ارﺗﻘﺎء ﮐﯿﻔﯿﺖ ﻓﺮآﯾﻨﺪ ﻫﺎي ﺟﺮاﺣﯽ و درﻣﺎن ﺑﺎ اﺳﺘﻔﺎده از ﻧﻤﻮدارﻫﺎي ﮐﻨﺘﺮل ﺟﻤﻊ ﺗﺠﻤﻌﯽ: ﯾﮏ ﺑﺮرﺳﯽ ﺟﺎﻣﻊ و ﮐﺎرﺑﺮدي

Improving the Quality of Surgical and Treatment Processes Using Cumulative Sum Control Charts: A Comprehensive and Applied Review

زﻣﯿﻨﻪ و ﻫﺪف: ﺗﻮﺳﻌﻪ اﺳﺘﻔﺎده از روش ﻫﺎي ﮐﻨﺘﺮل ﻓﺮآﯾﻨﺪ آﻣﺎري، در ﺣﻮزه ﻫﺎي ﻣﺨﺘﻠﻒ ﭘﺰﺷﮑﯽ، اﻣﺮوزه ﯾﮑﯽ از ﻣﻮﺿﻮﻋﺎت ﺟﺬاب ﺑﺮاي ﻣﺤﻘﻘﯿﻦ اﺳﺖ. ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﻫﺎي اﻃﻼﻋﺎت ﺑﯿﻤﺎران ﺑﺎ روﯾﮑﺮد ﮐﻨﺘﺮل ﻓﺮآﯾﻨﺪ آﻣﺎري، ﻣﯽ ﺗﻮاﻧﺪ در ﭘﺎﯾﺶ اﺛﺮﺑﺨﺶ، و ﺑﻬﺒﻮد ﮐﯿﻔﯿﺖ ﻓﺮآﯾﻨﺪﻫﺎي ﺟﺮاﺣﯽ و دﯾﮕﺮ ﺧﺪﻣﺎت درﻣﺎﻧﯽ ﻧﻘﺶ ﻣﻬﻤﯽ را اﯾﻔﺎ ﻧﻤﺎﯾﺪ. در ﻣﯿﺎن روش ﻫﺎي ﮐﻨﺘﺮل ﻓﺮآﯾﻨﺪ آﻣﺎري، ﻧﻤﻮدارﻫﺎي ﺟﻤﻊ ﺗﺠﻤﻌﯽ ﺑﻪ ﺳﺒﺐ ﺗﻔﺴﯿﺮ آﺳﺎن و ﺣﺴﺎﺳﯿﺖ ﺑﺎﻻ در ﺗﺸﺨﯿﺺ ﺗﻐﯿﯿﺮات ﮐﻮﭼﮏ و ﻣﺘﻮﺳﻂ، ﺑﯿﺶ از دﯾﮕﺮ روش ﻫﺎ از ﺳﻮي ﻣﺤﻘﻘﯿﻦ ﻣﻮرد اﺳﺘﻔﺎده ﻗﺮار ﮔﺮﻓﺘﻪ اﺳﺖ. اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺟﺎﻣﻊ درﺻﺪد اﺳﺖ ﮐﻪ ﺗﺄﺛﯿﺮ ﻣﺜﺒﺖ و اﺳﺘﺜﻨﺎﯾﯽ اﺳﺘﻔﺎده از اﯾﻦ ﻧﻮع ﻧﻤﻮدارﻫﺎ را در ﻓﺮآﯾﻨﺪ ﺟﺮاﺣﯽ، ﻓﺮآﯾﻨﺪ درﻣﺎن ﺑﯿﻤﺎران و دﯾﮕﺮ ﻓﺮآﯾﻨﺪﻫﺎي ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ ﻧﺸﺎن دﻫﺪ. ﻣﻮاد و روش ﻫﺎ: ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ، ﯾﮏ ﭘﮋوﻫﺶ ﺟﺎﻣﻊ ﻣﺮوري اﺳﺖ ﮐﻪ ﺑﺎ ﺑﻬﺮه ﺑﺮداري از ﻣﻨﺎﺑﻊ ﻋﻠﻤﯽ ﻣﻌﺘﺒﺮ ﻣﻨﺘﺸﺮ ﺷﺪه، ﺑﺪون ﻣﺤﺪودﯾﺖ زﻣﺎﻧﯽ، ﺑﻪ ﺑﺮرﺳﯽ ﺟﺎﻣﻊ ﺗﺤﻘﯿﻘﺎت و ﻧﺘﺎﯾﺞ ﺣﺎﺻﻞ از اﺳﺘﻔﺎده از ﻧﻤﻮدارﻫﺎي ﮐﻨﺘﺮل ﺟﻤﻊ ﺗﺠﻤﻌﯽ در ﺑﺨﺶ ﻫﺎي ﻣﺨﺘﻠﻒ ﺑﻬﺪاﺷﺖ و درﻣﺎن ﻣﯽ ﭘﺮدازد. ﯾﺎﻓﺘﻪ ﻫﺎ: اﯾﻦ ﺗﺤﻘﯿﻖ ﻧﺸﺎن ﻣﯽ دﻫﺪ ﮐﻪ از ﻣﺪلﻫﺎي ﻣﺨﺘﻠﻒ ﻧﻤﻮدارﻫﺎي ﮐﻨﺘﺮل ﺟﻤﻊ ﺗﺠﻤﻌﯽ، ﻣﯽﺗﻮان ﺑﻪ ﺻﻮرت اﺛﺮﺑﺨﺶ در ﺑﻬﺒﻮد و ﮐﻨﺘﺮل ﻓﺮآﯾﻨﺪﻫﺎي ﺟﺮاﺣﯽ و درﻣﺎﻧﯽ، اﺳﺘﻔﺎده ﮐﺮد. روش ﻫﺎي ﺗﻌﺪﯾﻞ رﯾﺴﮏ ﮐﻪ ﺑﺎ در ﻧﻈﺮ ﮔﺮﻓﺘﻦ ﻣﺨﺎﻃﺮات ﭘﯿﺶ از ﻋﻤﻞ ﺑﯿﻤﺎران، ﺑﻪ ﻫﻤﮕﻦ ﺳﺎزي و ﺗﻌﺪﯾﻞ ﺗﺄﺛﯿﺮ ﺷﺮاﯾﻂ ﺟﺴﻤﺎﻧﯽ و ﻓﯿﺰﯾﻮﻟﻮژﯾﮑﯽ ﺑﯿﻤﺎران ﻣﯽ ﭘﺮدازد، از ﻣﺆﺛﺮﺗﺮﯾﻦ ﻧﻤﻮدار ﻫﺎي ﺟﻤﻊ ﺗﺠﻤﻌﯽ ﺑﮑﺎرﮔﺮﻓﺘﻪ ﺷﺪه ﻣﯽﺑﺎﺷﺪ. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﻧﻤﻮدارﻫﺎي ﺟﻤﻊ ﺗﺠﻤﻌﯽ، ﺑﺎﯾﺪ ﺑﺎ ﺗﻮﺟﻪ ﻧﻘﺎط ﺿﻌﻒ و ﻗﻮت ﻫﺮ ﯾﮏ از ﻧﻤﻮدارﻫﺎ و ﺗﻮزﯾﻊ ﭼﮕﺎﻟﯽ اﺣﺘﻤﺎل داده ﻫﺎ، ﻣﻮرد اﺳﺘﻔﺎده ﻗﺮار ﮔﯿﺮد. اﯾﻦ ﺗﺤﻘﯿﻖ ﻧﺸﺎن ﻣﯽدﻫﺪ ﮐﻪ ﺑﮑﺎرﮔﯿﺮي روش ﻫﺎي ﺗﻌﺪﯾﻞ رﯾﺴﮏ در ﻧﻤﻮدارﻫﺎي ﺟﻤﻊ ﺗﺠﻤﻌﯽ ﻣﯽ ﺗﻮاﻧﺪ ﻧﺘﺎﯾﺞ ﻋﻤﻠﮑﺮد ﺑﺨﺶ ﺟﺮاﺣﯽ را ﺑﺎ دﻗﺖ ﺑﯿﺸﺘﺮي ﻣﻨﻌﮑﺲ ﻧﻤﺎﯾﺪ. ﻫﻤﭽﻨﯿﻦ اﺳﺘﻔﺎده از روش ﺟﻤﻊ ﺗﺠﻤﻌﯽ در ﻣﻨﺤﻨﯽ ﻫﺎي ﯾﺎدﮔﯿﺮي نيز ﻣﯽ ﺗﻮاﻧﺪ ﺑﺨﻮﺑﯽ و ﺑﻪ ﺻﻮرت ﮐﺎرآ ﺳﻄﺢ ﻋﻤﻠﮑﺮد ﮐﺎرآﻣﻮزان ﭘﺰﺷﮑﯽ را ﭘﺎﯾﺶ ﮐﻨﺪ.

