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Quality of Care

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A new quality improvement tool is being developed for deriving benchmarks of clinical care

A new quality improvement tool for estimating data-driven benchmarks may soon provide an alternative to opinion-based approaches for identifying best medical care practices. This tool, which can be used in performance feedback to health care providers, is being developed and tested with support from the Agency for Health Care Policy and Research (HS09446).

Clinical care benchmarks serve as a standard of best clinical care practice against which other similar practices can be measured. Such benchmarks pervade the health care quality improvement literature. However, they usually are based on subjective assessments of providers, or arbitrarily chosen performance levels, rather than data-derived measurements. As such, benchmarks may not yield an achievable level of excellence that can be reproduced under specified conditions, notes Catarina I. Kiefe, Ph.D., M.D., of the University of Alabama at Birmingham.

Dr. Kiefe and her colleagues are developing a method to identify peer-group-based, objective, reproducible, data-driven performance measures called Achievable Benchmarks of Care (ABC) at the process-of-care indicator level. The ABC relies on two mathematical concepts. The first, the pared-mean, applies quantitative techniques to determine "top performance," that is, the mean of the best care achieved for at least 10 percent of the population. The ABC also uses a Bayesian estimator technique to reduce the impact of providers with small numbers of eligible patients.

The researchers used the ABC in an initial benchmarking analysis in the Cooperative Cardiovascular Project (CCP), which focused on six specific process of care indicators for heart attack patients ranging from smoking cessation counseling to hospital administration of low-dose heparin. Pooling the patients eligible for smoking cessation counseling at 12 hospitals resulted in a benchmark performance level of 49 percent. Of these 12 benchmark contributors, 10 hospitals had rates above 49 percent, that is, were benchmark performers. Hospitals responded positively to their performance feedback.

See "Identifying achievable benchmarks of care (ABCs): Concepts and methodology," by Dr. Kiefe, Norman W. Weissman, Ph.D., Jeroan J. Allison, M.D., M.S., and others, in the October 1998 International Journal for Quality in Health Care 10(5), pp. 443-447.

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