Control charts to identify adverse outcomes in elective colon resection

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• 作者：Donald E. Fry ; M.D. ; F.A.C.S.^a ; ^b ; ^c ; ^{dfry@consultmpa.com} ; Michael Pine ; M.D. ; M.B.A.^a ; ^d ; Barbara L. Jones ; M.A.^a ; Roger J. Meimban ; Ph.D.^a
• 关键词：Control charts ; Risk-adjusted outcomes ; Colon surgery ; Adverse outcomes ; Linear regression analysis
• 刊名：The American Journal of Surgery
• 出版年：2012
• 期刊代码：9_00029610
• 类别：med
• 出版时间：March, 2012
• 卷：203
• 期：3
• 页码：392-396
• 文件大小：165 K

摘要

Background

Control charts have been proposed for the measurement of quality in surgical care.

Methods

For each of 181 study hospitals in the 2005 National Inpatient Sample of the Healthcare Cost and Utilization Project database, an average moving range control chart for risk-adjusted postoperative length of stay (RApoLOS) was created for patients discharged alive after elective colectomy. RApoLOS outliers using upper control limits of 2.0蟽, 2.5蟽, and 3.0蟽 were correlated to coded complications (CCs). Hospital costs were correlated to RApoLOS outliers and CCs.

Results

Of 13,118 live discharges, 902 (6.9%) were outliers using a 3.0蟽 upper control limit, 1,350 (10.3%) were 2.5蟽 outliers, and 2,053 (15.7%) were 2.0蟽 outliers. CCs were identified in 92.7%of 3.0蟽 outliers, in 81.3%of 2.5蟽 outliers, and 70.6%of 2.0蟽 outliers. Increased costs were associated with RApoLOS outliers and poorly with CCs.

Conclusions

Average moving range control charts for RApoLOS outliers are valid tools for measurement of surgical quality and costs.