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PubMed2005

Anatomic pathology databases and patient safety.

CONTEXT: The utility of anatomic pathology discrepancies has not been rigorously studied. OBJECTIVE: To outline how databases may be used to study anatomic pathology patient safety. DESIGN: The Agency for Healthcare Research and Quality funded the creation of a national anatomic pathology errors database to establish benchmarks for error frequency. The database is used to track more frequent errors and errors that result in more serious harm, in order to design quality improvement interventions intended to reduce these types of errors. In the first year of funding, 4 institutions (University of Pittsburgh, Henry Ford Hospital, University of Iowa, and Western Pennsylvania Hospital) reported cytologic-histologic correlation error data after standardizing correlation methods. Root cause analysis was performed to determine sources of error, and error reduction plans were implemented. PARTICIPANTS: Four institutions self-reported anatomic pathology error data. MAIN OUTCOME MEASURES: Frequency of cytologic-histologic correlation error, case type, cause of error (sampling or interpretation), and effect of error on patient outcome (ie, no harm, near miss, and harm). RESULTS: The institutional gynecologic cytologic-histologic correlation error frequency ranged from 0.17% to 0.63%, using the denominator of all Papanicolaou tests. Based on the nongynecologic cytologic-histologic correlation data, the specimen sites with the highest discrepancy frequency (by project site) were lung (ranging from 16.5% to 62.3% of all errors) and urinary bladder (ranging from 4.4% to 25.0%). Most errors detected by the gynecologic cytologic-histologic correlation process were no-harm events (ranging from 10.7% to 43.2% by project site). Root cause analysis identified sources of error on both the clinical and pathology sides of the process, and error intervention programs are currently being implemented to improve patient safety. CONCLUSIONS: A multi-institutional anatomic pathology error database may be used to benchmark practices and target specific high-frequency errors or errors with high clinical impact. These error reduction programs have national import.

Benchmarking↗
PubMed1997

When data were scarce, ED managers formed group.

Emergency department managers in the Midwest formed benchmarking group in 1996, when traditional data sources proved scarce. Group has established protocols and projects and is well on its way to comparing outcomes for initial projects. Internal benchmarking has already left its mark on members.

Benchmarking↗
PubMed1997

Meaningful data: ask the right questions at the right times.

"Garbage in equals garbage out" is never more true than when benchmarking with peers. Asking the right questions about your own operation as well as your benchmarking partner's takes some practice. Managers can be trained to interview, maximize the information gathered, and get pertinent facts. Experts say too rigid a focus on "apples to apples" comparisons will cause you to miss opportunities for improvements.

Benchmarking↗
PubMed1998

Focus on high-volume procedures for greatest cost savings, finds new study.

Data Benchmarks: Target high-volume procedures for greatest impact. A new study demonstrates the potential for cost savings and reductions in length of stay for 65 inpatient surgical procedures. The study, based on Medicare surgical data, ranks the top procedures with highest potential for savings, looks at the influence of managed care penetration in the marketplace, and offers national and regional benchmark comparisons. Here are the details and data.

Aged↗
PubMed1998

Certification programs target CM departments.

Two organizations--the Commission on Accreditation for Rehabilitation Facilities (CARF) and the American Accreditation HealthCare Commission/URAC--are developing accreditation standards for case management departments. Both will be available sometime next year. Just as certification has helped establish a benchmark for individual practice, these organizations hope their programs will establish larger-scale benchmarks for whole departments. It's expected that the CARF standards will be geared more toward acute care, while the Commission/URAC will apply more to payer-based programs.

Accreditation↗
PubMed1997

Hospital outpatient surgery cost, reimbursement, and utilization data find Medicare a loser.

Data Library: Outpatient surgery costs, reimbursement, and utilization benchmarks. This new CHIPS survey finds providers consistently lose money for 56 outpatient procedures under Medicare. The only winners are those in high managed care areas and high-volume facilities. The data offer some valuable benchmarks by geographic area, managed care penetration, as well as age and sex.

Ambulatory Surgical Procedures↗
PubMed1997

Minimize risk and costly adverse events with data gathering, reporting program.

Benchmarking errors and adverse events: Studies show adverse events affect up to 35% of all patients, add up to 15% to each hospital's bottom line, and cost the country billions in health care dollars. But you can measure how often and where these events are occurring--and begin making improvements. Here's how to track incidents, aggregate the data, and use it to benchmark against other facilities and pinpoint improvement efforts-plus, sample reports from two hospitals.

Benchmarking↗
PubMed1999

Top-performing physician groups focus on innovative cost control.

DATA BENCHMARKS: Top-performing physician group practices reveal why they are head and shoulders above their peers. A new study released by the Medical Group Management Association offers benchmark data that shows how leading group practices in various specialties are faring compared with their colleagues nationwide.

Benchmarking↗
PubMed1999

Public sector HMO members report more hospital days in Medicaid, Medicare study.

