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研究生:余冀昇
研究生(外文):Chi-Sheng Yu
論文名稱:建構醫療風險考量下之多變量累積和管制圖
論文名稱(外文):Using risk-adjusted multivariate cumulative sum control chart in medical outcomes
指導教授:古東源古東源引用關係
指導教授(外文):Tong-Yuan Koo
學位類別:碩士
校院名稱:國立雲林科技大學
系所名稱:工業工程與管理研究所碩士班
學門:工程學門
學類:工業工程學類
論文種類:學術論文
論文出版年:2007
畢業學年度:96
語文別:中文
論文頁數:57
中文關鍵詞:統計製程管制多變量累積和管制圖風險調整
外文關鍵詞:Statistical Process ControlRisk adjustmentMultivariate Cumulative Sum Control Chart
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  • 被引用被引用:2
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統計製程管制(SPC)的方法已被應用到醫療產業上,例如:醫生實行手術的成功率或是醫院內病人的跌倒率...等;在醫療產業方面,其監控的對象主要是病人,它跟工業產品不一樣的地方在於工業產品具有同質性,所以有相同的比較基礎,但是在監控病人時,因為病人異質性的關係,所以比較的基準會有所不同;因此,利用「風險調整」方法能夠將病人的異質性風險調整到同一個比較基準上。另外醫療資料在發生微小變動時,對於結果就有顯著的影響,因此單變量方面利用累積和管制圖(CUSUM)來進行監控,在同時監控兩種醫療方面結果(Outcome)的情況下,則必須使用多變量累積和管制圖(MCUSUM)來進行監控。本研究應用風險調整方法以MCUSUM管制圖來監控病人跌倒率及頭部外傷發生率。結果發現,單變量CUSUM管制圖藉由風險調整的方法能夠比較準確監控因環境引起的發生率,而MCUSUM管制圖則對於兩變數具有相關性時,能夠偵測出單變量CUSUM管制圖忽略掉的部份。
Cumulative sum control chart (CUSUM) is a useful technique for quick detection of process variation in industrial. Recently, it has been applied in health care to monitor the performance of clinical practitioners, such as surgeons and mortality rate. Unlike in industrial context, where the “subjects”(products) may be relatively homogeneous in nature, for medical applications the subjects (patients) with different clinical presentations and physiology have different prior risk and hence will often vary greatly. To detect changes in falling rate of patients, with allowance being made for patient case mix, the risk adjustment is implemented in MCUSUM chart. Comparisons between the standard MCUSUM and risk-adjusted MCUSUM charts are made. The result of this research displays that using the risk-adjusted CUSUM control char can more accurately monitor the falling rate and head trauma rate of the environment. When the two variables are dependent, using MCUSUM control chart can detect the out-of-control signals which ignore on the CUSUM control chart.
目錄
中文摘要 I
英文摘要 II
誌謝 III
目錄 IV
表目錄 VI
圖目錄 VII
第一章 緒論 1
1.1 研究背景與動機 1
1.2 研究目的 2
1.3 研究架構 2
第二章 文獻回顧與探討 4
2.1 醫療上使用之管制圖 4
2.2 病人風險因子調整相關文獻探討 4
2.2.1 病人風險的定義 4
2.2.2 風險調整的資料類型 5
2.3 應用於醫療風險調整之管制圖相關文獻探討 5
2.3.1 風險調整管制圖 ─ O-E圖 6
2.3.2 風險調整管制圖 ─ CUSUM管制圖 10
2.3.3 風險調整管制圖 ─ RSPRT管制圖 12
2.4 MCUSUM管制圖模式探討 13
第三章 研究方法 17
3.1 資料類型 17
3.2 CUSUM管制圖建構 17
3.2.1未調整風險之CUSUM管制圖建構 17
3.2.2調整風險之CUSUM管制圖建構 19
3.3 風險調整之MCUSUM管制圖建構 21
3.4管制圖之管制界限 22
3.4.1 CUSUM之管制界限 22
3.4.2 MCUSUM之管制界限 23
3.5 績效衡量指標 24
第四章 實例結果與模擬分析 25
4.1 實際資料描述 25
4.2 邏輯迴歸模式建構 27
4.3 實際資料結果 29
4.3.1 跌倒發生率實際資料 29
4.3.2 頭部外傷發生率實際資料 31
4.3.3 實際資料風險調整MCUSUM管制圖 34
4.4 模擬資料 35
4.5 監控跌倒發生率 38
4.6 監控頭部外傷發生率 40
4.7 同時監控跌倒與頭部外傷發生率 42
第五章 結論與建議 44
參考文獻 46
一、中文部分
[1]周瓊珍,2000,”醫療品質管理之研究─以加護病房生命徴象之心跳監測過程為例”,國立中山大學企業管理研究所博士論文。
二、英文部分
[2]Aylin, P., Best, N., Bottle, A., and Marshall, C., 2003, “Following Shipman: A Pilot System for Monitoring Mortality Rates in Primary Care”, The Lancet, Vol.382, pp.485-491.
[3]Baker, R., 2001, Harold Shipmen’s Clinical Practice 1974-1998: a Review commissioned by the Chief Medical Officer, London: Stationery Office.
[4]Carey, R. G., and Lloyd, R. C., 1995, Measuring Quality Improvement in Healthcare─A Guide to Statistical Process Control Applications, ASQ Quality Press, Milwaukee.
