Army Public Health Center, Aberdeen Proving Ground, Maryland, USA.
Inj Prev. 2017 Dec;23(6):416-422. doi: 10.1136/injuryprev-2016-042089. Epub 2017 Feb 23.
An essential aspect of an injury prevention process is surveillance, which quantifies and documents injury rates in populations of interest and enables monitoring of injury frequencies, rates and trends. To drive progress towards injury reduction goals, additional tools are needed. Statistical process control charts, a methodology that has not been previously applied to Army injury monitoring, capitalise on existing medical surveillance data to provide information to leadership about injury trends necessary for prevention planning and evaluation.
Statistical process control Shewhart u-charts were created for 49 US Army installations using quarterly injury medical encounter rates, 2007-2015, for active duty soldiers obtained from the Defense Medical Surveillance System. Injuries were defined according to established military injury surveillance recommendations. Charts display control limits three standard deviations (SDs) above and below an installation-specific historical average rate determined using 28 data points, 2007-2013. Charts are available in Army strategic management dashboards.
From 2007 to 2015, Army injury rates ranged from 1254 to 1494 unique injuries per 1000 person-years. Installation injury rates ranged from 610 to 2312 injuries per 1000 person-years. Control charts identified four installations with injury rates exceeding the upper control limits at least once during 2014-2015, rates at three installations exceeded the lower control limit at least once and 42 installations had rates that fluctuated around the historical mean.
Control charts can be used to drive progress towards injury reduction goals by indicating statistically significant increases and decreases in injury rates. Future applications to military subpopulations, other health outcome metrics and chart enhancements are suggested.
伤害预防过程的一个重要方面是监测，它量化和记录了目标人群中的伤害率，并能够监测伤害频率、发生率和趋势。为了推动实现减少伤害的目标，还需要额外的工具。统计过程控制图是一种以前未应用于陆军伤害监测的方法，它利用现有的医疗监测数据为领导层提供有关伤害趋势的信息，这是预防规划和评估所必需的。
使用来自国防医疗监测系统的 2007-2015 年现役士兵每季度伤害医疗遭遇率，为 49 个美国陆军设施创建了统计过程控制谢哈特 u 图。根据既定的军事伤害监测建议定义伤害。图表显示控制限在安装特定历史平均值上下三个标准差（SD），该平均值使用 28 个数据点确定，范围为 2007-2013 年。图表可在陆军战略管理仪表板中查看。
2007 年至 2015 年，陆军伤害率范围为每 1000 人年 1254 至 1494 例独特伤害。各设施的伤害率范围为每 1000 人年 610 至 2312 例。控制图在 2014-2015 年期间至少有四个设施的伤害率超过上限控制限一次，至少有三个设施的伤害率低于下限控制限一次，42 个设施的伤害率在历史平均值附近波动。
控制图可用于通过指示伤害率的统计显著增加和减少来推动实现减少伤害的目标。建议未来在军事亚群、其他健康结果指标和图表增强方面的应用。
