A simple signaling rule for variable life‐adjusted display derived from an equivalent risk‐adjusted CUSUM chart

A simple signaling rule for variable life‐adjusted display derived from an equivalent... The variable life‐adjusted display (VLAD) is the first risk‐adjusted graphical procedure proposed in the literature for monitoring the performance of a surgeon. It displays the cumulative sum of expected minus observed deaths. It has since become highly popular because the statistic plotted is easy to understand. But it is also easy to misinterpret a surgeon's performance by utilizing the VLAD, potentially leading to grave consequences. The problem of misinterpretation is essentially caused by the variance of the VLAD's statistic that increases with sample size. In order for the VLAD to be truly useful, a simple signaling rule is desperately needed. Various forms of signaling rules have been developed, but they are usually quite complicated. Without signaling rules, making inferences using the VLAD alone is difficult if not misleading. In this paper, we establish an equivalence between a VLAD with V‐mask and a risk‐adjusted cumulative sum (RA‐CUSUM) chart based on the difference between the estimated probability of death and surgical outcome. Average run length analysis based on simulation shows that this particular RA‐CUSUM chart has similar performance as compared to the established RA‐CUSUM chart based on the log‐likelihood ratio statistic obtained by testing the odds ratio of death. We provide a simple design procedure for determining the V‐mask parameters based on a resampling approach. Resampling from a real data set ensures that these parameters can be estimated appropriately. Finally, we illustrate the monitoring of a real surgeon's performance using VLAD with V‐mask. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Statistics in Medicine Wiley

A simple signaling rule for variable life‐adjusted display derived from an equivalent risk‐adjusted CUSUM chart

Download PDF
19 pages
Read Article

Loading next page...
 
/lp/wiley/a-simple-signaling-rule-for-variable-life-adjusted-display-derived-CORfPn5gJK
Publisher
Wiley
Copyright
Copyright © 2018 John Wiley & Sons, Ltd.
ISSN
0277-6715
eISSN
1097-0258
DOI
10.1002/sim.7647
Publisher site
See Article on Publisher Site

Abstract

The variable life‐adjusted display (VLAD) is the first risk‐adjusted graphical procedure proposed in the literature for monitoring the performance of a surgeon. It displays the cumulative sum of expected minus observed deaths. It has since become highly popular because the statistic plotted is easy to understand. But it is also easy to misinterpret a surgeon's performance by utilizing the VLAD, potentially leading to grave consequences. The problem of misinterpretation is essentially caused by the variance of the VLAD's statistic that increases with sample size. In order for the VLAD to be truly useful, a simple signaling rule is desperately needed. Various forms of signaling rules have been developed, but they are usually quite complicated. Without signaling rules, making inferences using the VLAD alone is difficult if not misleading. In this paper, we establish an equivalence between a VLAD with V‐mask and a risk‐adjusted cumulative sum (RA‐CUSUM) chart based on the difference between the estimated probability of death and surgical outcome. Average run length analysis based on simulation shows that this particular RA‐CUSUM chart has similar performance as compared to the established RA‐CUSUM chart based on the log‐likelihood ratio statistic obtained by testing the odds ratio of death. We provide a simple design procedure for determining the V‐mask parameters based on a resampling approach. Resampling from a real data set ensures that these parameters can be estimated appropriately. Finally, we illustrate the monitoring of a real surgeon's performance using VLAD with V‐mask.

Journal

Statistics in Medicine – Wiley

Published: Jan 20, 2018

Keywords: ; ; ; ;

