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Taking a closer look: using statistical process control to identify patterns of improvement in a quality-improvement
Tracey Timmerman1, Tanya Verrall, Lisa Clatney
1Health Quality Council, Saskatoon, Canada.
Quality & Safety in Health Care
|July 3, 2010
Summary
Quality improvement collaboratives show varied results. Statistical process control and line graphs effectively identified differences in practice improvement, highlighting the potential role of geographic factors in healthcare quality initiatives.
Area of Science:
- Healthcare Management
- Quality Improvement Science
- Health Services Research
Background:
- Significant variation exists in participant improvement capacity within quality improvement collaboratives.
- Understanding the success factors of complex quality initiatives requires mixed-methods approaches.
- Time-series analysis, including line graphs and statistical process control, offers a robust quantitative method for evaluating interventions.
Purpose of the Study:
- To apply and demonstrate line graphs and statistical process control.
- To identify variations in improvement among practices in the Saskatchewan Chronic Disease Management Collaborative.
Main Methods:
- Utilized line graphs and regression analysis for aggregate improvement assessment.
- Employed small multiples, rational ordering, and rational subgrouping to analyze practice-level improvement differences.
- Examined variations in the level and rate of improvement across participating practices.
Main Results:
- Small multiples visually revealed qualitative differences in improvement patterns among practices.
- Rational subgrouping on control charts provided quantitative evidence of these variations.
- Stratification by administrative health region indicated a potential influence of location on improvement outcomes.
Conclusions:
- Statistical process control and line graphs are valuable tools for assessing variation in quality improvement initiatives.
- Practice location may influence the capacity for and rate of improvement in chronic disease management.
- Further qualitative research is warranted to explore the reasons behind observed improvement disparities.
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