A Risk-Adjusted Exponentially Weighted Moving Average Control Chart for Detection of the Scale Parameter in Surgical Quality Monitoring.

Risk-adjusted control charts have been widely used in monitoring surgical quality in detecting risks of surgical performance. Most of the previous approaches focus on shifts in the location parameter as well as the existence of the scale parameter, which cannot get the full measure of the scale parameter under different levels. Ignoring the magnitude of the scale parameter, the monitoring methods cannot detect different variations of surgical mortality that is measured by scale parameter and required to reflect surgical quality improvement. The method of detecting variations in surgical quality is of interest in surgical quality improvement. This paper uses a new weighted h-likelihood method to obtain a weighted score test for the surgical risks from the logistic model. Then an exponentially weighted moving average chart can be constructed to monitor the changes in the variance of risks, which could be of interest in practical surgical monitoring programs. Simulation results indicate that the proposed approach performs more efficiently than existing methods under various magnitudes of shifts in scale parameters on top of different pre-set threshold stability. In addition, the application of the proposed method to real surgical data from the Surgical Outcome Monitoring and Improvement Program in Hong Kong shows the improvement and deterioration in a hospital's outcomes.