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      Sense and sensibility: on the diagnostic value of control chart rules for detection of shifts in time series data

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          Abstract

          Background

          The aim of this study was to quantify and compare the diagnostic value of The Western Electric (WE) statistical process control (SPC) chart rules and the Anhoej rules for detection of non-random variation in time series data in order to make recommendations for their application in practice.

          Methods

          SPC charts are point-and-line graphs showing a measure over time and employing statistical tests for identification of non-random variation.

          In this study we used simulated time series data with and without non-random variation introduced as shifts in process centre over time. The primary outcome was likelihood ratios of combined tests. Likelihood ratios are useful measures of a test’s ability to discriminate between the true presence or absence of a specific condition.

          Results

          With short data series (10 data points), the WE rules 1–4 combined and the Anhoej rules alone or combined with WE rule 1 perform well for identifying or excluding persistent shifts in the order of 2 SD. For longer data series, the Anhoej rules alone or in combination with the WE rule 1 seem to perform slightly better than the WE rules combined.

          However, the choice of which and how many rules to apply in a given situation should be made deliberately depending on the specific purpose of the SPC analysis and the number of available data points.

          Conclusions

          Based on these results and our own practical experience, we suggest a stepwise approach to SPC analysis: Start with a run chart using the Anhoej rules and with the median as process centre. If, and only if, the process shows random variation at the desired level, apply the 3-sigma rule in addition to the Anhoej rules using the mean as process centre.

          Electronic supplementary material

          The online version of this article (10.1186/s12874-018-0564-0) contains supplementary material, which is available to authorized users.

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          Most cited references9

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          Diagnostic tests 4: likelihood ratios.

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            Plotting basic control charts: tutorial notes for healthcare practitioners.

            There is considerable interest in the use of statistical process control (SPC) in healthcare. Although SPC is part of an overall philosophy of continual improvement, the implementation of SPC usually requires the production of control charts. However, as SPC is relatively new to healthcare practitioners and is not routinely featured in medical statistics texts/courses, there is a need to explain the issues involved in the selection and construction of control charts in practice. Following a brief overview of SPC in healthcare and preliminary issues, we use a tutorial-based approach to illustrate the selection and construction of four commonly used control charts (xmr-chart, p-chart, u-chart, c-chart) using examples from healthcare. For each control chart, the raw data, the relevant formulae and their use and interpretation of the final SPC chart are provided together with a notes section highlighting important issues for the SPC practitioner. Some more advanced topics are also mentioned with suggestions for further reading.
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              Run Charts Revisited: A Simulation Study of Run Chart Rules for Detection of Non-Random Variation in Health Care Processes

              Background A run chart is a line graph of a measure plotted over time with the median as a horizontal line. The main purpose of the run chart is to identify process improvement or degradation, which may be detected by statistical tests for non-random patterns in the data sequence. Methods We studied the sensitivity to shifts and linear drifts in simulated processes using the shift, crossings and trend rules for detecting non-random variation in run charts. Results The shift and crossings rules are effective in detecting shifts and drifts in process centre over time while keeping the false signal rate constant around 5% and independent of the number of data points in the chart. The trend rule is virtually useless for detection of linear drift over time, the purpose it was intended for.
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                Author and article information

                Contributors
                jacob@anhoej.net
                tore.wentzellarsen@gmail.com
                Journal
                BMC Med Res Methodol
                BMC Med Res Methodol
                BMC Medical Research Methodology
                BioMed Central (London )
                1471-2288
                3 October 2018
                3 October 2018
                2018
                : 18
                : 100
                Affiliations
                [1 ]ISNI 0000 0001 0674 042X, GRID grid.5254.6, Centre of Diagnostic Investigation, Rigshospitalet, , University of Copenhagen, ; Copenhagen, Denmark
                [2 ]Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Centre for Violence and Traumatic Stress Studies, Oslo, Norway
                Author information
                http://orcid.org/0000-0002-7701-1774
                Article
                564
                10.1186/s12874-018-0564-0
                6171235
                30285737
                be122a87-beca-4c41-90aa-bbf53d81fd7a
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 May 2018
                : 25 September 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Medicine
                quality improvement,statistical process control,shewhart control charts,run charts,diagnostic tests,likelihood ratios

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