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Copyright © 2002, MCB UP Limited
The editorial staff of Benchmarking: An International Journal are committed to helping those working at a senior level in industry, the public sector, consultancy, or academic institutions, to stay current on developments in the areas of quality, technology and benchmarking. The focus of the journal is on “topics that have substantial management content, rather than being primarily technical in nature.” The Internet editorials will center on sites with a similar focus. I will examine sites believed to be of interest to BIJ readers and report, in what I believe to be a fair and objective manner, what I find at those sites.
This editorial is devoted to benchmarking healthcare. Healthcare is a very broad area that encompasses or is related to the following: hospice care; health maintenance organizations (HMOs) or similar institutions; hospitals; nursing homes; home healthcare; government-sponsored healthcare; the pharmaceutical industry; medical research; the medical insurance industry; the medical equipment industry; education, training, compensation and performance of doctors and other healthcare professionals; and more. The quality of life for people around the globe is affected by the quality and availability of healthcare. Not surprisingly, the growing cost of healthcare and related costs such as health insurance (provided by the private or public sector) have become major concerns within public and private institutions worldwide. The growth of the World Health Organization and its growing global influence on United Nations and government healthcare policies demonstrates the global importance of healthcare and related issues. In the Americas, Europe, Asia, Africa and elsewhere, healthcare has come under increased scrutiny and the quality and cost of healthcare have become major concerns of business, government and individuals. Given the growing concern for healthcare, it should not surprise one to learn that benchmarking is in vogue in the many healthcare-related industries. When I started conducting research for this editorial, I expected to have little difficulty finding sites to review – I happened upon several healthcare-related sites in preparing for other editorials. I did not expect, however, to find so many sites. Four sites are featured herein, but many more exist. I will now explain how I found the sites featured herein and many more.
As in all of my Internet editorials, I provide information about searches and search engines as well as benchmarking sites. In addition to using two of my three preferred meta-search engines (WebCrawler and Google – I did not use MetaCrawler this time), I tried something a little different in seeking Web resources for this editorial. I conducted a key word/phrase search in Google for “healthcare search engines” in an attempt to find one or more specialized search engines for healthcare. What I found did not serve me particularly well in identifying sites for this editorial, but the results are worth sharing. Many items (83,600 to be exact) appeared on the hit list resulting from my Google search. I did not move beyond the first 200 hits – it was not practical to examine all 83,600. From those links examined, I got a good feel for the nature of sites contained on the hit list. Among the more interesting of those examined were the following: http://www.glenlib.demon.co.uk/medsearch.htm, a site appropriately named “Medical Search Engines;” http://www.achoo.com/search/web.asp, the “Achoo Gateway to Healthcare;” and http://diannebrownson.tripod.com/nursesearch.html, “Brownson’s Nursing Notes.” These three sites well represent the general categories of sites comprising the hit list (searchable sites, gateways, and sites comprised mostly of hyperlink lists). Medical Search Engines had links to support searches of medical databases, searches for clinical resources, and even links to medical mailing lists. It directly supported Web searches and provided much guidance to assist in searches. The Achoo Gateway to Healthcare comprises largely of links to various medical resources. Achoo supported searches of common Web search engines and meta-search engines accessible elsewhere on the Web. It was in essence a portal for medical professionals. Brownson’s Nursing Notes was an individual’s Web site comprised of links to many searchable healthcare sites. None of these three sites led me to discover useful benchmarking-related sites, not already discovered through searches with Google and WebCrawler, but these and other sites found in my search for search engines were interesting and potentially useful. These three and others like them would be quite helpful to individuals searching for medical trials in which to participate, symptoms and treatments for a specified disease, information on prescription drugs (availability, common use, side effects, etc.), directories of hospitals and healthcare providers, professional organizations associated with healthcare and more.
The search engines most useful in discovering sites featured in this editorial were two of my trusty old standbys, Google and WebCrawler. Three search phrases that proved productive in the Google and WebCrawler searches were as follows: “healthcare benchmarking,” “hospital benchmarking,” and “healthcare management.” The words in the phrases were reversed (i.e. “benchmarking healthcare”) but it made little difference in hit list contents. The three searches produced lists from 44 to 57 hits in length in the WebCrawler and hit lists containing tens of thousands of hits in Google. The obvious advantage of the WebCrawler was that the hit lists were far less cumbersome to examine than the Google hit lists, yet the “best” sites featured herein appeared on that much shorter WebCrawler lists. Many potentially useful Web pages and sites were identified through the searches. It should be noted that, as with past editorials, some of the featured sites are the property of “for profit” enterprises. My review of those sites is not to be taken as a recommendation of the goods or services of sponsoring entities. Now, I shall describe and examine the four sites featured in this editorial.
