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研究生:賴世昌
研究生(外文):Su-Chung Lie
論文名稱:應用統計製程管制於肩關節手術流程管制之研究
論文名稱(外文):Application of statistical process control process control in shoulder surgery study
指導教授:邱靜娥邱靜娥引用關係
指導教授(外文):Jing-Er Chiu
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:2011
畢業學年度:99
語文別:中文
論文頁數:47
中文關鍵詞:肩關節手術醫療CUSUM管制圖風險調整
外文關鍵詞:Shoulder SurgeryMedical Cumulative Sum Control ChartRisk Adjustment
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在醫療健康行業上面統計製程管制(Statistical Process Control, SPC)已經很廣泛地運用,使用統計方法來進行醫療工程的管理,為了在監控病患與醫師獲得一個穩定的醫療品質是實施統計製程管制之目的。監控醫療健康的醫療CUSUM管制圖與傳統上的CUSUM管制圖有些許的差異,不過基本上CUSUM管制圖都是將一序列的病患資料以累加方式加以整合,以偵測出病患在手術過程中一的變化。健康醫療的品質特性,是根據病患的性別、年齡與身體狀況等等的資料來做蒐集。與一般工業界蒐集資料不同的地方在於,實際上病患之間存在異質性的問題,因此需要考慮到病患之間存在的異質性風險,每位病患的身體結構、遺傳的基因與後天環境帶來的影響都不盡相同。因此病患的風險因子對於在進行監控的比較基準就會有所不同。本研究應用風險調整的方式對於肩關節手術的結果做風險調整,發現風險調整前後有些微的不同,利用風險調整中的權重,對於比較權重中勝算比例大小的不同在風險調整前後所表示的意義可做為醫療上面不同的解釋。已風險調整權重中勝算比的比例不會因為參數變動,醫療CUSUM管制圖監控的績效就不穩定。
In the health industry, statistical process control (Statistical Process Control, SPC) has been used widely .The medical officers use the statistical methods for health care project management. In order to monitor the patients and physicians to obtain a stable medical quality. The health care quality characteristics are based on patient sex, age and physical condition. In fact, the patients have heterogeneity problems between each other. The application of shoulder surgery risk adjustment, we find that before risk adjustment different in after risk adjustment. Comparison of the weight ratio in the health care, before risk adjustment and after risk adjustment that it can be used medical sense in different interpretations. After risk-adjusted weight ratio will not change in the parameters, medical health CUSUM control chart for monitoring the performance of instability.
摘要 i
ABSTRACT ii
誌謝 iii
目錄 iv
表目錄 v
圖目錄 vi
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 CUSUM管制圖 4
2.2 CUSUM管制圖應用於醫療方面 5
2.3 邏輯斯迴歸應用於醫療方面 9
2.3.1邏輯斯迴歸(Logistic Regression) 9
2.3.2 邏輯斯迴歸應用在外科手術 10
2.4 不同於CUSUM應用於醫療上面其它的管制圖 11
2.4.1 累積觀察-期望管制圖O-E PLOT 11
2.4.2連續機率比檢定型管制圖RSPRT 13
第三章、研究方法 15
3.1資料類型 15
3.2 醫療CUSUM管制圖建構 15
3.3 醫療CUSUM管制圖風險調整前後的權重建構: 17
3.3.1 醫療CUSUM管制圖風險調整前 17
3.3.2 醫療CUSUM管制圖風險調整 19
3.4 風險調整的CUSUM管制圖之管制界限 22
第四章、實例結果分析 24
4.1 實際資料描述 24
4.2 邏輯斯迴歸模式建構 26
4.3 實際資料分析的結果 28
4.3.1 風險調整前權重中勝算比比例的比較 28
4.3.2 風險調整前與風險調整後的比 30
4.3.3 風險調整後權重中勝算比比例的比較 31
4.4 模擬的資料數據 35
第五章、結論與建議 36
參考文獻 37
1.余冀昇,2007,建構醫療風險考量下之多變量累積和管制圖,國立雲林科技大學工業工程與管理研究所碩士論文。
2.鄭宇庭、蔡政憲、程毅君,2008,心臟冠狀動脈繞道手術之醫療風險評估一個台灣的實證研究,國立政治大學風險管理學報。
3.Bruce, L.& Jennie K., 1985, “The CUSUM test of homogeneity with an application in spontaneous,” Statistics in Medicine, Vol. 4, pp. 469-488.
