Abstract:
OBJECTIVE:To use funnel plots and cumulative funnel plots to compare in-hospital outcome data for operators undertaking percutaneous coronary interventions with predicted results derived from a validated risk score to allow for early detection of variation in performance. DESIGN:Analysis of prospectively collected data. SETTING:Tertiary centre NHS hospital in the north east of England. PARTICIPANTS:Five cardiologists carrying out percutaneous coronary interventions between January 2003 and December 2006. MAIN OUTCOME MEASURES:In-hospital major adverse cardiovascular and cerebrovascular events (in-hospital death, Q wave myocardial infarction, emergency coronary artery bypass graft surgery, and cerebrovascular accident) analysed against the logistic north west quality improvement programme predicted risk, for each operator. Results are displayed as funnel plots summarising overall performance for each operator and cumulative funnel plots for an individual operator's performance on a case series basis. RESULTS:The funnel plots for 5198 patients undergoing percutaneous coronary interventions showed an average observed rate for major adverse cardiovascular and cerebrovascular events of 1.96% overall. This was below the predicted risk of 2.06% by the logistic north west quality improvement programme risk score. Rates of in-hospital major adverse cardiovascular and cerebrovascular events for all operators were within the 3sigma upper control limit of 2.75% and 2sigma upper warning limit of 2.49%. CONCLUSION:The overall in-hospital major adverse cardiovascular and cerebrovascular events rates were under the predicted event rate. In-hospital rates after percutaneous coronary intervention procedure can be monitored successfully using funnel and cumulative funnel plots with 3sigma control limits to display and publish each operator's outcomes. The upper warning limit (2sigma control limit) could be used for internal monitoring. The main advantage of these charts is their transparency, as they show observed and predicted events separately. By this approach individual operators can monitor their own performance, using the predicted risk for their patients but in a way that is compatible with benchmarking to colleagues, encapsulated by the funnel plot. This methodology is applicable regardless of variations in individual operator case volume and case mix.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Kunadian B,Dunning J,Roberts AP,Morley R,Twomey D,Hall JA,Sutton AG,Wright RA,Muir DF,de Belder MAdoi
10.1136/bmj.39512.529120.BEsubject
Has Abstractpub_date
2008-04-26 00:00:00pages
931-4issue
7650eissn
0959-8138issn
1756-1833pii
bmj.39512.529120.BEjournal_volume
336pub_type
杂志文章abstract:OBJECTIVE:To compare ultrasonography with intravenous urography in the investigation of adults with haematuria. DESIGN:Prospective study entailing the examination of all patients with both investigations concurrently. The investigations were performed independently on routine lists by different duty radiologists. Each...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.301.6760.1074
更新日期:1990-11-10 00:00:00
abstract:OBJECTIVE:To investigate the association between cerebral palsy and direct evidence for perinatal exposure to neurotropic viruses. DESIGN:Population based case-control study. SETTING:Adelaide Women's and Children's Hospital Research Laboratory. PARTICIPANTS AND MAIN OUTCOME MEASURES:Newborn screening cards of 443 wh...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38668.616806.3A
更新日期:2006-01-14 00:00:00
abstract:OBJECTIVE:To evaluate the association between body mass index and mortality from overall cardiovascular disease and specific subtypes of cardiovascular disease in east and south Asians. DESIGN:Pooled analyses of 20 prospective cohorts in Asia, including data from 835,082 east Asians and 289,815 south Asians. Cohorts w...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.f5446
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:To describe the progression of HIV disease in a haemophilic cohort and to show the influence of treatment. DESIGN:11 year longitudinal clinical and laboratory study. SETTING:A haemophilia centre. PATIENTS:111 patients infected with HIV during October 1979 to July 1985. MAIN OUTCOME MEASURES:Symptoms of HI...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.303.6810.1093
更新日期:1991-11-02 00:00:00
abstract:OBJECTIVE:To analyse the cost effectiveness of a national programme to screen blood donors for infection with the human T cell leukaemia/lymphoma virus. DESIGN:Three models for calculating the costs and benefits of screening were developed. The first model analysed the cost of continuously testing all donations; the s...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.316.7142.1417
更新日期:1998-05-09 00:00:00
