Key result
RA-CUSUM outperforms VLAD in quickly detecting simulated changes in surgical adverse event rates.
Why the study?
Monitoring of individual surgeon or hospital surgical outcomes using funnel plots may delay detection of process changes, and the comparative performance of VLAD versus RA-CUSUM charts needed evaluation.
Does the RA-CUSUM chart improve the detection of changes in surgical adverse event rates compared to the VLAD chart?
Does the RA-CUSUM chart improve the detection of changes in surgical adverse event rates compared to the VLAD chart?
The RA-CUSUM approach demonstrates superior statistical performance over the VLAD approach for prospectively monitoring and detecting changes in surgical adverse event rates.
Answers are grounded in this paper and cite their sources.
RA-CUSUM may enable earlier detection of surgical performance shifts than VLAD; hypothesis-generating for routine monitoring pending validation.
BACKGROUND: There is considerable recent interest in the monitoring of individual surgeon or hospital surgical outcomes. If one aggregates data over time and assesses performance with a funnel plot, then the detection of any process deterioration or improvement could be delayed. The variable life adjusted display (VLAD) is widely used for monitoring on a case-by-case basis, but we show that use of the risk-adjusted Bernoulli cumulative sum (RA-CUSUM) chart leads to much better performance. DISCUSSION: We use simulation to illustrate that the RA-CUSUM chart has better performance than the VLAD in detecting changes in the rates of adverse events. We recommend the RA-CUSUM approach over the VLAD approach for monitoring surgical performance. If the VLAD is used, we recommend running the RA-CUSUM chart in the background to generate signals that the process performance has changed.
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Steiner et al. (2016) studied Surgical performance monitoring. Risk-adjusted Bernoulli cumulative sum (RA-CUSUM) chart vs. Variable life adjusted display (VLAD) was evaluated on Detection of changes in rates of adverse events (simulated). The risk-adjusted cumulative sum (RA-CUSUM) chart demonstrated superior performance compared to the variable life adjusted display (VLAD) in quickly detecting simulated changes in surgical adverse event rates.
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