Department of Management and Marketing, Eastern Connecticut State University, Willimantic, Connecticut.
J Healthc Manag. 2022;67(5):353-366. doi: 10.1097/JHM-D-21-00235.
Given that length of stay (LOS) of acute myocardial infarction (AMI) patients has a significant impact on the utilization of hospital resources and the health status of communities, this study focused on how best to monitor LOS of AMI patients admitted to U.S. hospitals by employing statistical process control (SPC).
Data were abstracted from the Healthcare Cost and Utilization Project Nationwide Readmissions Database between 2010 and 2016. A total of 1,491 patients were examined in the study. Patients who were admitted to nonfederal government (public) hospitals in metropolitan areas of at least 1 million residents with the primary diagnosis of AMI were abstracted. They were excluded if they developed AMI secondary to an interventional procedure or surgery, died during their index hospitalization, and were admitted and discharged on the same day. Patients were also excluded if they were discharged to short-term hospitals, nursing facilities, intermediate care facilities, home healthcare, or against medical advice. Individual moving range (I-MR) charts were used to monitor LOS of individual AMI patients in each subgroup from 2010 to 2016.
The results showed I-MR charts could be used to indicate statistically out-of-control signals on LOS. Specifically, I-MR charts showed that LOS decreased between 2010 and 2016. LOS appeared to be longer at teaching hospitals compared to nonteaching hospitals and varied by gender. Female patients appeared to stay longer than male patients in the hospitals.
The application of SPC and control charts can facilitate improved decision-making in healthcare organizations. This study shows the value of integrating control charts in administrative and medical decision-making processes. It may also help healthcare providers and managers achieve higher quality and lower cost of care.
鉴于急性心肌梗死（AMI）患者的住院时间（LOS）对医院资源的利用和社区的健康状况有重大影响，本研究专注于如何通过统计过程控制（SPC）来最佳监测美国医院收治的 AMI 患者的 LOS。
从 2010 年至 2016 年，从医疗保健成本和利用项目全国再入院数据库中提取数据。本研究共检查了 1491 名患者。从至少有 100 万居民的大都市地区的非联邦政府（公立）医院入院的、以 AMI 为主要诊断的患者被纳入研究。如果患者因介入性手术或手术而继发 AMI、在指数住院期间死亡、在同一天入院和出院、出院至短期医院、护理设施、中级护理设施、家庭保健或未经医嘱出院，则将其排除在外。个体移动范围（I-MR）图表用于监测 2010 年至 2016 年每个亚组中每位 AMI 患者的 LOS。
结果表明，I-MR 图表可用于指示 LOS 的统计失控信号。具体而言，I-MR 图表显示 LOS 在 2010 年至 2016 年间下降。与非教学医院相比，教学医院的 LOS 似乎更长，且性别不同。与男性患者相比，女性患者在医院的停留时间似乎更长。
SPC 和控制图的应用可以促进医疗保健组织中决策的改进。本研究表明，将控制图集成到行政和医疗决策过程中具有价值。它还可以帮助医疗保健提供者和管理者实现更高的质量和更低的护理成本。