[5]Carey, R. G., 2003, Improving Healthcare with Control Charts─Basic and Advanced SPC Methods and Case Studies, American Society for Quality, Wisconsin.
[6]Cook, D. A., Steiner, S. H., Farewell, V. T., and Morton, A. P., 2003, “Monitoring the Evolutionary Process of Quality: Risk Adjusted Charting to Track Outcomes in Intensive Care.”, Critical Care in Medicine, Vol.31, pp.1676-1682.
[7]Crosier, R. B., 1988, “Multivariate Generalizations of Cumulative Sum Quality-Control Schemes”, Technometrics, Vol.30, No.3, pp.291-302.
[8]Gallus, G., Mandelli, C., Marchi, M., and Radaelli, G., 1986, “On Surveillance Methods for Congenital Malformations”, Statistics in Medicine, Vol.5, pp.565-571.
[9]Grigg, O. A., and Farewell, V. T., 2004, “A risk-adjusted Sets method for monitoring adverse medical outcomes”, Statistical Methods in Medical Research, Vol.23, pp.1593-1602.
[10]Grigg, O., Farewell, V., and Spiegelhalter, D. J., 2003, “The Use Of Risk-Adjusted CUSUM and RSPRT Charts for Monitoring in Medical Contexts”, Statistical Methods in Medical Research, Vol.12, pp.147.170.
[11]Grigg, O., and Farewell, V., 2004, “An Overview of Risk- Adjusted Charts”, Journal of the Royal Statistical Society, Series A, Vol.167, Part 3, pp.523-539.
[12]Hawkins, D. M.., 1993, “Cumulative Sum Control Charting: An Underutilized SPC Tool.”, Quality Engineering, Vol.5. No. 3 pp.463-477.
[13]Hong, B., and Hardin, M., 2004, “A report of the properties of the multivariate forecast-based processing scheme.” In: Proceedings of the Joint Statistical Meetings, Toronto, Canada: American Statistical Association; August 2004.
[14]Kelley, D. L., 1999, How to Use Control Charts for Healthcare, American Society for Quality, Wisconsin.
[15]Lie, R. T., Heuch, I., and Irgens, L. M., 1993, “A New Sequential Procedure for Surveillance for Down’s Syndrome.”, Statistics in Medicine, Vol.12, pp.13-25.
[16]Lovegrove, J., Valencia, O., Treasure, T., Sherlaw-Johnson, C., and Gallivan, S., 1997, “Monitoring the results of cardiac surgery by variable life-adjusted display”, The Lancet, Vol.350, pp.1128-1130.
[17]Montgomery, D. C., 2001, Introduction To Statistical Quality Control, 4th Edition, John Wiley & Sons Inc, New York.
[18]Morton, N. E., and Lindsten, J., 1976, “Surveillance of Down’s Syndrome as a Paradigm of Population Monitoring.”, Human Heredity, Vol.26, pp.360-371.
[19]Moustakides, G. V., 1986, “Optimal Stopping Times for Detecting Changes in Distributions.”, Annals of Statistics, Vol.14, pp.1379-1387.
[20]Nix, A., Rowlands, R. J., and Kemp, K. W., 1986, “Internal Quality Control in Clinical Chemistry”, Statistics in Medicine, Vol.6, pp.425-440.
[21]Page, E. S., 1961, ”Cumulative Sum Charts”, Technometrics, Vol.3, pp.1-9.
[22]Parsonnet, V., Dean, D., and Bernstein, A. D., 1989, “A method of uniform stratification of risks for evaluating the results of surgery in acquired adult heart disease” Circulation, Vol.79, pp.1-12.
[23]Poloniecki, J., Valencia, O., and Littlejohns, P., 1998, “Cumulative risk adjusted mortality chart for detecting changes in death rate: observational study of heart surgery”, British Medical Journal. Vol.316, pp.1697-1700.
[24]Rogerson, P. A., and Yamada, I., 2004, ”Monitoring Change in Spatial Patterns of Disease: Comparing Univariate and Multivariate Cumulative Sum Approaches.”, Statistics in Medicine, Vol.23, pp.2195-2214.
[25]Stoto, M., 2004, “Multivariate methods for aberration detection: a simulation report using the District of Columbia''s syndromic surveillance data.” In: Proceedings of the 2004 National Syndromic Surveillance Conference [Oral Presentation]. Boston, MA.
[26]Spiegelhalter, D. J., Grigg, O., Kinsman, R., and Treasure, T., 2003, “Risk-Adjusted Sequential Probability Ratio Tests: Application to Bristol, Shipman and Adult Cardiac Surgery”, International Journal for Quality in Health Care, Vol.15 pp.7-13.
[27]Steiner, S. H., Cook, R. J., Farewell, V. T., and Treasure, T., 2000, “Monitoring Surgical Performance Using Risk-Adjusted Cumulative Sum Charts” Biostatistics, Vol.1, pp.441-452.
[28]Woodall, W. H., 2006, “The Use of Control Charts in Health-Care and Public-Health Surveillance”, Journal of Quality Technology, Vol.38, No.2 pp.89-104, April.
[29]Woodall, W. H., and Ncube, M. M., 1985, “Multivariate CUSUM Quality-Control Procedures”, Technometrics, Vol.27, No.3 pp.285-2。
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