How unusual are the "unusual events" detected by control chart techniques in healthcare settings?

Challenging Cases in Statistical Process Control for Quality Improvement in Neonatal Intensive Care

Effective quality improvement (QI) depends on rigorous analysis of time-series data through methods such as statistical process control (SPC). As use of SPC has become more prevalent in health care, QI practitioners must also be aware of situations that warrant special attention and potential modifications to common SPC charts, which include skewed continuous data, autocorrelation, small persistent changes in performance, confounders, and workload or productivity measures. This article reviews these situations and provides examples of SPC approaches for each.

Routine assessment of patient-reported outcomes in behavioral health: room for improvement

Outcomes assessment has become an important tool in assessing the quality of health care. To date, most quality initiatives have focused on adverse events, clinical processes, and/or cost variables. Considerably less attention has been paid to indices of clinical improvement, especially from a patient's perspective and in behavioral health settings. The relative inattention given to clinical improvement is attributable to a number of reasons, including (but not limited to) a lack of consensus regarding measures of improvement, few simple methods for data collection and analysis, and an inability to provide timely feedback. In this article, the authors describe a Web-based system designed to routinely collect quality-of-life ratings from patients in outpatient behavioral health clinics, allowing for real-time feedback at the patient levels regarding clinical improvement. The system also allows for administrative evaluation of overall clinic performance. The costs and benefits of this system are discussed.

Clinical outcomes assessment in behavioral healthcare: searching for practical solutions

Most quality management initiatives in behavioral healthcare have focused on adverse events, clinical processes, or cost variables. Considerably less attention has been paid to indices of clinical improvement, likely because of a lack of agreed-upon measures of improvement, a lack of availability of simple methods for data collection and analysis, and an inability to provide timely feedback regarding clinical improvement, among other reasons. A computerized system was designed to collect relevant psychiatric symptom ratings in a manner that allows for real-time feedback at the patient and clinician Levels regarding clinical improvement and for higher-level, administrative evaluation of overall clinic performance. The costs and benefits of this system are discussed.