compared with nontrauma centers. The operative rates at both trauma centers and nontrauma centers exceed published American Pediatric Surgical Association benchmarks for all children with spleen injury (5% to 11%) and the subset with isolated spleen injury (0% to 3%). Independent risk factors for splenectomy included ages 15 to 19 years (p < 0.002), spleen injury severity (p < 0.0001), and presence of multiple injuries (p < 0.04). Adjusted odds ratio for risk of splenic operation in all patients with spleen injury was 2.122 (95% CI:1.455- 3.096) when treated at a nontrauma center (p < 0.0001). CONCLUSIONS: These multistate discharge data indicate that treatment of children with blunt spleen injury differs significantly when comparing trauma centers and nontrauma centers. Because nearly two-thirds of these children were treated at trauma centers, dissemination of American Pediatric Surgical Association guidelines and benchmarks through state or regional trauma systems may reduce the number of children having operations for splenic injury.

Adolescent↗

PubMedDate not supplied

A rationale for developing benchmarks for the treatment of muscle-invasive bladder cancer.

Benchmarks are established standards of operation developed by a given group or industry generally designed to improve outcomes. The health care industry is increasingly required to develop such standards and document adherence to meet demands of regulatory bodies. Although established practice patterns exist for the treatment of invasive bladder cancer, there is significant treatment variation. This article provides a rationale for the development of benchmarks in the treatment of invasive bladder cancer. Such benchmarks may permit advances in treatment application and potentially improve patient outcomes.

Benchmarking↗

PubMed1999

Benchmarking and quality improvement: the Harvard Emergency Department Quality Study.

PURPOSE: To determine whether feedback of comparative information was associated with improvement in medical record and patient-based measures of quality in emergency departments. SUBJECTS AND METHODS: During 1-month study periods in 1993 and 1995, all medical records for patients who presented to five Harvard teaching hospital emergency departments with one of six selected chief complaints (abdominal pain, shortness of breath, chest pain, hand laceration, head trauma, or vaginal bleeding) were reviewed for the percent compliance with process-of-care guidelines. Patient-reported problems and patient ratings of satisfaction with emergency department care were collected from eligible patients using patient questionnaires. After reviewing benchmark information, emergency department directors designed quality improvement interventions to improve compliance with the process-of-care guidelines and improve patient-reported quality measures. RESULTS: In the preintervention period, 4,876 medical records were reviewed (99% of those eligible), 2,327 patients completed on-site questionnaires (84% of those eligible), and 1,386 patients completed 10-day follow-up questionnaires (80% of a random sample of eligible participants). In the postintervention period, 6,005 medical records were reviewed (99% of those eligible), 2,899 patients completed on-site questionnaires (84% of those eligible), and 2,326 patients completed 10-day follow-up questionnaires (80% of all baseline participants). In multivariate analyses, adjusting for age, urgency, chief complaint, and site, compliance with process-of-care guidelines increased from 55.9% (preintervention) to 60.4% (postintervention, P = 0.0001). We also found a 4% decrease (from 24% to 20%) in the rate of patient-reported problems with emergency department care (P = 0.0001). There were no significant improvements in patient ratings of satisfaction. CONCLUSION: Feedback of benchmark information and subsequent quality improvement efforts led to small, although significant, improvement in compliance with process-of-care guidelines and patient-reported measures of quality. The measures that relied on patient reports of problems with care, rather than patient ratings of satisfaction with care, seemed to be more responsive to change. These results support the value of benchmarking and collaboration.

Benchmarking↗

PubMed1998

Functional task benchmarks for stroke rehabilitation.

