Aspiotes Christine R, Gothard Matthew Q, Gothard M David, Parrish Rollie, Schwartz Hamilton P, Bigham Michael T
Department of Pediatrics, Division of Medical Education, Akron Children's Hospital, Akron, OH.
BIOSTATS, Inc, East Canton, OH.
Air Med J. 2018 Jul-Aug;37(4):244-248. doi: 10.1016/j.amj.2018.03.002. Epub 2018 Apr 30.
Critical care transport (CCT) supports regionalization of medical care. Focus on the quality of CCT care prompted the development of the Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement collaborative database which tracks consensus quality metrics. The Institute of Medicine recommends benchmarking of comparative data to accelerate improvement. Herein, we report the strategies and rationale for GAMUT QI Collaborative benchmarking.
The GAMUT database includes >350 programs internationally with >200,000 annual patient contacts. Evidence-based literature review performed in May 2016 and October 2017 identified benchmarking strategies were evaluated and summarized, specific to the GAMUT metrics. Statistical analyses include simple statistics and weighted expectation calculations for benchmark examples (Pearson chi-square with Bonferroni adjusted post-hoc z tests).
Evidence-based literature search yielded 70 articles, and 31 were selected for inclusion in our evidence table. 5 evidence-based benchmark strategies were considered: average (mean), average (median), adjusted benchmark (based on expected outcome), Achievable Benchmark of Care (ABC), and Delphi. ABC threshold establishes a higher target (90th percentile) forcing more programs to achieve higher performance.
Benchmarking is not well-suited for a single strategy and requires customized consideration based on each metric, though adjusted benchmark and ABC generally set higher performance benchmarks.
重症监护转运（CCT）支持医疗服务的区域化。对CCT护理质量的关注促使了地面和空中医疗转运质量（GAMUT）质量改进协作数据库的开发，该数据库跟踪共识质量指标。医学研究所建议对比较数据进行基准测试以加速改进。在此，我们报告GAMUT质量改进协作基准测试的策略和基本原理。
GAMUT数据库包括国际上350多个项目，每年有超过20万患者接触。2016年5月和2017年10月进行的循证文献综述确定了针对GAMUT指标进行评估和总结的基准测试策略。统计分析包括基准示例的简单统计和加权期望计算（Pearson卡方检验及Bonferroni校正的事后z检验）。
循证文献检索产生70篇文章，其中31篇被选入我们的证据表。考虑了5种循证基准测试策略：均值、中位数、调整后的基准（基于预期结果）、可实现护理基准（ABC）和德尔菲法。ABC阈值设定了更高的目标（第90百分位数），促使更多项目实现更高的绩效。
基准测试不太适合单一策略，需要根据每个指标进行定制化考虑，尽管调整后的基准和ABC通常会设定更高的绩效基准。