Data Benchmarks: Medicaid, Medicare study reveals that public-sector HMO members have higher hospital utilization. Based on an excerpt from National Health Information's book, Managed Medicaid: Data Sourcebook, this benchmarking data can help providers with Medicare and Medicaid risk contracts compare their utilization data with national statistics and be better prepared at the bargaining table.

Ambulatory Care↗
PubMed2001

Adverse events regional feasibility study: methodological results.

AIMS: To assess the feasibility of research into the occurrence, causation and prevention of adverse events (AEs) in New Zealand public hospitals. METHODS: A two-stage retrospective review was carried out on 1,575 medical records selected by systematic list sample from admissions for 1995 in three public hospitals in the Auckland region. Following initial screening, medical records were subject to structured implicit review using a standardised protocol. Feasibility measures, using international benchmarks where possible, were: adequacy of sample selection; completeness of medical records; reliability and validity of screener and reviewer judgements; internal consistency and face validity of AE determination and preventability assessment. RESULTS: The sample selection procedure was effective, although nearly 10% of records could not be secured. Information in medical records was sufficient for the identification and analysis of AEs. Adequate levels of agreement were achieved for screener and reviewer judgements, with kappa scores ranging between 0.302 and 0.622 and positive predictive values between 50.0% and 89.7%. The criteria for AE determination showed internal consistency and face validity, as did those for preventability. CONCLUSIONS: Research into the occurrence, causation and prevention of AEs in New Zealand health care settings is methodologically feasible and meets international benchmark standards.

Algorithms↗
PubMed2001

Competition no obstacle in a new cancer project created by consortium.

Cancer hospitals always are quick to explain that they are different, often pointing to their special commitment to their patients and ability to deal with end-of-life issues. But those differences are rarely accounted for in the benchmarking data they use. The facilities have a keen sense of competition and have, until recently, been unwilling to come together for benchmarking purposes. But all that changed in 1997 when the Joint Commission on Accreditation of Healthcare Organizations started talking about ORYX. Cancer hospital executives knew from experience that comparing data with noncancer hospitals wouldn't be useful, so a group of them came together and created a National Cancer Database initiative that would allow for subcomparisons within the ORYX system.

Benchmarking↗
PubMed2001

UHC records project is attention grabber.

Talk about benchmarking in general and most hospitals will probably think of clinical quality indicators or financial comparisons. But for the University HealthSystem Consortium of Oak Brook, IL, a recently completed project has benchmarked medical records practices at 37 member facilities.

Benchmarking↗
PubMed2001

Performance indicators in water and sanitation for developing areas.

There is a move throughout the developed world to introduce benchmarking techniques to the management of water and sanitation systems. The indicators that are being considered for benchmarking purposes tend to cover a broad band of activities that are part of the scope of management of large organisations. Most of the lists that have been prepared do not really cater for the implementation and operation of small rural schemes. The greatest need is the implementation of sustainable schemes for this category of consumer. The implementation of a rural water and sanitation scheme involves the negotiation in the initial stages with the local community representatives of what the community wants and how it will be provided and operated. This may have to be preceded by a period of empowerment so that the negotiations can be conducted by informed people. At the conclusion of the negotiations a business plan can be prepared that should be implemented in association with the community. The project is at this stage mainly in the control of a professional engineer, responsible for the technical interpretation of the business plan and the management of the construction phase. Finally, after commissioning, a water service provider will be responsible for the operation, management and maintenance of the scheme on a sustainable basis. The key actions and activities are identified and performance criteria defined. As communication at the beginning of the project is a critical component, the success of this is confirmed by examination and discussion as to how much has in fact been communicated and understood correctly. Other performance indicators for the operational phase are derived from the conventional ones used in the developed world. Finally, it is important that the participants, do not see the measurement of performance as a threatening situation, but rather a stepping stone to improvement of not only performance, but also of subsequent reward.

Benchmarking↗
PubMed2001

Leveraging performance measurement and management: the quality and efficiency edge.

The University HealthSystem Consortium (UHC) is a mission-based, member driven alliance of academic health centers. UHC's objectives are to pool resources, create economies of scale, improve clinical and operating efficiencies, and influence the direction and delivery of health care. To assist our members in developing these strategies, UHC conducted concurrent clinical and operational cardiology benchmarking projects. The goals of the cardiology-benchmarking project were to: Identify successful organizational structures and operational processes used by members to provide cardiology service. Identify methods to maximize productivity, and manage supply and equipment costs. Share methods of measuring and reporting outcomes (report cards, databases).

Academic Medical Centers↗
PubMed2002

Evaluation of several respirometry-based activated sludge toxicity control strategies.