Introduction & Objective: Developing the use of statistical process control (SPC) methods for the healthcare area is evaluated as an attractive contribution. Analyzing patient data using SPC approach plays an important role to monitor effectively a health care process, improving the quality surgical processes, and other medical service processes. Among SPC methods, cumulative sum approach have been attracted more attention in the medical literature due to its simple formulation and interpretation, as well as more sensitivity to detect medium and small shifts compared to other methods. The aim of this study is to provide analytically positive effects of using CUSUM charts for hospitals, surgical, and therapeutic processes. Materials & Methods: This study is a comprehensive literature review. This paper investigates comprehensively researches and results of the used CUSUM charts in different areas of healthcare focusing on reported reliable scientific sources without any limitation of time. Results: This study reveals that different cumulative sum control chart types are proposed to use in therapeutic and surgical processes leading to improvement of the processes. The analysis indicates that risk adjustment methods considering patients’ risk before surgery is more superior compared to other CUSUM types. This approach focuses on homogenizing and adjusting the effect of physical and physiological conditions corresponding to patients. Conclusions: Cumulative sum charts should be used considering strength and weakness points of each chart as well as data probability distribution. This paper reveals that the use of risk-adjusted cumulative sum charts can be more accurately reflect the performance results of a surgery compared to other chart types. Furthermore the use of CUSUM methods for learning curves is capable of monitoring effectively the performance of medical trainees.