OBJECTIVE: To determine typical outcome "benchmarks" for 18 functional tasks in patients undergoing stroke rehabilitation. The benchmarks are intended to serve as points of reference to which the outcomes of patients with similar impairments and degrees of disability can be compared. SUBJECTS: Records from 26,339 stroke patients discharged from 252 inpatient facilities across the United States that submitted 1992 data to the Uniform Data System for Medical Rehabilitation. METHODS: Stroke impairment was detailed as the presence or absence of hemiparesis resulting from stroke and the side(s) of involvement. Within each of five stroke impairment categories, patients were further classified by the Functional Independence Measure-Function-Related Groups (FIM-FRGs) into nine syndromes by degree of disability (admission motor and cognitive FIM scores) and by age. Outcomes were determined for each stroke syndrome at patients' discharge from medical rehabilitation. MAIN OUTCOME MEASURES: Patients' median performance levels on each of the 18 items making up the FIM, length of stay, and community discharge rates. RESULTS: The majority of patients whose admission motor FIM scores were above 37 were able to eat, groom, dress the upper body, and manage bladder and bowel functions independently by discharge. In addition to these tasks, most of those whose motor FIM scores were above 55 were able to dress the lower body, bathe, and transfer onto a chair/bed or toilet. The majority of patients whose initial motor FIM scores were above 62 points and whose cognitive FIM scores were above 30 gained independence in most tasks, including stair climbing and tub transfers. Community discharge rates ranged from 51.6% for the group of patients with the most severe disabilities to 99.2% for the group with the least severe disabilities. CONCLUSION: The clinician can apply these benchmarks to guideline development and quality improvement, and in establishing patient goals.

Activities of Daily Living↗

PubMed1999

The Telemedicine benchmark--a general tool to measure and compare the performance of video conferencing equipment in the telemedicine area.

In this paper, we describe the 'Telemedicine Benchmark' (TMB), which is a set of standard procedures, protocols and measurements to test reliability and levels of performance of data exchange in a telemedicine session. We have put special emphasis on medical imaging, i.e. digital image transfer, joint viewing and editing and 3D manipulation. With the TMB, we can compare the aptitude of different video conferencing software systems for telemedicine issues and the effect of different network technologies (ISDN, xDSL, ATM, Ethernet). The evaluation criteria used are length of delays and functionality. For the application of the TMB, a data set containing radiological images and medical reports was set up. Considering the Benchmark protocol, this data set has to be exchanged between the partners of the session. The Benchmark covers file transfer, whiteboard usage, application sharing and volume data analysis and compression. The TMB has proven to be a useful tool in several evaluation issues.

Benchmarking↗

PubMed1997

Asthma: benchmarking for quality improvement.

BACKGROUND: Linked medical and pharmacy claims can be used to identify patients with asthma and benchmark current practice standards. METHOD: This was a 3-year study of five independent practice association style health maintenance organizations with an annual enrollment of 870,000. More than 28,000 members were identified with claims for asthma. OBJECTIVE: The intent of this study was to benchmark current asthma practice. Before quality improvement projects can be implemented baseline data are required. RESULTS: The prevalence of asthma varied by geographic regions. Specialty care was associated with greater use of anti-inflammatory medications and more refills of these drugs. Refill rates for inhaled corticosteroids for all patients was low. Specialty care of asthmatic members was associated with a lower rate of emergency service events and hospitalizations. CONCLUSIONS: Linked medical and pharmacy claims' databases can be used to benchmark current practice performance and serve as a reference for quality improvement programs. Appropriate use of specialty care may improve asthma outcomes.

Adolescent↗

PubMed2003

Use of benchmarking in the development of biopharmaceutical products.

As the pharmaceutical and biotechnology industry enters the 21st century, the pressure on companies to maintain the level of productivity required for consistent year-on-year growth is increasing. Benchmarking has become a tool for obtaining the information needed to support continuous improvement and gain a competitive advantage. During the process of benchmarking, best practices can be identified while giving management the ability to improve on existing performance in an objective, well-informed manner. When used appropriately, benchmarking provides a new perspective on traditional methods while enabling companies to monitor their performance.

Benchmarking↗

PubMed2006

Benchmarking as a tool of continuous quality improvement in postoperative pain management.