abstract:OBJECTIVE:To determine the incidence of cervical cancer after several negative cervical smear tests at different ages. DESIGN:Prospective observational study of incidence of cervical cancer after the third consecutive negative result based on individual level data in a national registry of histopathology and cytopatho...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b1354
更新日期:2009-04-24 00:00:00
abstract:OBJECTIVE:To develop and refine a complex intervention for diabetes support and education in minority ethnic groups, delivered through bilingual health advocates. DESIGN:Action research framework-a variety of methods used in an emergent and developmental manner, in partnership with clinicians, managers, and service us...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.330.7492.628
更新日期:2005-03-19 00:00:00
abstract:OBJECTIVES:To determine the impact on teenage pregnancy of interventions that address the social disadvantage associated with early parenthood and to assess the appropriateness of such interventions for young people in the United Kingdom. DESIGN:Systematic review, including a statistical meta-analysis of controlled tr...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.b4254
更新日期:2009-11-12 00:00:00
abstract:OBJECTIVES:To assess and improve the quality of care provided to women undergoing induced abortion. DESIGN:Two rounds of prospective, criterion based case note review audit. SETTING:Ten NHS gynaecology units throughout Scotland. SUBJECTS:2004 patient episodes of abortion care identified consecutively during two roun...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.309.6946.15
更新日期:1994-07-02 00:00:00
abstract::This article reports the success of WHO in eliminating onchocerciasis or river blindness in most of West Africa. The onchocerciasis control program was able to save 100,000 people at immediate risk of contracting the disease and prevented the infection of about 12 million children. About 1.25 million onchocercal inf...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:10.1136/bmj.319.7217.1090a
更新日期:1999-10-23 00:00:00
abstract:OBJECTIVES:To evaluate the long term effects of perioperative beta blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. DESIGN:Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat. SETTING:University anaesthesia and sur...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.332.7556.1482
更新日期:2006-06-24 00:00:00
abstract:OBJECTIVES:To measure the impact of socioeconomic deprivation on rates of teenage pregnancy and the extent of local variation in pregnancy rates in Scotland, and to examine how both have changed over time. DESIGN:Population study using routine data from hospital records, aggregated for small areas. SUBJECTS:Female te...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.323.7306.199
更新日期:2001-07-28 00:00:00
abstract::Monocycline is the most widely prescribed systemic antibiotic for acne largely because it needs to be given only once or twice a day and seems not to induce resistance. Up to April 1994 11 cases of minocycline induced systemic lupus erythematosus and 16 cases of hepatitis had been reported to the Committee on Safety o...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7024.169
更新日期:1996-01-20 00:00:00
abstract:OBJECTIVE:To determine whether maternal smoking during pregnancy causes impairment in growth after birth. DESIGN:Longitudinal study. SETTING:Six medical university centres of six towns of north, central, and south Italy. SUBJECTS:12,987 babies (10,238 born from non-smoking mothers, 2276 from mothers smoking one to n...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6982.768
更新日期:1995-03-25 00:00:00
abstract:OBJECTIVE:To compare blood pressure control, satisfaction, and adherence to drug treatment in patients with treated hypertension followed up by their family physicians either every three months or every six months for three years. DESIGN:Randomised equivalence clinical trial. Settings 50 family practices in south east...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.37967.374063.EE
更新日期:2004-01-24 00:00:00
abstract:OBJECTIVE:To explore geographical and sociodemographic factors associated with variation in equity in access to total hip and knee replacement surgery. DESIGN:Combining small area estimates of need and provision to explore equity in access to care. SETTING:English census wards. SUBJECTS:Patients throughout England w...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.c4092
更新日期:2010-08-11 00:00:00
abstract::Organs for donation are in short supply in the United Kingdom, resulting in allegations that relatives of potential donors are not being asked for consent. Legislation on "required request" has been proposed to overcome this. The incidence, causes, complications, and patterns of organ donation in brain stem dead patie...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6706.1009
