QICs have been adopted widely as an approach to shared learning and improvement in healthcare. Overall, the QICs included in this review reported significant improvements in targeted clinical processes and patient outcomes. These reports are encouraging, but most be interpreted cautiously since fewer than a third met established quality and reporting criteria, and publication bias is likely.

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Background Reducing hospital readmission rates is a national priority; however, evidence about hospital strategies that are associated with lower readmission rates is limited. We sought to identify hospital strategies that were associated with lower readmission rates for patients with heart failure. Methods and Results Using data from a Web-based survey of hospitals participating in national quality initiatives to reduce readmission (N=599; 91% response rate) during 2010–2011, we constructed a multivariable linear regression model, weighted by hospital volume, to determine strategies independently associated with risk-standardized 30-day readmission rate (RSRR) adjusted for hospital teaching status, geographic location, and number of staffed beds. Strategies that were associated with lower hospital RSRR included: 1) partnering with community physicians or physician groups to reduce readmission (0.33 percentage point lower RSRR, P-value = 0.017), 2) partnering with local hospitals to reduce readmissions (0.34 percentage point, P-value = 0.020), 3) having nurses responsible for medication reconciliation (0.18 percentage point, P-value = 0.002), 4) arranging follow-up appointments before discharge (0.19 percentage point, P-value = 0.037), 5) having a process in place to send all discharge paper or electronic summaries directly to the patient's primary physician (0.21 percentage point, P-value = 0.004), and 6) assigning staff to follow up on test results that return after the patient is discharged (0.26 percentage point, P-value =0.049). Although statistically significant, the magnitude of the effects was modest with individual strategies associated with less than half a percentage point reduction in RSRR; however, hospitals that implemented more strategies had significantly lower RSRRs (reduction of 0.34 percentage point for each additional strategy). Conclusions Several strategies were associated with lower hospital RSRR for patients with heart failure.