BACKGROUND AND OBJECTIVE: Quality of acute pain management is far from being satisfactory. These deficits are not caused by the complexity of the medical problem but by difficulties in organization and hospital structures, sand procedures. Continuous quality improvement is a recommended tool to overcome such difficulties and to increase quality in the long run. This study reports the implementation of benchmarking-based continuous quality improvement to improve postoperative pain management at a university hospital. METHODS: A specialised pain nurse interviewed patients of three surgical departments on the first day after surgery, and continuously assessed process and outcome quality parameters. A multidisciplinary team of anaesthetists, surgeons, nurses and pharmacists implemented a regular procedure of data analysing and internal benchmarking. Results and suggested improvements were fed back to the healthcare teams. RESULTS: From 1998 to 2002, 6,756 patients were assessed. Average pain on ambulation and maximal pain were 3.7 +/- 2.4 and 5.0 +/- 2.5 (mean +/- SD) on a 11-point numeric rating scale. Pain intensity at rest was 1.9 +/- 1.8. Over time, pain intensity on ambulation decreased (P = 0.022) whereas maximal pain and pain at rest remained unchanged. There was an increase in the number of patients who received non-opioid analgesia (P < 0.001). CONCLUSIONS: A continuous quality improvement process could be established and is now successfully used in clinical routine. Cornerstones of this project were frequent assessments of process and outcome parameters, regular benchmarking and implementation of feedback mechanisms. Changes in organization of medical management and multidisciplinary teamwork seem to be more important than medical or technical aspects.

Abdomen↗

PubMed2026

Protein Language Model Decoys for Target Decoy Competition in Proteomics: Quality Assessment and Benchmarks.

Large-scale proteomics relies heavily on target-decoy competition for false discovery rate estimation in peptide identification, and the performance of this strategy depends strongly on the design of the decoy database. Classical generators such as reversal and shuffling remain widely used. Here, we introduce the first protein language model-based (PLM) decoy generation for peptide identification and benchmark it against classical strategies. We evaluate these approaches using three complementary quality-control layers: sequence-based separability, search-engine-agnostic spectral-space diagnostics, and end-to-end mass spectrometry benchmarks, including pipelines with rescoring. Across these analyses, PLM-based decoys are harder for sequence-only neural networks to distinguish than most classical generators, suggesting fewer obvious sequence-level artifacts. However, this signal is only weakly informative for search performance. Spectral diagnostics further show that short peptides occupy a particularly crowded target-decoy space and are therefore especially prone to local collisions across all generators. In full search pipelines, reverse decoys remain a strong baseline, and current PLM-based generators do not yet provide a clear overall advantage. We therefore view PLM-based decoys not as universal replacements for reverse decoys but as tunable tools for benchmarking, diagnostics, stress testing, and future adaptive decoy optimization, with increasing value as search models become more expressive.

Proteomics↗

PubMed2000

Determining the artifact sensitivity of recent pulse oximeters during laboratory benchmarking.

