Achievable benchmarks of care: the ABC(TM)s of benchmarking

Benchmarking is generally considered to be an important tool for quality im provement. Traditional approaches to benchmarking have relied on subjective identification of 'leaders in the field'. We derive an objective, reproduc ible and attainable Achievable Benchmark of Care (ABC(TM)) by measuring and analysing performance on process-of-care indicators. Three characteristics of the ABC(TM) that we deem essential are: (1) benchmarks represent a meas urable level of excellence; (2) benchmarks are demonstrably attainable; (3) benchmarks are derived from data in an objective, reproducible and predete rmined fashion. From these characteristics it follows that (4) providers wi th high performance are selected to define a level of excellence in a prede termined fashion, but (5) providers with high performance on small numbers of cases do not influence unduly benchmark levels. We use the 'pared mean' to operationalize the ABC(TM). Roughly, the pared mean summarizes the perfo rmance of top-ranked providers whereby at least 10% of the patient pool acr oss all providers is included. Bayesian estimators for adjustment of perfor mance of providers with small sample sizes are used to rank providers. Rand omized controlled trials to assess the independent effect of the ABC(TM) in quality improvement projects are under way. We have developed a methodolog y objectively and reproducibly to derive a level of excellent, attainable p erformance, based on measured performance by a group of providers. The ABC( TM) can be applied to groups of providers in communities, to institutions a nd departments within them, or to individual practitioners.