دانلود مقاله : 

Monitoring surgical performance using risk-adjusted cumulative sum charts 2000

نویسندگان :

STEFAN H. STEINER , RICHARD J. COOK  VERN T. FAREWELL TOM TREASURE

چکیده :

The cumulative sum (CUSUM) procedure is a graphical method that is widely used for quality monitoring

in industrial settings. More recently it has been used to monitor surgical outcomes whereby it

‘signals’ if sufficient evidence has accumulated that there has been a change in the surgical failure rate. A

limitation of the standard CUSUM procedure in this context is that since it is simply based on the observed

surgical outcomes, it may signal as a result of changes in the referral pattern, such as an increased proportion

of high-risk patients, rather than due to a change in the actual surgical performance. We describe

a new CUSUM procedure that adjusts for each patient’s pre-operative risk of surgical failure through the

use of a likelihood-based scoring method. The procedure is therefore ideally suited for settings where

there is a variable mix of patients over time

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