Four different strategies including influent storage and reintroduction, step-feeding, rapid sludge recycle and waste sludge storage were evaluated using the denitrification layout of the IWA simulation benchmark. The control objective was to minimise deterioration in effluent quality caused by a certain toxic input event. In these strategies the maximum specific respiration rate (Rmax) was selected as a measured and controlled variable. To simplify the analysis, the toxicant was assumed to be a soluble and nonbiodegradable substance. Two toxic influent files were developed with square-wave input lasting 3 hours. To detect the influent toxicity, a pseudo-online flow-through respirometer was applied. A number of simulations were performed and the results suggested that the influent storage and reintroduction strategy provided the most optimistic results and other strategies could not mitigate the toxic effect. The influent storage and reintroduction strategy strongly depended on reintroduction flow rate from the storage tank. The simulation according to reintroduction flow could estimate the time required for completely treating toxic wastewater stored in the storage tank. Also the IWA simulation benchmark was enhanced to evaluate toxicity effect on the activated sludge process.

Benchmarking↗
PubMedDate not supplied

Preventable feto-infant mortality: application of a conceptual framework for perinatal health surveillance to Manitoba perinatal outcomes.

BACKGROUND: Perinatal health surveillance systems have lacked conceptual frameworks to translate data into information for policy and program planning. This paper demonstrates the application of a conceptual framework in the analysis of feto-infant mortality data in the province of Manitoba. METHODS: Fetal and infant deaths were categorized according to a two-dimensional framework of birthweight and age-at-death, and grouped into four broad categories of contributors to perinatal health: Maternal Health, Maternal Care, Newborn Care, and Infant Care. Birth Weight Proportionate Mortality Rates (BWPMR) were calculated for each of the four categories, and preventable "excess" feto-infant mortality was estimated through comparisons to a benchmark sub-population. RESULTS: Between 1985 and 1998, feto-infant mortality declined from 12.3 to 9.8 deaths per 1000 births in Manitoba. Much of this decline occurred in the Newborn Care category; there were only slight declines in deaths attributed to Maternal Health and Infant Care factors. Comparison of the feto-infant mortality rate to the benchmark rate revealed an excess of 3.46 deaths per 1000 births, an "opportunity gap" of 33%. Substantial regional variations in feto-infant mortality rates were observed. SUMMARY: Application of this conceptual framework provided useful information to aid in policy and program planning. As the greatest excess feto-infant mortality was observed in the Maternal Health and Infant Care categories, attention to the broader determinants of health which influence these categories will be required.

Adult↗
PubMed2003

Development of potentially better practices for the neonatal intensive care unit as a culture of collaboration: communication, accountability, respect, and empowerment.

OBJECTIVE: The Vermont Oxford Network (VON) CARE Group was formed in response to the need to create organizational cultures supportive of change and quality improvement. METHODS: The CARE Group consisted of team members from 4 participating neonatal intensive care units (NICUs). All CARE Group members chose to work on multidisciplinary teamwork for the duration of the Neonatal Intensive Care Quality Improvement Collaborative Year 2000. A questionnaire was developed by the CARE Group and administered to the 4 focus group NICUs. The survey focused on 6 domains of the organization: unit coordination, working in the NICU, leadership, management of disagreements, authority, and unit culture. Benchmarking visits were completed to supplement the information found in the survey and the literature. RESULTS: Seven potentially better practices (PBPs) were developed on the basis of the surveys, benchmark visits, and literature reviews. The PBPs include 1) a clear, shared NICU purpose, goals, and values; 2) effective communication among and between teams and team members; 3) leaders lead by example; 4) nurture a collaborative NICU environment with trust and respect; 5) live principled standards of conduct and standards of excellence; 6) nurture competent and committed teams and team members; and 7) commit to effective and positive conflict management. CONCLUSIONS: The CARE Group successfully used quality improvement methods and collaboration to delineate principles and practices of multidisciplinary teamwork.

Benchmarking↗
PubMed2003

Modification of the equilibrium partitioning approach for volatile organic compounds in sediment.

Although weakly hydrophobic chemicals such as volatile organic compounds (VOCs) tend not to persist in sediments, they may nevertheless be present in some sediments because of recent or ongoing releases. Standard methods are not available for assessing risks to benthic invertebrates due to VOCs in sediment. More strongly hydrophobic organic chemicals are frequently assessed by using the equilibrium partitioning (EqP) approach, which predicts the bioavailable fraction of chemical (the concentration dissolved in pore water) from the sediment-sorbed fraction, assuming that partitioning is at equilibrium. As typically applied, the EqP approach is ineffective for assessing VOCs in sediment, because the standard EqP equation fails to account for the contribution of dissolved chemical to the total chemical concentration in sediment. For chemicals with low organic carbon-water partition coefficients (Kocs), this results in nonsensical sediment-quality benchmarks that are more conservative (i.e., lower) than benchmarks calculated by assuming 100% bioavailability. A modified EqP equation is presented that accounts for the dissolved fraction of total chemical concentrations in sediment. Results of the standard and modified EqP equations converge with increasing Koc and are essentially identical at log Koc values exceeding approximately 3.5.

Benchmarking↗