Exponentially weighted moving average charts to compare observed and expected values for monitoring risk-adjusted hospital indicators

Cook, D. A., Coory, M. and Webster, R. A. (2011) Exponentially weighted moving average charts to compare observed and expected values for monitoring risk-adjusted hospital indicators. BMJ Quality and Safety, 20 6: 469-474. doi:10.1136/bmjqs.2008.031831

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Author Cook, D. A.
Coory, M.
Webster, R. A.
Title Exponentially weighted moving average charts to compare observed and expected values for monitoring risk-adjusted hospital indicators
Journal name BMJ Quality and Safety   Check publisher's open access policy
ISSN 2044-5415
2044-5423
Publication date 2011-06-01
Sub-type Article (original research)
DOI 10.1136/bmjqs.2008.031831
Volume 20
Issue 6
Start page 469
End page 474
Total pages 6
Place of publication London, England, U.K.
Publisher B M J Group
Collection year 2012
Language eng
Formatted abstract
Objective To introduce a new type of risk-adjusted (RA) exponentially weighted moving average (EWMA) chart and to compare it to a commonly used type of variable life adjusted display chart for analysis of patient outcomes.

Data Routine inpatient data on mortality following admission for acute myocardial infarction, from all public and private hospitals in Queensland, Australia.

Methods The RA-EWMA plots the EWMA of the observed and predicted values. Predicted values were obtained from a logistic regression model for all hospitals in Queensland. The EWMA of the predicted values is a moving centre line, reflecting current patient case mix at a particular hospital. Thresholds around this moving centre line provide a scale by which to assess the importance of trends in the EWMA of the observed values.

Results The RA-EWMA chart can be designed to have equivalent performance, in terms of average run lengths, as variable life adjusted display chart. The advantages of the RA-EWMA are that it communicates information about the current level of an indicator in a direct and understandable way, and it explicitly displays information about the current patient case mix. Also, because it is not reset, the RA-EWMA is a more natural chart to use in health, where it is exceedingly rare to stop or dramatically and abruptly alter a process of care.

Conclusion
The RA-EWMA chart is a direct and intuitive way to display information about an indicator while accounting for differences in case mix.
Keyword Acute myocardial-infarction
Public-health surveillance
Mortality
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Public Health Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 12 times in Thomson Reuters Web of Science Article | Citations
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Created: Fri, 20 Jan 2012, 01:11:11 EST by Geraldine Fitzgerald on behalf of School of Public Health