Comparison of EWMA, MA, and MQ Under a Unified PBRTQC Framework for Thyroid and Coagulation Tests

Background: Patient-based real-time quality control (PBRTQC) enables continuous analytical monitoring using routine patient results; however, the performance of classical statistical process control (SPC) algorithms varies across analytes, and standardized evaluation and optimization strategies remain limited. To address this gap, this study compared three SPC algorithms—moving average (MA), moving quantile (MQ), and exponentially weighted moving average (EWMA)—within a unified preprocessing framework and proposed a composite performance metric for parameter optimization. Methods: Routine patient results from six laboratory analytes were analyzed using a standardized “transform–truncate–alarm” PBRTQC workflow. Simulated systematic biases were introduced for model training, and algorithm-specific parameters were optimized using a composite metric integrating sensitivity, false-positive rate (FPR), and detection delay. Performance was subsequently evaluated on an independent validation dataset. Results: For most analytes, all three SPC algorithms demonstrated robust PBRTQC performance, achieving high sensitivity (generally ≥0.85), very low false-positive rates (