Identifying continuous quality improvement publications: what makes an improvement intervention 'CQI'?

O’Neill, Sean M.; Hempel, Susanne; Lim, Yee-Wei; Danz, Marjorie; Foy, Robbie; Suttorp, Marika J; Shekelle, Paul G; Rubenstein, Lisa V.

doi:10.1136/bmjqs.2010.050880

Cited by 41 publications

(40 citation statements)

References 27 publications

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“…This is in line with prevailing definitions of climate as ‘the policies, practices, and procedures as well as the behaviours that get rewarded, supported, and expected in a work setting’ [85]. It is also consistent with recent attempts to identify an operational definition for CQI interventions, which focused on CQI methods such as the use of data to design changes [86]. …”

Section: Resultssupporting

confidence: 82%

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Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

et al. 2012

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BackgroundContinuous quality improvement (CQI) methods are widely used in healthcare; however, the effectiveness of the methods is variable, and evidence about the extent to which contextual and other factors modify effects is limited. Investigating the relationship between these factors and CQI outcomes poses challenges for those evaluating CQI, among the most complex of which relate to the measurement of modifying factors. We aimed to provide guidance to support the selection of measurement instruments by systematically collating, categorising, and reviewing quantitative self-report instruments.MethodsData sources: We searched MEDLINE, PsycINFO, and Health and Psychosocial Instruments, reference lists of systematic reviews, and citations and references of the main report of instruments. Study selection: The scope of the review was determined by a conceptual framework developed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). Papers reporting development or use of an instrument measuring a construct encompassed by the framework were included. Data extracted included instrument purpose; theoretical basis, constructs measured and definitions; development methods and assessment of measurement properties. Analysis and synthesis: We used qualitative analysis of instrument content and our initial framework to develop a taxonomy for summarising and comparing instruments. Instrument content was categorised using the taxonomy, illustrating coverage of the InQuIRe framework. Methods of development and evidence of measurement properties were reviewed for instruments with potential for use in primary care.ResultsWe identified 186 potentially relevant instruments, 152 of which were analysed to develop the taxonomy. Eighty-four instruments measured constructs relevant to primary care, with content measuring CQI implementation and use (19 instruments), organizational context (51 instruments), and individual factors (21 instruments). Forty-one instruments were included for full review. Development methods were often pragmatic, rather than systematic and theory-based, and evidence supporting measurement properties was limited.ConclusionsMany instruments are available for evaluating CQI, but most require further use and testing to establish their measurement properties. Further development and use of these measures in evaluations should increase the contribution made by individual studies to our understanding of CQI and enhance our ability to synthesise evidence for informing policy and practice.

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Section: Resultssupporting

confidence: 82%

“…First, there is limited consensus in the literature on what defines a CQI intervention and its components, and large variability in the content of CQI interventions across studies [86]. In part, this is attributed to the evolution and local adaptation of CQI interventions.…”

Section: Discussionmentioning

confidence: 99%

Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

et al. 2012

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“…Continuous quality improvement procedures are a distinctive component of QA systems intended to maximize the utility of implementation evaluation in routine practice via site-specific performance feedback (O'Neill et al 2011). …”

Section: Need For Efficient Fidelity Measures To Support Ebi Quality mentioning

confidence: 99%

Validity of Therapist Self-Report Ratings of Fidelity to Evidence-Based Practices for Adolescent Behavior Problems: Correspondence between Therapists and Observers

Hogue

Dauber

Lichvar

et al. 2014

Adm Policy Ment Health

114

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Developing therapist-report fidelity tools to support quality delivery of evidence-based practices in usual care is a top priority for implementation science. This study tested the reliability and accuracy of two groups of community therapists who reported on their use of family therapy (FT) and motivational interviewing/cognitive-behavioral therapy (MI/CBT) interventions during routine treatment of inner-city adolescents with conduct and substance use problems. Study cases (n = 45) were randomized into two conditions: (a) Routine Family Therapy (RFT), consisting of a single site that featured family therapy as its standard of care for behavioral treatment; or (b) Treatment As Usual (TAU), consisting of five sites that featured non-family approaches. Therapists and trained observational raters provided FT and MI/CBT adherence ratings on 157 sessions (104 RFT, 53 TAU). Overall therapist reliability was adequate for averaged FT ratings (ICC = .66) but almost non-existent for MI/CBT (ICC = .06); moreover, both RFT and TAU therapists were more reliable in reporting on FT than on MI/CBT. Both groups of therapists overestimated the extent to which they implemented FT and MI/CBT interventions. Results offer support for the feasibility of using existing therapist-report methods to anchor quality assurance procedures for FT interventions in real-world settings, though not for MI/CBT.

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“…We showed that, while these features can be reliably abstracted from the literature, there are few articles that include all of them [19]. We also found that articles are so diverse in terms of where they report the features (e.g.…”

Section: Discussionmentioning

confidence: 99%

How can we recognize continuous quality improvement?

Rubenstein

Khodyakov

Hempel

et al. 2013

International Journal for Quality in Health Care

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ObjectiveContinuous quality improvement (CQI) methods are foundational approaches to improving healthcare delivery. Publications using the term CQI, however, are methodologically heterogeneous, and labels other than CQI are used to signify relevant approaches. Standards for identifying the use of CQI based on its key methodological features could enable more effective learning across quality improvement (QI) efforts. The objective was to identify essential methodological features for recognizing CQI.DesignPrevious work with a 12-member international expert panel identified reliably abstracted CQI methodological features. We tested which features met rigorous a priori standards as essential features of CQI using a three-phase online modified-Delphi process.SettingPrimarily United States and Canada.Participants119 QI experts randomly assigned into four on-line panels.Intervention(s)Participants rated CQI features and discussed their answers using online, anonymous and asynchronous discussion boards. We analyzed ratings quantitatively and discussion threads qualitatively.Main outcome measure(s)Panel consensus on definitional CQI features.ResultsSeventy-nine (66%) panelists completed the process. Thirty-three completers self-identified as QI researchers, 18 as QI practitioners and 28 as both equally. The features ‘systematic data guided activities,’ ‘designing with local conditions in mind’ and ‘iterative development and testing’ met a priori standards as essential CQI features. Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI.ConclusionsWe found consensus among a broad group of CQI researchers and practitioners on three features as essential for identifying QI work more specifically as ‘CQI.’ All three features are needed as a minimum standard for recognizing CQI methods.

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Identifying continuous quality improvement publications: what makes an improvement intervention 'CQI'?

Cited by 41 publications

References 27 publications

Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

Validity of Therapist Self-Report Ratings of Fidelity to Evidence-Based Practices for Adolescent Behavior Problems: Correspondence between Therapists and Observers

How can we recognize continuous quality improvement?

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