Institute for Health Care Improvementhttp://www.ihi.org/
The Institute for Health Care Improvement (IHI) is a non-profit organization dedicated to the improvement of healthcare systems by continuously improving quality and increasing value for constituents. IHI measures health status, clinical outcomes, cost, access, ease of use, as well as patient and community satisfaction. In order to examine fully site features, I joined IHI. The sign-up form was short and required only basic information. It took me about one minute to fill out and submit the form. The response was instantaneous. I was immediately afforded access to areas of the site reserved for members.
IHI offers different types of memberships. Individual and organizational memberships are available. Organizations can sign up to participate in action groups, collaborative studies, on-site courses, conferences, etc. A program called IMPACT is comprised of several action groups dedicated to improving patient outcomes; patient, provider and staff satisfaction; and healthcare costs (to learn more examine the “IMPACT” link on the home page navigation bar). Organizations can participate in these action groups along with IHI faculty, in a joint effort to achieve, sustain and spread breakthrough improvements. Other programs available from IHI include what they call Collaboratives. There is a link on the navigation bar, appropriately labeled “Collaboratives,” that accesses a page describing these programs. The Collaboratives give organizations an opportunity to collaborate with 20 to 40 healthcare organizations for six to eight months in an intensive effort to improve outcomes and reduce costs. Improvement guides are one of the outputs of the collaborative efforts. There are other ways in which organizations may participate in IHI, but one should visit the site to find out more about the many programs and initiatives. Links on the home page navigation bar make it easy for visitors to find out more about these and other programs. One particularly useful link is the “Resources” link. On the page accessed via that link, one finds links grouped into three categories: “Publications,” “Topic Areas” and “Other Resources.” Under Publications one will find links to improvement guides, newsletters (Continuous Improvement and Eye on Improvement newsletters) and success stores. Both newsletters are worth examining, and possibly worth subscribing to, for they provide access to important healthcare improvement information from many other publications. The Resources link provides access to pages describing the topics and containing many links to materials pertaining to those topics. The Other Resources group includes links to a health education online directory which houses a searchable directory of people teaching healthcare quality improvement in academic health centers and in academic programs. Also under Other Resources one will also find links for video tapes and Web links. The video tapes one will have to buy (there were many available and they were organized by year – links for years), but the Web links are free. The “Web Links” list comprises of hyperlinks to the sites of healthcare organizations, most of which were non-profit and government institutions based in North America. The last feature of this site that I wish to mention is the Communities, accessible via the “Communities” link on the navigation bar. IHI supports public discussion groups organized by community. One will find discussion group links for “Access and Office Efficiency,” “Patient Safety,” and more. These discussions group links support Web-based discussions. There are also six public list-servers to which one can subscribe in order to participate in e-mail-based discussions of such topics as “Adult Intensive Care,” “End of Life” and “Chronic Disease.” I examined a couple of the Web-based discussions and they appeared to be fairly active – some more than others as one might expect. These discussion groups and list-servers offer one the opportunity to ask questions and carry on a dialog with other healthcare professions with similar interest.
This site is not devoted exclusively to benchmarking healthcare, but it is devoted to improving healthcare. Benchmarking is about improvement and there was much information available on this site about healthcare improvement. The site has something to offer the casual visitor, individual members, and institutional participants. The site appeared to be well maintained (I did not encounter a link that did not work) and it was tastefully designed (it was pleasing to the eye and navigation was easy). The site is one worth visiting for anyone with an interest in healthcare improvement and related topics such as benchmarking.
The Hospital Benchmarks site is sponsored by Ingenix, a for-profit organization. Ingenix developed HospitalBenchmarks.com (HBC), which it describes as a “customizable subscription service” to provide healthcare executives with 24-7 Web access to the data they need to make critical decisions for their organizations. Ingenix claims to have one of the most comprehensive healthcare databases in the USA, maintaining current data on over 6,000 US hospitals. The Ingenix Data warehouse is designed to support performance analysis and competitive analysis. Subscribers are afforded the flexibility to generate reports tailored to their specific information needs. The cost of the subscription to individual subscribers is US$549.95. For that price individual subscribers have unlimited access for one calendar year. The cost of multi-user access is determined by calculation, but I was unable to determine exactly how it is computed. Is the service worth the price? One would have to ask a subscriber. I did not subscribe, for I, not being a healthcare professional, would have no meaningful way of evaluating the value of the data.
