Hart Marilyn K, Lee Kwan Y, Hart Robert F, Robertson James W
College of Business, University of Wisconsin, Oshkosh, USA.
Qual Manag Health Care. 2003 Jan-Mar;12(1):5-19. doi: 10.1097/00019514-200301000-00004.
This article proposes a new class of control charts that may be used for monitoring and improving the quality of care. Unlike conventional control charts that rely on observed performance data, these charts use risk-adjusted data in addition to the observed data. The resulting time-ordered charts are capable of reducing time-to-time variation that may stem from uncontrollable changes in patient mix over time. Depending on how observed and risk-adjusted data are combined, proposed charts are categorized under the framework of either additive or multiplicative models. Risk-adjusted rates are obtained using multivariate logistic regression models. It was found that the risk-adjusted control charts could be effective in reducing biases that arise from variation in patient mix. These charts can potentially achieve higher sensitivity and specificity compared with ordinary control charts.
本文提出了一类可用于监测和改善护理质量的新型控制图。与依赖观察到的绩效数据的传统控制图不同，这些控制图除了使用观察到的数据外，还使用风险调整后的数据。由此产生的按时间顺序排列的图表能够减少因患者组合随时间不可控变化而产生的逐时变化。根据观察到的数据和风险调整后的数据的组合方式，所提出的图表在加法或乘法模型的框架下进行分类。风险调整率使用多元逻辑回归模型获得。研究发现，风险调整控制图在减少因患者组合变化而产生的偏差方面可能是有效的。与普通控制图相比，这些图表可能具有更高的灵敏度和特异性。