References

  • Monitoring the results of cardiac surgery by variable life‐adjusted display
    Lovegrove, J; Valencia, O; Treasure, T; Sherlaw‐Johnson, C; Gallivan, S
  • Cumulative risk adjusted mortality chart for detecting changes in death rate: observational study of heart surgery
    Poloniecki, J; Valencia, O; Littlejohns, P
  • On‐line variable live‐adjusted displays with internal and external risk‐adjusted mortalities. A valuable method for benchmarking and early detection of unfavourable trends in cardiac surgery
    Albert, AA; Walter, JA; Arnrich B
  • Monitoring the performance of residents during training in off‐pump coronary surgery
    Caputo, M; Reeves, BC; Rogers, CA; Ascione, R; Angelini, GD
  • Control chart methods for monitoring cardiac surgical performance and their interpretation
    Rogers, CA; Reeves, BC; Caputo, M; Ganesh, JS; Bonser, RS; Angelini, GD
  • On behalf of the steering Group. Cumulative risk adjusted monitoring of 30‐day mortality after cardiothoracic transplantation: UK experience
    Rogers, CA; Ganesh, JS; Banner, NR; Bonser, RS
  • Acquiring proficiency in off‐pump surgery: traversing the learning curve, reproducibility, and quality control
    Murphy, GJ; Rogers, CA; Caputo, M; Angelini, GD
  • Direct comparison of risk‐adjusted and non‐risk‐adjusted CUSUM analyses of coronary artery bypass surgery outcomes
    Novick, RJ; Fox, SA; Stitt, LW; Forbes, TL; Steiner, S
  • Quality assurance in congenital heart surgery
    Kang, N; Tsang, VT; Gallivan, S
  • Monitoring risk‐adjusted outcomes in congenital heart surgery: does the appropriateness of a risk model change with time
    Tsang, VT; Brown, KL; Synnergren, MJ
  • Short‐term outcome following cardiac surgery—a comparison between consultant and trainees' performance
    Hosseini, MT; Saeed, I; Mandal, K; Kourliouros, A; Valencia, O; Jahangiri, M
  • Predictive value of the additive and logistic EuroSCOREs in patients undergoing aortic valve replacement
    Koene, BM; van Straten, AH; Soliman Hamad, MA
  • Real time monitoring of risk‐adjusted paediatric cardiac surgery outcomes using variable life‐adjusted display: implementation in three UK centres
    Pagel, C; Utley, M; Crowe, S
  • Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study
    Lawrance, RA; Dorsch, MF; Sapsford, RJ
  • Comparing risk‐prediction methods using administrative or clinical data in assessing excess in‐hospital mortality in patients with acute myocardial infarction
    Scott, IA; Thomson, PL; Narasimhan, S
  • Application of variable life adjusted display (VLAD) in early detection of deficiency in trauma care
    Tan, HB; Cross, SF; Goodacre, SW
  • Impact of introducing multiple evidence‐based clinical practice protocols in a medical intensive care unit: a retrospective cohort study
    Afessa, B; Gajic, O; Keegan, MT; Seferian, EG; Hubmayr, RD; Peters, SG
  • Sudden survival improvement in critical neurotrauma: an exploratory analysis using a stratified statistical process control technique
    Søvik S; Skaga NO; Hanoa R; Eken T
  • Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk‐adjusted p charts
    Cockings, JG; Cook, DA; Iqbal, RK
  • Monitoring the performance of intensive care units using the variable life‐adjusted display: a simulation study to explore its applicability and efficiency
    Foltran, F; Baldi, I; Bertolini, G; Merletti, F; Gregori, D
  • Monitoring the occurrence of wound infections after cardiac surgery
    Sherlaw‐Johnson, C; Wilson, AP; Keogh, B; Gallivan, S
  • Sequential analysis of uncommon adverse outcomes
    Morton, A; Mengersen, K; Waterhouse, M; Steiner, S; Looke, D
  • Automating the monitoring of surgical site infections using variable life‐adjusted display charts
    Vasilakis, C; Wilson, AP; Haddad, FS
  • Application of variable life adjusted display (VLAD) to risk‐adjusted mortality of esophagogastric cancer surgery
    Guest, RV; Chandrabalan, VV; Murray, GD; Auld, CD
  • Control chart methods for monitoring surgical performance: a case study from gastro‐oesophageal surgery
    Collins, GS; Jibawi, A; McCulloch, P
  • P.Re.Val.E.: outcome research program for the evaluation of health care quality in Lazio, Italy