更新日期:1989-10-21 00:00:00
abstract:OBJECTIVE:To determine the outcome of administration of neuroleptics to patients with senile dementia of Lewy body type confirmed at necropsy. DESIGN:Retrospective analysis of clinical notes blind to neuropathological diagnosis. SETTING:Specialist psychogeriatric assessment units referring cases for necropsy to a tea...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6855.673
更新日期:1992-09-19 00:00:00
abstract:OBJECTIVE:To assess treatment related changes in quality of life up to 15 years after diagnosis of localised prostate cancer. DESIGN:Population based, prospective cohort study with follow-up over 15 years. SETTING:New South Wales, Australia. PARTICIPANTS:1642 men with localised prostate cancer, aged less than 70, an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m3503
更新日期:2020-10-07 00:00:00
abstract:OBJECTIVES:Analysis of incidence and characteristics of congenital abdominal wall defects, with special reference to the differences between the incidence of gastroschisis and exomphalos (omphalocele). DESIGN:Retrospective analysis using data from the Office of Population Censuses and Surveys (recoded to differentiate...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7062.903
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6856.746
更新日期:1992-09-26 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.311.7018.1479
更新日期:1995-12-02 00:00:00
abstract:OBJECTIVE:To investigate the effect of overweight on premature mortality and work disability in young and middle aged Finns. DESIGN:Prospective cohort study based on data collected in the multiphasic health examinations by the Social Insurance Institution of Finland from 1966 to 1972 and follow up until 1982. SETTING...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.301.6756.835
更新日期:1990-10-13 00:00:00
abstract:OBJECTIVE:To assess strategies for advice on analgesia and steam inhalation for respiratory tract infections. DESIGN:Open pragmatic parallel group factorial randomised controlled trial. SETTING:Primary care in United Kingdom. PARTICIPANTS:Patients aged ≥ 3 with acute respiratory tract infections. INTERVENTION:889 p...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.f6041
更新日期:2013-10-25 00:00:00
abstract:OBJECTIVES:To assess the effects of treatments for non-metastatic invasive squamous cell carcinoma (SCC) of the skin using evidence from observational studies, given the paucity of evidence from randomised controlled trials. DESIGN:Systematic review of observational studies. DATA SOURCES:Medline, Embase, to December ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.f6153
更新日期:2013-11-04 00:00:00
abstract:OBJECTIVE:To assess whether causal criteria can be used to find out whether there is support in published research for maintaining that menopause causes depression. DESIGN:Ninety four articles from 30 years of research examining the relation of natural menopause to depression were traced by using Medline and systemati...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.313.7067.1229
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abstract:OBJECTIVE:To assess the association between genitourinary infections in the month before conception to the end of the first trimesterand gastroschisis. DESIGN:Case-control study with self reported infections from a computer assisted telephone interview. SETTING:National birth defects prevention study, a multisite, po...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.39567.509074.25
更新日期:2008-06-21 00:00:00
abstract::This review summarises the literature on shift work and its relation to insufficient sleep, chronic diseases, and accidents. It is based on 38 meta-analyses and 24 systematic reviews, with additional narrative reviews and articles used for outlining possible mechanisms by which shift work may cause accidents and adver...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.i5210
更新日期:2016-11-01 00:00:00
abstract::A total of 22,552 workers employed by the Atomic Weapons Establishment between 1951 and 1982 were followed up for an average of 18.6 years. Of the 3115 who died, 865 (28%) died of cancer. Mortality was 23% lower than the national average for all causes of death and 18% lower for cancer. These low rates were consistent...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6651.757
更新日期:1988-09-24 00:00:00
abstract:OBJECTIVE:To derive and validate an algorithm to estimate the absolute risk of having ovarian cancer in women with and without symptoms. DESIGN:Cohort study with data from 375 UK QResearch general practices for development and 189 for validation. PARTICIPANTS:Women aged 30-84 without a diagnosis of ovarian cancer at ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.d8009
更新日期:2011-01-04 00:00:00