4.Charles, A. W., Chan, K. H.,& Byung, K. S., 1994. “Monitoring the performance of a reorder point system: A control chart approach,” International Journal of Operations & Production Management, Vol. 14, Issue. 2, pp. 51-61.
5.Axelrod, D. A., Guidinger, M. K., Metzger, R. A., Wiesner, R. H., Webb, R. L. & Merion,.R. M.,2006, ” Transplant Center Quality Assessment Using a Continuously Updatable, Risk-Adjusted Technique (CUSUM), Vol. 6, pp. 313-323.
6.Fricker, R. D., Hegler, B. L.& Dunfee, D. A., 2008, ”Comparing syndromic surveillance detection methods : EARS'' versus a CUSUM-based methodology,” Statistics in medicine, Vol. 27, no17, pp. 3407-3429.
7.Hardoon, S. L., Lewsey, J. D.& Van, D. M. J. H. P., 2007, “Continuous monitoring of long-term outcomes with application to hip prostheses” Statistics in medicine, Vol. 26, no28, pp. 5081-5099
8.James, C. B.& Alicia, D. B., 2003, “Risk-adjusted sequential probability ratiotests and longitudinal surveillance methods,” International Journal for Quality in Health Care, Vol. 15, NO. 1, pp. 5-6.
9.Landon, H. S., William, H. W.& Marion, R.R., 2007. “A comparison of surveillance methods for small incidence rates,” Statistics in Medicine, Vol. 27 Issue 8, pp. 1225-1247.
10.Michael, D. J. Jr., William, H. W.& Marion, R. R. J., 2008, ”Detecting a rate increase using a Bernoulli scan statistic,” Statistics in medicine, Vol. 27, no14, pp. 2555-2575.
11.Morton, A. P., Whitby, M., Mclaws, M., Dobson, A., Mcelwain, S., Looke, D.,Stackelroth, J.& Sartor, A., 2001, “The application of statistical process control charts to the detection and monitoring of hospital-acquired infections,” Journal of Quality in Clinical Practice, Vol.21, pp.112-117.
12.Pinaki, B.& John, D. K., 2008.“A risk-adjusted CUSUM in continuous time based on the Cox model.,” Statistics in Medicine, Vol. 27, pp. 3382-3406.
13.Rina, C., 1987,“The relative efficiency of the sets and the CUSUM techniques in monitoring the occurrence of a rare event,” Statistics in Medicine, Vol.6, pp.517-525.
14.Rogers, C. A., Ganesh, J. S., Banner, N. R.& Bonser, R. S., 2005, “Cumulative risk adjusted monitoring of 30-day mortality after cardiothoracic transplantation:UK,” European Journal of Cardio-Thoracic Surgery, Vol. 27, Issue 6, pp. 1022-1029
15.Steiner, S. H., Cook, R. J., Farewell, V. T. & Treasure, T., 2000, “Monitoring Surgical Performance Using Risk-Adjusted Cumulative Sum Charts” Biostatistics, Vol.1, pp.441-452.
16.Sung ,W. H., Kwok, L.T., Bancha, A.& Seoung, B. K., 2009, “A Comparison of CUSUM, EWMA, and Temporal Scan Statistics for Detection of Increases in Poisson Rates,” Quality and Reliability Engineering International, Vol. 27 , pp. 2555-2575.
17.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.
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