Assessing doctors' competence: application of CUSUM technique in monitoring doctors' performance
作者:T. O. LIM、A. SORAYA、L. M. DING、Z. MORAD
DOI:10.1093/oxfordjournals.intqhc.a002616
日期:2002.6.1
Background. Quality assurance of medical practice requires assessment of doctors’ performance, whether informally via a system such as peer review or more formally via one such as credentialing. Current methods of assessment are, however, subjective or implicit. More objective methods of assessment based on statistical process control technique such as cumulative sum procedure (CUSUM) may be helpful. Objective. To determine the usefulness and acceptability of CUSUM charting for assessing doctors’ performance. Method. We applied CUSUM charting to assess doctors’ performance of endoscopic retrograde pancreatography, renal and breast biopsies, thyroidectomy, and instrumental delivery. A CUSUM chart is a graphical representation of the trend in the outcome of a series of consecutive procedures. At acceptable levels of performance, the CUSUM curve is flat, while at unacceptable levels of performance, the curve slopes upward and eventually crosses a decision interval. When this occurs, the CUSUM chart indicates unsatisfactory performance. Thus, it provides an early warning of an adverse trend. Results. All participating doctors found the technique useful to objectively measure their proficiency. CUSUM charts showed the progress of trainees in acquiring new skills. As they become more skilful with training, their CUSUM curves flatten. Among consultants, level CUSUM curves demonstrated ongoing maintenance of competence. All participants found the technique acceptable as a self-assessment tool. They were, however, less certain of its acceptability as a basis for credentialing. Conclusion. We recommend the use of CUSUM charting as a tool for personal audit at an individual level. It may also be used to show proof of technical competence for the purpose of credentialing.
背景。要保证医疗质量,就必须对医生的工作表现进行评估,无论是通过同行评议等非正式制度,还是通过资格认证等正式制度。然而,目前的评估方法都是主观或隐含的。基于统计过程控制技术(如累积总和程序)的更客观的评估方法可能会有所帮助。目标。确定 CUSUM 图表在评估医生绩效方面的实用性和可接受性。方法。我们应用 CUSUM 图表评估医生在内镜逆行胰腺造影术、肾脏和乳腺活组织检查、甲状腺切除术和器械接生中的表现。CUSUM 图表是一系列连续手术结果趋势的图形表示。在可接受的绩效水平下,CUSUM 曲线是平的,而在不可接受的绩效水平下,曲线会向上倾斜并最终越过决策区间。当出现这种情况时,CUSUM 图表就会显示出不理想的绩效。因此,它提供了不利趋势的预警。结果所有参与调查的医生都认为这项技术有助于客观衡量他们的工作能力。CUSUM 图表显示了学员在掌握新技能方面取得的进步。随着受训医生的技能不断提高,他们的 CUSUM 曲线也逐渐趋于平缓。在顾问中,水平 CUSUM 曲线显示了能力的持续保持。所有参与者都认为,该技术作为一种自我评估工具是可以接受的。不过,他们不太确定该技术是否可作为资格认证的依据。结论我们建议使用 CUSUM 图表作为个人层面的个人审核工具。它还可用于证明技术能力,以便进行资格认证。