Annals of Operations Research

, Volume 67, Issue 1, pp 45–60 | Cite as

Risk-adjusted control charts for health care assessment

  • Farrokh Alemi
  • Walter Rom
  • Eric Eisenstein


The recent Joint Commission on Accreditation of Healthcare Organization (JCAHO) requirement that hospital accreditation be based upon a Total Quality Management (TQM) approach has focused the attention of health care administrations on the use of techniques such as control charts. However, control charts are not typically adjusted for severity of illness. This adjustment is needed because, unlike industrial organizations, hospitals are not able to control all of their inputs and must accept variances in their patients. In this paper, we present a methodology for adjusting a health care organization's control charts to reflect their patient population's severity of illness during different time intervals. We then demonstrate that risk-adjusting expected patient outcomes can change our assessments of the relative quality of care offered by a health care organization in different time periods.


Control chart quality of care risk adjustment severity of illness total quality management 


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Copyright information

© J.C. Baltzer AG, Science Publishers 1996

Authors and Affiliations

  • Farrokh Alemi
    • 1
  • Walter Rom
    • 2
  • Eric Eisenstein
    • 3
  1. 1.Health Care Administration ProgramCleveland State UniversityClevelandUSA
  2. 2.Production and Operations Management DepartmentCleveland State UniversityClevelandUSA
  3. 3.Outcomes Research and Assessment GroupDuke University Medical CenterDurhamUSA

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