• Tsung-Tai Chen, Kuo-Piao Chung, Fu-Chang Hu, Chieh-Min Fan, and Ming-Chin Yang.
• Center for Health Insurance Research, College of Public Health, National Taiwan University, Taipei, Taiwan.
• J Eval Clin Pract. 2011 Feb 1;17(1):71-7.

ObjectiveBased on previous experience from surgical surveillance, risk-adjusted cumulative sum (CUSUM)-type charts were applied to monitor out-of-hospital cardiac arrest (OHCA) patient mortality.Materials And MethodsData from 2356 OHCA patients were collected by the Taipei County Fire Bureau from June 2006 to November 2007. Logistic regression analysis was applied to create a risk-adjusted model. Next, a risk-adjusted CUSUM chart, a risk-adjusted resetting sequential probability ratio test chart and a cumulative risk-adjusted mortality with prediction limits chart were used to detect excess deaths of the OHCA patients rescued by the emergency medical service (EMS) system.ResultsThe overall mortality rate, defined as having no return of spontaneous circulation, was 79.3%. These three charts signalled an increase in the death rate at similar sites, and also suggested a small process shift.ConclusionA visual approach to EMS systems monitoring that combines the risk-adjusted cumulative sum, Risk-adjusted resetting sequential probability ratio test and cumulative risk-adjusted mortality with prediction limits charts was established. It was found that this approach can be effectively used by the EMS community to monitor OHCA outcomes in real time.© 2010 Blackwell Publishing Ltd.

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