Evidence-Based Quality Improvement: The State Of The Science

Abstract

Routine practice fails to incorporate research evidence in a timely and reliable fashion. Many quality improvement (QI) efforts aim to close these gaps between clinical research and practice. However, in sharp contrast to the paradigm of evidence-based medicine, these efforts often proceed on the basis of intuition and anecdotal accounts of successful strategies for changing provider behavior or achieving organizational change. We review problems with current approaches to QI research and outline the steps required to make QI efforts based as much on evidence as the practices they seek to implement.

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

“…42 This study design cannot account for secular trends or other factors, includ- ing other QI interventions, that could influence the effect of an intervention. 26 The statistically significant reduction in impatient mortality in the control arm of the MERIT trial is an instructive example; this decline could have been a result of the educational intervention on caring for deteriorating patients, other ongoing QI projects at the individual hospitals, or simply random variation during the relatively short (6-month) follow-up period.…”

“…The remaining articles had only scant details about the intervention and its implementation, a common problem noted in the quality improvement literature. 42,52,53 Our analysis had several limitations. We attempted to identify as many RRS trials as possible by searching multiple databases and reviewing abstract proceedings, but as the RRS literature is in its infancy, we may not have located other unpublished studies or "gray literature."…”

An evaluation of three methods of in-hospital cardiac arrest educational debriefing: The cardiopulmonary resuscitation debriefing study

“…Key biases stemmed from the before/ after design, such that it was not possible to control for underlying secular trends, and the use of a single NHS Trust as the study setting, which increased the risk of intervention contamination between study sites. [32][33][34] We also observed a number of differences in baseline patient demographics between the two study periods, which may have influenced study findings. A further limitation is that we were unable to accurately record individual clinician exposure to cardiac arrest following receipt of the debriefing intervention and it is unclear whether there was any difference in staff characteristics between debriefing recipients and non-recipients.…”

Bridging the Gap Between Evidence and Practice in Venous Thromboembolism Prophylaxis: The Quality Improvement Process

“…11 There are 6 general categories of QI strategies: provider education, provider reminder systems and decision support, audit and feedback, education of patients, organizational change, and financial incentives, regulation, and policy. 11 The Joint Commission initiative is a QI strategy at regulation and policy level. Little information is yet available on the effects of organizational change and the use of regulation and policy as QI strategies for VTE prophylaxis.…”

“…Furthermore, available publications may be biased toward positive results. 11,12 Few direct comparisons of different types of quality initiatives have been undertaken, making it difficult to abstract optimal strategies. 11,12 In addition, responses to a QI initiative may depend on factors related to the practice, such as the issue being studied and the level of acceptance it has achieved among health care professionals.…”