Establishment and evaluation of Voting algorithm-based internal quality control (ViQC), a patient-based real-time...

Patient-Based Real-Time Quality Control (PBRTQC) has emerged as a supplementary programme to traditional internal quality control (iQC) mechanisms. Despite its growing popularity, practical applications in clinical settings reveal several challenges. The primary objective of this research is to introduce and develop an Artificial Intelligence (AI)-based method, named Voting algorithm based iQC (ViQC), designed to enhance the precision and reliability of existing PBRTQC systems.

In this study, we conducted a retrospective analysis of 111,925 inpatient serum glucose test results from Nanjing Drum Tower Hospital, Nanjing, China, to provide an unbiased data set. The Voting iQC (ViQC) algorithm, established by the principles of the Voting algorithm, was then developed. Its analytical performance was evaluated through the calculation of random errors (RE). Subsequently, its clinical efficacy was assessed by comparison with five statistical algorithms: Moving Average (MA), Exponentially Weighted Moving Average (EWMA), Moving Median (movMed, MM), Moving Quartile (MQ), and Moving Standard Deviation (MovSD).

The ViQC model incorporates a variety of machine learning models, including logistic regression, Bayesian methods, K-Nearest Neighbor, decision trees, random forests, and gradient boosting decision trees, to establish a robust predictive framework. This model consistently maintains a false positive rate below 0.002 across all six evaluated error factors, showcasing exceptional precision. Notably, its performance further excels with an error factor of 3.0, where the false positive rate drops below 0.001, and achieves an accuracy rate as high as 0.965 at an error factor of 2.0. The classification effectiveness of ViQC model is evaluated by an area under the curve (AUC) exceeding 0.97 for all error factors. In comparison to five conventional PBRTQC statistical methods, ViQC significantly enhances error detection efficiency, maximum reducing the trimmed average number of patient samples required for detecting errors from 724 to 168, thereby affirming its superior error detection capability.

The new established PBRTQC using artificial intelligence yielded satisfactory performance compared to the traditional PBBTQC in real world setting.