Browsing by Subject "performance measurement"

Now showing 1 - 4 of 4
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    Bearing More Risk for Results: Performance Accountability and Nonprofit Relational Work
    (SAGE, 2008) Benjamin, Lehn M.; School of Philanthropy
    Performance accountability systems require nonprofits to bear more risk for achieving results. Although a growing body of work has examined nonprofit accountability, less attention has been given to the concept of risk. This article points to a potential conflict between performance accountability frameworks and nonprofit work. This conflict can be best understood as a one between managing risk in task-driven relationships, in which relationships are formed simply to achieve desirable results, and managing risk in developmentally driven relationships, in which performing a task is intended not only to achieve desirable results but also to build enduring capacity to take action on common problems.
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    Estimating and Reporting on the Quality of Inpatient Stroke Care by Veterans Health Administration Medical Centers
    (2012-01) Arling, Greg; Reeves, Mathew; Ross, Joseph S.; Williams, Linda S.; Keyhani, Salomeh; Chumbler, Neale R.; Phipps, Michael S.; Roumie, Christianne L; Myers, Laura J.; Salanitro, Amanda H; Ordin, Diana L.; Myers, Jennifer; Bravata, Dawn M.
    Background—Reporting of quality indicators (QIs) in Veterans Health Administration Medical Centers is complicated by estimation error caused by small numbers of eligible patients per facility. We applied multilevel modeling and empirical Bayes (EB) estimation in addressing this issue in performance reporting of stroke care quality in the Medical Centers. Methods and Results—We studied a retrospective cohort of 3812 veterans admitted to 106 Medical Centers with ischemic stroke during fiscal year 2007. The median number of study patients per facility was 34 (range, 12–105). Inpatient stroke care quality was measured with 13 evidence-based QIs. Eligible patients could either pass or fail each indicator. Multilevel modeling of a patient's pass/fail on individual QIs was used to produce facility-level EB-estimated QI pass rates and confidence intervals. The EB estimation reduced interfacility variation in QI rates. Small facilities and those with exceptionally high or low rates were most affected. We recommended 8 of the 13 QIs for performance reporting: dysphagia screening, National Institutes of Health Stroke Scale documentation, early ambulation, fall risk assessment, pressure ulcer risk assessment, Functional Independence Measure documentation, lipid management, and deep vein thrombosis prophylaxis. These QIs displayed sufficient variation across facilities, had room for improvement, and identified sites with performance that was significantly above or below the population average. The remaining 5 QIs were not recommended because of too few eligible patients or high pass rates with little variation. Conclusions—Considerations of statistical uncertainty should inform the choice of QIs and their application to performance reporting.
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    Evaluation and Civil Society
    (Springer, 2020) Benjamin, Lehn M.; Doan, Dana R. H.
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    Examining the Relationship between Clinical Decision Support and Performance Measurement
    (2009-11) Haggstrom, David A.; Militello, Laura G.; Arbuckle, Nicole; Flanagan, Mindy; Doebbeling, Bradley N.
    In concept and practice, clinical decision support (CDS) and performance measurement represent distinct approaches to organizational change, yet these two organizational processes are interrelated. We set out to better understand how the relationship between the two is perceived, as well as how they jointly influence clinical practice. To understand the use of CDS at benchmark institutions, we conducted semistructured interviews with key managers, information technology personnel, and clinical leaders during a qualitative field study. Improved performance was frequently cited as a rationale for the use of clinical reminders. Pay-for-performance efforts also appeared to provide motivation for the use of clinical reminders. Shared performance measures were associated with shared clinical reminders. The close link between clinical reminders and performance measurement causes these tools to have many of the same implementation challenges.