Levett J M, Carey R G
Department of Surgery, Lutheran General Hospital, Park Ridge, Illinois, USA.
Ann Thorac Surg. 1999 Aug;68(2):353-8; discussion 374-6. doi: 10.1016/s0003-4975(99)00547-0.
Measuring quality has become a high priority in the era of managed care. Nevertheless, it can be counterproductive to use the same methods for measuring improvement in surgical procedures and processes as we use for measurement in basic research. Techniques of statistical process control have been used for many years to measure process improvement in industry and are now being applied to health care.
Examples of using statistical process control charts to monitor coronary artery bypass grafting mortality, intensive care unit admission time, and length of stay are reviewed.
The major advantage of using control chart methodology is that it allows one to determine whether the process being evaluated is in fact stable and to detect when significant or special cause variation occurs.
Summary statistics currently provided to purchasers of care and regulatory agencies do not ensure that the processes being evaluated are stable. We need to look at data over time with statistically validated methods such as control charts to better monitor our processes of care and thereby provide accurate statistics.
在管理式医疗时代，衡量质量已成为高度优先事项。然而，用于衡量外科手术程序和流程改进的方法与我们用于基础研究测量的方法可能会产生适得其反的效果。统计过程控制技术已在工业中用于衡量过程改进多年，现在正应用于医疗保健领域。
回顾了使用统计过程控制图监测冠状动脉搭桥术死亡率、重症监护病房入院时间和住院时间的示例。
使用控制图方法的主要优点是它使人们能够确定所评估的过程是否实际上稳定，并在出现显著或特殊原因变异时进行检测。
目前提供给医疗保健购买者和监管机构的汇总统计数据并不能确保所评估的过程是稳定的。我们需要使用统计验证方法（如控制图）对一段时间内的数据进行观察，以更好地监测我们的医疗过程，从而提供准确的统计数据。