Among the comparative data (data only goes back four years) residing in the Ingenix database are the following:
Highly detailed price and cost information.
Hospital profiles that include statistics on such things as the number of beds and types of services offered, as well as hospital addresses.
Benchmarks and ratios for individual hospitals and specified groups of hospitals.
Financial statements for selected hospitals along with specified ratios and measurements such as number of patients per day, cost per discharge, price per discharge and more.
The navigation bar found on the HBC home page contained several links. The “Subscription” link takes one to a page containing information about subscriptions. On the subscriptions page, the “Subscription Questions” link is useful in that it provides one with additional information about how the subscription works, what one gets for the subscription, the origins of data contained in the database, and more. Anyone interested in subscribing should examine the questions to learn more about what to expect from the somewhat pricey subscription. The “Reports” link provides one with additional information about the nature of reports – their contents, source data, how to view reports and more. Another potentially useful link on the HB.com homepage navigation bar is the “Product Details” link. That link accesses a page with four product-related links along with short link descriptions. The “Product Overview” link was very helpful to me in learning more about an HBC subscription – the description was very concise and thus quite helpful. A second link, the “Data” link, provided a good overview of the data contained in the database, touching on sources and the credibility of those sources, frequency of updates, etc. HBC claims that their database contains the most current data in the industry. The “Samples” link afforded me access to numerous sample reports. I examined all of the sample reports. Although I cannot comment on the accuracy of the data contained in the reports, the report detail was impressive. The organization and format of the reports made them easy to read. The last link on the Product Overview page was the Hospitals link. Following that link, I found a searchable list of hospitals represented in the HBC database. Instructions for the search suggested that a complete list of participating hospitals could be seen by clicking the search button, but I was unable to see a complete list of hospitals following the instructions provided. Perhaps membership is required in order for one to use the search hospital feature, but I saw no such warning in the search instructions. In order to evaluate the subscription process, I clicked the “Subscribe” link. Surprisingly, the link directed me to the site of St Anthony’s Publishing/Medicode (I could not really ascertain which was the correct site name, but it was a subsidiary of Ingenix) to support a secure transaction in completing the subscribe process. I did not complete the transaction, but the process appeared to be no more complicated than purchasing a book on Amazon.com. It is noteworthy that reading materials pertaining to benchmarking in healthcare are available from that site as are many other informational products and services. That site can be accessed directly at http://www.ingenixonline.comM. The Hospital Benchmarks.com site could be of interest to hospital personnel involved in benchmarking. The site visit will cost one nothing but a little time.
NHS Benchmarking Clubhttp://www.nhsbenchmarking.nhs.uk/
Founded in 1996, the NHS Benchmarking Club (NHSBC) comprises members from the UK. The membership comprises of health authorities, primary care groups, local health groups and primary care trusts in England, Scotland and Wales, as well as health and social services boards from Northern Ireland. The NHS leadership expects other NHS organizations to join in the future. Stated NHSBC goals are as follows:
to promote the effective use of benchmarking techniques in the NHS to improve health, healthcare and organizational performance;
to provide a “safe” environment in which members can analyse and compare their performance;
to influence decision makers locally and nationally.
