How to Use an Article About Quality Improvement

Abstract

Quality improvement (QI) attempts to change clinician behavior and, through those changes, lead to improved patient outcomes. The methodological quality of studies evaluating the effectiveness of QI interventions is frequently low. Clinicians and others evaluating QI studies should be aware of the risk of bias, should consider whether the investigators measured appropriate outcomes, should be concerned if there has been no replication of the findings, and should consider the likelihood of success of the QI intervention in their practice setting and the costs and possibility of unintended effects of its implementation. This article complements and enhances existing Users' Guides that address the effects of interventions-Therapy, Harm, Clinical Decision Support Systems, and Summarizing the Evidence guides-with an emphasis on issues specific to QI studies. Given the potential for widespread implementation of QI interventions, there is a need for robust study methods in QI research.

Quasi-Experimental Designs in Practice-based Research Settings: Design and Implementation Considerations

“…Consequently, alternative approaches to evaluating clinical and community interventions have received increased attention, particularly those that can retain some elements of randomization such that they can be considered "controlled" trials. [2][3][4][5][6] Such designs are consistent with discussions of "practical clinical trials" 7 in that these designs adapt to local considerations, such as those raised above, and therefore are likely to achieve better outcomes. In light of the recognition that evidence-based practice must be informed by practice-based evidence, 8 practice-based research (PBR), in particular may benefit from approaches that do not require randomization of individuals in settings where it may not be feasible.…”

Emergency surgery in the elderly patient: a quality improvement approach

“…An alternative method is to use a quality improvement approach, with data displayed as 'run charts' using statistical process control techniques and small samples paired with repeated small tests of change using 'plan-do-study-act' (PDSA) methods [16,17]. Of course, quality improvement studies should be as rigorously evaluated as randomised controlled trials before implementation [18]. What is certain, as Lord Darzi stated in the NHS plan, is that ' 'We cannot improve what we cannot measure'' [19].…”

Impact of an Intervention to Improve Weekend Hospital Care at an Academic Medical Center: An Observational Study

“…To help mitigate such concerns, we performed a time trend study, which accounts for secular trends, and adjusted for patient case mix. 17 In addition to these relatively routine threats to validity, our hospital delivery system experienced two changes during the study period: a natural disaster and a new EHR. The biggest challenge to the validity of our analytic framework in this realworld study was the evacuation, shutdown, and phased reopening of the entire hospital in the wake of Hurricane Sandy.…”

“…In this quasiexperimental design, changes in an outcome are associated with the introduction of an intervention while accounting for temporal trends in the outcome. 17 Patients eligible for inclusion in the study were those who were 18 years of age and older and who were admitted to the hospital after January 1, 2011 and discharged before January 31, 2014. We excluded patients on the obstetrical service and patients who were discharged on October 30, 2012, the day on which the hospital was evacuated due to the effects of Hurricane Sandy.…”