Topic last updated Jan. 2006
Remember |
Benchmarking can improve productivity by:
Identifying
a problem:
- |
selecting
the external benchmark |
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gathering
internal data |
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identifying
variances |
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establishing
targets |
Taking
action:
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determining
actions |
- |
defining
responsibilities |
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implementing
the changes |
- |
monitoring
performance |
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How to Make Systems Changes
for Improved Care
Assessment and Accountability
Medical record audit and feedback, in which clinicians receive reports
of their performance and often a comparison to the mean performance
of their peers, is frequently used as a quality improvement methods.
Although based on the theory that comparison to peers would be a
powerful motivator for change, this method has had only small to
moderate effects on improving health outcomes.
13
A recent
advance to increase the effectiveness of performance feedback is
the achievable benchmark method, calculated for a specific indicator
of care such as the percentage of patients with diabetes receiving
an A1C test twice a year.14
15 It represents the average performance for the top
10 percent of clinicians being assessed in a peer group. Group practices
can use benchmarking to improve physician productivity to best-practice
levels by first identifying a problem, then taking action.16
In
a randomized, controlled trial, the use of benchmarks enhanced the
effectiveness of physician performance feedback and led to a significantly
greater proportion of patients receiving evidenced-based diabetes
care.14
Achievable benchmarks of care are easily calculated from existing
performance data.
Comparison
of random medical record reviews in over 75 percent of Indian Health
Service and tribal facilities have been compared for 1995, 1996,
and 1997 as part of a diabetes care and outcomes audit using Diabetes
Quality Improvement Project (DQIP) measures as benchmarks. Results
showed that almost all DQIP measures improved over the three-year
period.17
For more information on DQIP click
here (or see resources).
Feedback systems can be enhanced by the addition of items on which the provider may take direct action. In addition to reporting provider performance (the percentage of patients that have not had an A1C in the last six months) the provider is given the names of patients who failed to meet the goal. Armed with this information, providers can take concrete steps to improve their performance. For example, the list of patients may be contacted by office staff to schedule the necessary services. |
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