The NHSBC site appears to be relatively new, and subsequently is not well endowed with content at present. Statements by NHSBC personnel suggest that expansion of the site is planned for the near future. With that in mind, we will examine the evolving NHSBC site to see what it offers site visitors and member organizations. To learn more about the organization one can examine the “Aims of the Club” link found on the NHSBC home page. That link was the source of the information provided herein about the organization and its goals. The goals of the organization are succinctly stated. I was a little uncertain about what was meant by a “safe” environment for analyzing and comparing performance. One would assume it means secure – data are protected. Membership details can be examined by following the “Members Link.” Membership is open to health authorities in the UK, their PCGs, as well as health boards in Northern Ireland and Scotland. The cost of a subscription is £2,000 which covers a health authority, its PCGs/LHGs, and other NHS organizations in the local health community. PCT annual membership cost £500. There is a link on the membership page to allow one to examine a list of current members, and another to allow interested parties to contact a member of the NHSBC steering group for more information about membership. There were a total of 60 members as of January 2002. The number of new members (shown in italics on the list) would seem to suggest that NHSBC membership is growing rapidly. The “Projects” link on the homepage moves one to a page that describes various current, planned and completed projects. Current projects include “Benchmarking asthma, diabetes and CHD in primary care,” “Benchmarking dental, optometric, and pharmaceutical services” and “Benchmarking the PCG performance management process.” Planned projects include “Benchmarking joint working arrangements between PCTs and social services,” “Benchmarking ‘improving access’ targets in the NHS plan,” and “Benchmarking PCT resourcing and management costs.” Completed projects (there were only two) included “Benchmarking the contribution of public health to the health authority agenda” and “Improvement programmes phase 1: comparing the first HImPs.” One need not click project titles expecting to find more information on projects, because the titles are not hyperlinks. Few details were provided about the projects, but “membership has its privileges.” Members have access to more detailed project information. The “Current Events” link can be followed to learn more about NHSBC events. The event announcements found on the Current Events page were past events – two for January 2002, and one for April 17 (billed as a planned event, but the date had passed at the time I visited the site). No detail, other than time, place, and title, was provided about the events on the Current Events page or through hyperlinks. The “Contact the Club” link on the home page provides access to names, addresses, phone numbers and e-mail addresses one would need for contacting NHSBC representatives to learn more about membership. The “Member’s Zone” link accesses a page that describes a future service that will be available to members via the NHSBC extranet (limiting access to members). The plan calls for “an interactive area where participants can suggest a new project, ask for help with implementing a particular piece of work, find benchmarking partners to work with in more detail on a project, or post their views on a discussion board.” Plans call for this service to be available within a year.
The appearance of Web pages on the NHSBC site was pleasing, and the organization of the site and page content was logical and efficient. All links worked (there were none to take the visitor off the site), but the last update of the pages viewed was in January, some four months prior to my visit to the site. At present the content of the NHSBC Web site is limited; however, it is premature to judge the site harshly for lack of content. This relatively new site appears to be evolving at this point in time, as many Web sites do. “Official” comments found on the site suggest that NHSBC intends to expand the Web site to include additional member services. As expansion moves forward, perhaps more time will be devoted to updating the site regularly. Even with planned changes, it seems unlikely that the NHSBC site will house significant content for anyone other than members. The site would thus seem to be of greatest interest to healthcare organizations in the UK – organizations that would like to join the club to improve their own benchmarking programs through collaboration with like organizations that have similar interest.
Agency for Health Care Research and Qualityhttp://www.ahcpr.gov
The Agency for Health Care Research and Quality (AHRQ) originated in 1989, as the Agency for Health Care Policy and Research, a branch of the Department of Health and Human Services. The agency was reauthorized in 1999 under its new name. The mission of AHRQ is “to improve outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services.” The purpose of research supported by AHRQ is to produce information that helps patients and clinicians, health system leaders, purchasers, and policymakers make better decisions about healthcare. Approximately 80 percent of AHRQ’s annual budget is allocated to the funding of research grants and contracts awarded to universities and other research institutions throughout the USA. AHRQ operates at the same federal agency level as agencies like the Food and Drug Administration, Center for Disease Control and National Institute of Health. To learn more about AHRQ, its mission, strategy, major programs, sub-units and such, one should examine links found on the navigation bar (on left side of the home page) below the “About AHRQ” heading. The “Budget and Mission,” “Strategy” and “Organization and Contracts” links will give one a good overview of the agency’s purpose, major thrusts, major programs and activities, as well as its internal organization. Agency sub-units and their individual missions, strategies, etc. are described in great detail, and that detail is well organized through the use of hyperlinks.
