IDENTIFYING ACHIEVABLE BENCHMARKS OF CARE - CONCEPTS AND METHODOLOGY

Webster's Dictionary defines a benchmark as 'something that serves as a standard by which others can be measured'. Benchmarking pervades the health care quality improvement literature, and benchmarks are usuall y based on subjective assessment rather than on measurements derived f rom data. As such, benchmarks may fail to yield an achievable level of excellence that can be replicated under specific conditions. In this paper, we provide an overview of benchmarking in health care. We then describe the evolution of our data-driven method for identifying an Ac hievable Benchmark of Care (ABC(TM)) on the basis of process-of-care i ndicators. Here, our experience leads us to postulate the following pr emises for sound benchmarks: (i) benchmarks should represent a level o f excellence; (ii) benchmarks should be demonstrably attainable; (iii) providers with high performance should be selected from among all pro viders in a predefined way using reliable data; (iv) all providers wit h high performance levels should contribute to the benchmark level; an d (v) providers with high performance levels but small numbers of case s should not unduly influence the level of the benchmark. An example o f an ABC(TM) applied to the cooperative cardiovascular project leads t he reader through the computation of an ABC(TM). Finally, we consider several refinements of the original ABC(TM) concept that are in progre ss, e.g. how to approach the special problems posed by very small deno minators. The ABC(TM) methodology has been well accepted in multiple q uality improvement projects. This approach lends objectivity and relia bility to benchmarks that have been a widely used, but until now, arbi trarily defined tool.