{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T08:08:21Z","timestamp":1743926901615,"version":"3.37.3"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,5,13]],"date-time":"2020-05-13T00:00:00Z","timestamp":1589328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,5,13]],"date-time":"2020-05-13T00:00:00Z","timestamp":1589328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100001502","name":"Blue Cross Blue Shield of Michigan","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100001502","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Systematic, automated methods for monitoring physician performance are necessary if outlying behavior is to be detected promptly and acted on. In the Michigan Urological Surgery Improvement Collaborative (MUSIC), we evaluated several statistical process control (SPC) methods to determine the sensitivity and ease of interpretation for assessing adherence to imaging guidelines for patients with newly diagnosed prostate cancer.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Following dissemination of imaging guidelines within the Michigan Urological Surgery Improvement Collaborative (MUSIC) for men with newly diagnosed prostate cancer, MUSIC set a target of imaging &lt;\u200910% of patients for which bone scan is not indicated. We compared four SPC methods using Monte Carlo simulation: p-chart, weighted binomial CUSUM, Bernoulli cumulative sum (CUSUM), and exponentially weighted moving average (EWMA). We simulated non-indicated bone scan rates ranging from 5.9% (within target) to 11.4% (above target) for a representative MUSIC practice. Sensitivity was determined using the average run length (ARL), the time taken to signal a change. We then plotted actual non-indicated bone scan rates for a representative MUSIC practice using each SPC method to qualitatively assess graphical interpretation.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>EWMA had the lowest ARL and was able to detect changes significantly earlier than the other SPC methodologies (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The p-chart had the highest ARL and thus detected changes slowest (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). EWMA and p-charts were easier to interpret graphically than CUSUM methods due to their ability to display historical imaging rates.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>SPC methods can be used to provide informative and timely feedback regarding adherence to healthcare performance target rates in quality improvement collaboratives. We found the EWMA method most suited for detecting changes in imaging utilization.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12911-020-1126-z","type":"journal-article","created":{"date-parts":[[2020,5,13]],"date-time":"2020-05-13T10:02:45Z","timestamp":1589364165000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prospective monitoring of imaging guideline adherence by physicians in a surgical collaborative: comparison of statistical process control methods for detecting outlying performance"],"prefix":"10.1186","volume":"20","author":[{"name":"for the Michigan Urological Surgery Improvement Collaborative (MUSIC)","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Inadomi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karandeep","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji","family":"Qi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodney","family":"Dunn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Linsell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Denton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Hurley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Kleer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Montie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6089-0733","authenticated-orcid":false,"given":"Khurshid R.","family":"Ghani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,5,13]]},"reference":[{"key":"1126_CR1","unstructured":"American Urological Association: Ten Things Physicians and Patients Should Question. http:\/\/www.choosingwisely.org\/societies\/american-urological-association\/."},{"key":"1126_CR2","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1016\/j.urology.2014.06.010","volume":"84","author":"S Merdan","year":"2014","unstructured":"Merdan S, Womble PR, Miller DC, Barnett C, Ye Z, Linsell SM, Montie JE, Denton BT. Toward better use of bone scans among men with early-stage prostate cancer. Urology. 2014;84:793\u20138.","journal-title":"Urology"},{"key":"1126_CR3","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1016\/j.urology.2014.07.051","volume":"84","author":"R Risko","year":"2014","unstructured":"Risko R, Merdan S, Womble PR, Barnett C, Ye Z, Linsell SM, Montie JE, Miller DC, Denton BT. Clinical predictors and recommendations for staging computed tomography scan among men with prostate cancer. Urology. 2014;84:1329\u201334.","journal-title":"Urology"},{"key":"1126_CR4","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1016\/j.juro.2016.11.098","volume":"197","author":"P Hurley","year":"2017","unstructured":"Hurley P, Dhir A, Gao Y, Drabik B, Lim K, Curry J, Womble PR, Linsell SM, Brachulis A, Sexton DW, et al. A state-wide intervention improves appropriate imaging in localized prostate Cancer. 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Those practices which were neither deemed to be not-regulated nor exempt from IRB approval were approved under expedited review as having \u201crisk [that] is no more than minimal to the human subjects\u201d. The practices approved through expedited review have a waiver of consent (45 CFR 46 116(d)) and waiver of HIPAA authorization. In practices in which MUSIC was deemed to be not-regulated or exempt from IRB approval, MUSIC\u2019s work in quality improvement was determined not to fit the definition of human subjects research requiring IRB approval (per 45 CFR 46, 21 CFR 56) and thus patient informed consent is not required under those regulations. See communication from University of Michigan Institutional Review Board below:\u201cBased on the information provided, the proposed study does not fit the definition of human subjects research requiring IRB approval (per 45 CFR 46, 21 CFR 56) because in this case, it is activities or procedures rather than human subjects that are the object of the study.\u201d","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"89"}}