The AHRQ home page is quite busy (many, many links and sections), but after one is initially overwhelmed with the sheer volume of links and starts to examine the page closely, one will find that the page is busy because there is so much on the site to examine and use. Because it would be impossible to explore every link, I will provide an overview of site contents and highlight some areas and links that one interested in healthcare benchmarking might find interesting. The “Newsroom” link accesses a page with agency and center news releases. A hyperlinked archive allows one to examine news releases from as far back as 1995. The most current news item found at the time I visited the site was two days old. Many of the press releases summarize and present highlights of AHRQ-funded studies. Many news items contain hyperlinks allowing one to access other sites, or other materials on the AHRQ site, to learn more about the research or program described therein. The FOIA Reading Room link, found on the Newsroom page, provides guidance in obtaining electronic information through the Freedom of Information Act. The “Publications and Products” link moves one to a page through which one can gain access to an astounding volume of studies and reports. While some of the documents are available on paper or by fax, many (perhaps most) are available online. Some documents are free (single copy is free), but some are for sale through the Government Printing Office or National Technical Information Services. Reports, details and data pertaining to thousands of past and current studies are available directly or indirectly through AHRQ. Electronic search capabilities make finding targeted data and information relatively easy, and good instructions are provided to help users conduct efficient searches. The volume of information made available through the Publications and Products page is staggering. After examining the availability of information via the navigation bar, one has but “scratched the surface.” Moving about the main page (homepage) one finds page contents organized under the following major headings: “Clinical Information”, “Consumers and Patients”, “Funding Opportunities”, “Data and Surveys”, “Research Findings” and “Quality Assessment”. The links under Consumers and Patients are intended primarily for individuals (consumers and patients). Those links help consumers and patients become more informed participants in their own health care. Areas containing links likely to be most useful to those studying or involved in healthcare benchmarking are Data and Surveys, Research Findings, Quality Assessment, and perhaps for researchers, Funding Opportunities. For clinicians, Clinical Information might be of interest as links found under that heading include “Outcomes and Effectiveness,” “Technology Assessment” and “Evidence Based Practice.” Studies relating to benchmarking clinical practice can be found in lists accessed via each of these three hyperlinks. One particularly interesting link, found under Data and Surveys, was one called “HCUP” (Healthcare Cost and Utilization Project). Through that link one can access a tool called HCUPnet, that can be used to identify, track, analyze and compare statistics on hospitals at the national, regional and state level. Other valuable resources accessible via the HCUP link are the HCUP listserv, tools and software, valuable healthcare studies and statistics, and links to related sites. The HCUP link is one of several found under Data and Surveys. A wealth of healthcare performance related data is accessible via those links. The Research Finding category includes some valuable links. The “Research Activities: Online Newsletter” and research “Fact Sheets” links provide access to summaries of many recent studies, and links to studies, that can help one more quickly find studies of interest. A “Search Research Activities” link found on the Research Activities: Online Newsletter page can be quite helpful in finding studies of interest. The last major area on the home page is the one entitled “Quality Assessment.” Many links appear under that heading. The CONQUEST link accesses a page describing the Computerized Needs Oriented Quality Measurement Evaluation System. The CONQUEST tool allows users to collect and evaluate healthcare quality measures and find measures that meet their needs. This product is downloadable and it is free. The CAHPS® link provides access to tools and information useful in assessing consumer perception of healthcare services. Specific benchmarking tools and information are available via the CAHPS® page. Other useful links can be found under Quality Assessment.
The AHRQ site is without question the most information packed site examined for this editorial. The site is sponsored and maintained by a US government agency, so most materials and tools are available at no charge. The site appeared to be well maintained. There were hundreds of hyperlinks on the site. Although I did not try each and every link, all that I examined were functional. I found all pages to be well maintained and evidence suggested frequent updating of pages and the site generally. I spent several hours examining the site, but in that time could examine only a small part of what the AHRQ site had to offer. This site is a must see for anyone (researcher, practitioner, or patient) with an interest in healthcare benchmarking and or healthcare quality. This is in my opinion the best site that I visited (I probably visited 50 sites) in preparing this editorial on benchmarking healthcare.
Benchmarking healthcare has become increasingly important to public sector policy makers and administrators, private sector healthcare managers and clinicians and researchers. Trends in healthcare such as escalating costs and increased government involvement, along with the growing importance of issues pertaining to healthcare access and quality, have brought healthcare to the forefront of public and political debate in recent years. Healthcare issues have attracted the interest of the news media. Healthcare quality is without question a major concern in developed and developing nations. Given the importance of healthcare generally, and healthcare quality, costs, access and effectiveness specifically, I was not surprised to find useful healthcare-related, Web-based resources, but I did not expect to find nearly so many. I included only four sites in this editorial. These four are fairly typical of the thousands of healthcare-related sites that can be found on the Web. Some are sponsored by public institutions, and some by private institutions. Some are information rich, and some are not. Some are very well maintained, and some are not. Some are quite general, and some are highly focused. More importantly for BIJ readers, many, many of them house information and tools that could be helpful in healthcare benchmarking. Hopefully, this editorial will be useful to BIJ readers with an interest in healthcare benchmarking. My goal, after all, is to write Internet editorials that will be valuable to BIJ readers. To accomplish this goal, I ask for the assistance of BIJ readers. If you have a site, or know of a site, that you would like to see featured in future editorials, please e-mail me your suggestions. If there is some particular area of benchmarking, or some industry you would like to see as the focus of an editorial, give me your suggestions. Your input would be greatly appreciated. Send your comments and suggestions to Ronald E. McGaughey at firstname.lastname@example.org.
Ronald E. McGaugheyInternet Editor