Cumulative sum schemes for surgical performance monitoring

Summary.  The standard cumulative sum (CUSUM), risk-adjusted CUSUM and Shiryayev–Roberts schemes for monitoring surgical performance are compared. We find that both CUSUM schemes are comparable in run length performance except when there is a high heterogeneity of surgical risks, in which case the risk-adjusted CUSUM scheme is more sensitive in detecting a shift in surgical performance. The Shiryayev–Roberts scheme is found to be less sensitive compared with the CUSUM schemes in detecting a deterioration in surgical performance. Using the Markov chain method, the exact average run length of a standard CUSUM scheme can be computed whereas the average run length of a risk-adjusted CUSUM scheme is approximated. For a risk-adjusted CUSUM scheme, the accuracy of the average run length depends on the fineness of the discretization of CUSUM values, which relies on the chart limit, shift to be detected optimally and in-control surgical risk distribution. A sensitivity analysis shows that the risk-adjusted CUSUM and Shiryayev–Roberts schemes still perform moderately well in detecting a deterioration and an improvement in surgical performances respectively even though there is a misspecification of the in-control surgical risk distribution. In general, the run length performance of the Shiryayev–Roberts scheme is comparatively less sensitive to a misspecification of the in-control surgical risk distribution.     

Multinomial Logistic模型在区域高等教育资源结构优化中的应用

在区域确定的前提下,将各高等教育资源数据进行整理,建立Multinomial Logistic模型,分析各结构的相对发生比率以及各结构的最佳分布。分析该回归分析的多维发生比率,由此确定各种离散等级状态之间的调整方向及调整程度。对黑龙江省的各高等教育区域进行实证分析,结果表明,黑龙江省高等教育资源结构以教学型、教学研究型、研究教学型、研究型的比例来判断,高等教育效用有待于进一步挖掘。多维发生比率以及自变量对多维发生比率的变化影响这两个参数对区域高等教育资源结构优化起着关键作用。