This study aimed to investigate and compare the performance of the algorithms contained in the newest generation of pulse oximeters (Masimo SET in IVY2000, Nellcor Oxismart N-3000, Agilent M3 rev. B) against a traditional pulse oximeter (Agilent CMS rel. A.0). The benchmark was performed in an efficient and reproducible way in the laboratory environment using patient signal recordings complemented by a two-hand volunteer motion test. A novel method of creating artifact/reference signal pairs from a clinical database, the noise-mix-composition (NMC), was developed. The new method enabled the simulation of critical clinical situations in a more realistic way than the usual two hand volunteer studies. An advantage of the laboratory tests over live clinical studies was that a continuous saturation reference was available, allowing accurate on-going determination of the SpO2 error. A new quantitative performance measure, the non-performance index (NPI), was developed and applied to the benchmark results. It covers the 3 performance aspects of a pulse oximeter: (1) SpO2 accuracy, (2) pulse rate accuracy and (3) drop out times. These factors were weighted according to clinical importance determined by a survey. During the restricted conditions of steady state and forced motion test on healthy volunteers Masimo/Ivy's pulse oximeter performed best with a 2.6 fold improvement over the conventional technology. Clear improvements were also found for Agilent's M3 (1.6 fold) and Nellcor's N-3000 (1.6 fold). In contrast, the clinically oriented NMC study yielded the best performance improvement--as measured in NPI numbers--for Agilent's M3 rev. B (1.6 fold) and due to more frequent SpO2 errors only 1.5 for Masimo and 1.3 for N-3000. A large difference was found for the dropout rate: the lowest was achieved by Masimo (3.0% of total time), the largest by Nellcor N-3000 (24.1% of total time), a factor which was rated high by clinicians. Very pronounced improvements (between 2.3 and 3.4 fold) on all of the newer devices were found for the pulse rate. The NMC turned out to be a very useful tool for generating a standard signal set for algorithm development and benchmarking purposes that eliminates repetitive clinical testing in early stages. The applicability of its results needs confirmation by clinical live studies.

Artifacts↗

PubMed2003

Performance measures and their benchmarks for assessing organizational cultural competency in behavioral health care service delivery.

A project is described in which performance measures of cultural competency in behavioral health care were selected and benchmarked. Input from an Expert Panel representing the four major ethnic and racial groups in the U.S. and persons with extensive experience in implementing cultural competency in health care, along with survey data from 21 sites were used in the process. Measures and benchmarks are made specific to organizations that administrate care networks, and to service entities that deliver care. Measures were selected to parallel an implementation process, and benchmarks were set at "gold standard" levels.

Attitude of Health Personnel↗

PubMed2004

Use of quality adjusted life years and life years gained as benchmarks in economic evaluations: a critical appraisal.

Researchers have grappled with various ways of placing the results of an economic evaluation in the appropriate context. One of the most common methods is to relate the results of a study to an appropriate benchmark (commonly, dollars 50,000 per QALY in the US or pounds sterling 30,000 per QALY in the UK). This paper examines the foundation for these cut-off points and critiques their use by researchers. Although it is difficult to establish an appropriate benchmark this paper notes that reference points may be too low based on published data. Further, the inconsistent application of benchmarks, and differences in the calculation of a value of a statistical life, will lead to an inefficient allocation of health care resources.

Benchmarking↗

PubMed2026

Integrated computational and experimental benchmarking of Bacillus phage endolysins reveals the relationship between peptidoglycan-fragment recognition descriptors and antibacterial performance.

Protein-based antibacterials such as bacteriophage endolysins offer a targeted therapeutic strategy against Gram-positive pathogens. However, prioritizing the most effective candidates from the large sequence diversity available remains a significant challenge. Here we present a standardized computational-experimental benchmarking framework that evaluates seven phage-derived endolysin variants (E1, E2, E3, E7, E10, E12, and E15) identified from Bacillus genomes. We combined molecular docking and residue-level interaction mapping against muramyl dipeptide (MDP), a minimal conserved peptidoglycan motif, with 1000-ns molecular dynamics simulations, MM/PBSA binding free-energy estimation, and matched functional inhibition assays against Staphylococcus aureus and Micrococcus luteus. Computational analyses revealed generally favorable MDP recognition across variants, albeit with notable differences in contact patterns and complex stability profiles. Experimental screening identified E2 as the most potent antibacterial agent against both species, while E7 and E1 performed strongly in selected computational metrics. Integrated analysis showed only modest correlations between computational descriptors of fragment recognition/stability and observed antibacterial performance. This study establishes a practical comparative benchmarking platform for endolysin candidate prioritization, nominates E2 and E7 as promising candidates for further development, and highlights E1 as a potential structural scaffold for rational engineering, while explicitly demonstrating both the utility and the current limitations of using minimal peptidoglycan fragments as proxies for full cell-wall recognition in lysin benchmarking.

Endopeptidases↗