One of the trickiest problems in Medicine is trying to identify whether an unusual trend in mortality rates is an indication of an incompetent physician, or worse, a physician who is actively killing patients.
I have not read the following article, but it proposes the use of control charts for monitoring mortality rates. From the abstract, it looks like a promising approach.
- Monitoring surgical performance using risk-adjusted cumulative sum charts. Steiner SH, Cook RJ, Farewell VT, Treasure T. Biostatistics 2000: 1(4); 441-52. [Medline] [Abstract]
A recent BMJ article
- BMJ 2005;330:329 (12 February), doi:10.1136/bmj.330.7487.329
discusses the use of this type of control chart in a particular hospital that had a hospital standardized mortality ratio of 130, which was "the highest of all main acute hospitals in England (30% above the value for England as a whole, which is 100)". In response, the authors used control charts to reduce this rate to 92.8, with the largest reductions in circulatory diseases and respiratory diseases.
You can find an earlier version of this page on my original website.