Are quality improvement collaboratives effective? A systematic review

Abstract

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.

External Facilitation as an Evidence‐Based Practice Implementation Strategy During an Antibiotic Stewardship Collaborative in Neonatal Intensive Care Units

“…In a systematic review, QI collaboratives have been a widely adopted approach to shared learning and QI in health care, demonstrating achievement of collaborative aims (Wells et al, ). In the Antibiotic Stewardship Collaborative EF QI model, the degree of attrition was also a significant challenge for participants, leading to a lack of a “community of learning” environment where teams share information, knowledge, and experiences (Nembhard, ).…”

Evaluating implementation and impact of a provincial quality improvement collaborative for the management of chronic diseases in primary care: the COMPAS+ study protocol

“…We are also using a mixed methods approach with rigorous quantitative (interrupted time series) and qualitative (multiple case study) components. Much of the previous research on QICs has involved uncontrolled before-after studies that are limited in their ability to mitigate for bias and confounding and consider contextual factors having a potential influence on outcomes targeted by the QIC (Wells et al 2018). Even when designs like ITS were used, previous studies have lacked enough repeated observations to adequately describe trends in outcomes (Wells 2018).…”

“…To achieve the study objectives, a mixed method convergent (concomitant) study design [40] will be used where the quantitative component of the study is a controlled interrupted time series (ITS) [41] and the qualitative component is a multiple case study [42]. Firstly, to asses whether COMPAS+ is more effective than feedback alone in improving the quality of services offered to people with a chronic healthcare condition, we will conduct an ITSthe most common evaluation approach used for large-scale QI collaboratives projects [29]. It represents an ideal choice of design in our circumstances given the iterative nature of local QI projects and the integrated healthcare organizations' need for flexibility in the roll out of the QICs.…”

“…In addition, a group of expert change agents often support participants by bringing together the scientific evidence, sharing practical knowledge and advice on best practices and QI methods, and facilitating implementation of strategies to improve care [19,27]. A recent systematic review of 64 studies found that QICs resulted in a significant improvement in at least one primary outcome measure in 83% of studies, and in 85% of studies conducted in primary care [29]. A small group of studies included in the review additionally reported that QICs could be cost effective or lead to cost savings, and that intervention effects could be sustained 6 to 24 months after the end of the QIC.…”

“…effectiveness, components, determinants of success) [27][28][29][30][31] have pointed to numerous areas where new knowledge for this strategy is urgently needed. Wells and collaborators [29] have also noted that few papers provide enough detail to fully understand QIC interventions and that approaches vary considerably from one study to another. Most studies report using the Model for Improvement but it remains very difficult to determine with how much fidelity and intensity the model was implemented.…”