Use of risk-adjusted CUSUM and RSPRT charts for monitoring in medical contexts
Use of risk-adjusted CUSUM and RSPRT charts for monitoring in medical contexts
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DOI：
10.1177/096228020301200205
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发表时间：
2003-03-01
影响因子：
2.3
通讯作者：
Spiegelhalter, DJ
中科院分区：
文献类型：
--
作者：
Grigg, OA;Farewell, VT;Spiegelhalter, DJ
本文讨论了序贯概率比检验(SPRT)图的使用：累积和(CUSUM)图、RSPRT(重置SPRT)和FIR(快速初始响应)CUSUM。描述了这些方法的理论发展，并探讨了在设计图表时可能涉及的一些考虑因素，包括平均运行长度(ARL)的近似值、检测过程中的改进的重要性以及检测信号后的过程参数的恶化和估计。两个例子被用来演示医疗环境中的质量控制的实际问题，第一个是运行的例子，第二个是充分工作的例子。第一个例子涉及1994-1998年间单一心脏外科医生的患者30天的死亡率，第二个例子涉及单一全科医生Harold Shipman执业期间的患者死亡。图表相对于彼此的表现显示出对被监测过程的“失控”状态的定义很敏感。有鉴于此，需要强调的是，在任何具体应用中，都要选择一种适当的方法来比较图表。
In this paper we discuss the use of charts derived from the sequential probability ratio test (SPRT): the cumulative sum (CUSUM) chart, RSPRT (resetting SPRT), and FIR (fast initial response) CUSUM. The theoretical development of the methods is described and some considerations one might address when designing a chart, explored, including the approximation of average run lengths (ARLs), the importance of detecting improvements in a process as well as detecting deterioration and estimation of the process parameter following a signal.Two examples are used to demonstrate the practical issues of quality control in the medical setting, the first a running example and the second a fully worked example at the end of the paper. The first example relates to 30-day mortality for patients of a single cardiac surgeon over the period 1994-1998, the second to patient deaths in the practice of a single GP, Harold Shipman.The charts' performances relative to each other are shown to be sensitive to the definition of the 'out of control' state of the process being monitored. In light of this, it is stressed that a suitable means by which to compare charts is chosen in any specific application.