    Fusco, D; Barone, AP; Sorge, C
  • Application of variable life adjusted displays (VLAD) on Victorian admitted episodes dataset (VAED)
    Andrianopoulos, N; Jolley, D; Evans, SM; Brand, CA; Cameron, PA
  • Evaluation of the learning curve in ileal pouch‐anal anastomosis surgery
    Tekkis, PP; Fazio, VW; Lavery, IC
  • A case‐mix model for monitoring of postoperative mortality after surgery for lung cancer
    Damhuis, R; Coonar, A; Plaisier, P
  • The UK scheme for mandatory continuous monitoring of early transplant outcome in all kidney transplant centers
    Collett, D; Sibanda, N; Pioli, S; Bradley, JA; Rudge, C
  • Innovations in the assessment of transplant center performance: implications for quality improvement
    Axelrod, DA; Kalbfleisch, JD; Sun, RJ
  • Review of methods for measuring and comparing center performance after organ transplantation
    Neuberger, J; Madden, S; Collett, D
  • A risk‐adjusted O‐E CUSUM with monitoring bands for monitoring medical outcomes
    Sun, RJ; Kalbfleisch, JD
  • New quality monitoring tools provided by the scientific registry of transplant recipients: CUSUM
    Snyder, JJ; Salkowski, N; Zaun, D
  • Development and implementation of prospective outcome monitoring in a regional burns service using cumulative sum (CUSUM) techniques
    Roberts, G; Thorburn, G; Collins, D; Smailes, S; Dziewulski, P
  • Monitoring mortality trends in low‐resource settings
    Pagel, C; Prost, A; Nair, N; Tripathy, P; Costello, A; Utley, M
  • Variable life‐adjusted display (VLAD) for hip fracture patients: a prospective trial
    Williams, H; Gwyn, R; Smith, A; Dramis, A; Lewis, J
  • Early identification of divergent performance in congenital cardiac surgery
    Gallivan, S; Davis, KB; Stark, JF
  • Using the quality improvement cycle on clinical indicators—improve or remove?
    Sketcher‐Baker, KM; Kamp, MC; Connors, JA; Martin, DJ; Collins, JE
  • Real‐time monitoring of coronary care mortality: a comparison and combination of two monitoring tools
    Sherlaw‐Johnson, C; Morton, A; Robinson, MB; Hall, A
  • The use of control charts in health‐care and public‐health surveillance
    Woodall, WH
  • The monitoring and improvement of surgical‐outcome quality
    Woodall, WH; Fogel, SL; Steiner, SH
  • Debate: what is the best method to monitor surgical performance?
    Steiner, SH; Woodall, WH
  • Monitoring surgical performance using risk‐adjusted cumulative sum charts
    Steiner, SH; Cook, RJ; Farewell, VT; Treasure, T
  • Using control charts to monitor quality of hospital care with administrative data
    Coory, M; Duckett, S; Sketcher‐Baker, K
  • A new sequential procedure for surveillance of Down's syndrome
    Lie, RT; Heuch, I; Irgens, LM
  • A method for detecting runs of good and bad clinical outcomes on variable life‐adjusted display (VLAD) charts
    Sherlaw‐Johnson, C
  • A new VLAD‐based control chart for detecting surgical outcomes
    Yue, J; Lai, X; Liu, L; Lai, PBS
  • Dynamic probability control limits for risk‐adjusted Bernoulli CUSUM charts
    Zhang, X; Woodall, WH
  • Control charts and stochastic processes
    Barnard, GA
  • A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease
    Parsonnet, V; Dean, D; Bernstein, AD
  • The average run length of the cumulative sum chart when a V‐mask is used
    Kemp, KW
  • Cumulative sum tests: theory and practice
    Dobben de Bruyn, CS
  • Optimal stopping times for detecting changes in distributions
    Moustakides, GV
  • The economic design of cumulative sum control charts
    Taylor, HM
  • A new two‐sided cumulative quality control scheme
    Crosier, RB
  • spcadjust: an R package for adjusting for estimation error in control charts
    Gandy, A; Kvaløy, JT

You’re reading a free preview. Subscribe to read the entire article.

Try 2 weeks free now

DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

or browse the journals available

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create folders to
organize your research

Export folders, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off

Sign up
for free
Start 14 day
Free Trial