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Projects
Advancing the Science of Continuous Quality Improvement: A Framework for Identifying, Classifying, and Evaluating Continuous Quality Improvement Studies
Sponsor
Robert Wood Johnson Foundation
Staff
Lisa Rubenstein, Principal Investigator
Paul Shekelle, Co-principal Investigator
Susanne Hempel
While the practice of continuous quality improvement (CQI) flourishes, the evolution of the scientific base underlying it is hampered by the complexity and diversity of information needed to evaluate and understand its implementation and effects. CQI is one of the few generally accepted methods for healthcare organizations to address quality problems in a systematic, measurement-directed way. However, in spite of its extensive use, rigorous evidence for the effectiveness of the method remains sparse, and scientists question whether current standards for evaluating CQI are too permissive. In contrast, many CQI researchers, journal editors, and practitioners recognize limitations in traditional randomized clinical trial frameworks when used as standards for preparing and judging CQI evaluation publications. These groups are concerned that over-reliance on traditional randomized trial approaches and standards limits both the advance of CQI science and the usefulness of CQI study results.
Achieving progress in building a useful knowledge base for CQI requires an expanded set of frameworks and standards for publication of CQI studies, covering the full range of projects and types of evidence and information generated by CQI research. The SQUIRE guidelines pioneered the development of quality standards for projects and publications on quality and safety improvement, and are a foundation for our work. Developing these frameworks will require a better understanding of the range of CQI projects and publications currently generated, and guidance in determining how to document these projects in a manner that provides the full range of required information (including, in particular, contextual information).
The overall goal of this project is to develop evidence-based methods for identifying and applying relevant quality criteria to published articles that empirically evaluate CQI interventions. The project has three goals:
- Develop and validate a CQI article search strategy, including an operational definition of CQI for use in literature searches.
- Identify and apply established, relevant quality criteria from the literature to a sample of CQI articles; document the level of adherence to these criteria; analyze the relationship between criteria and study outcomes; and identify and assess key methodological features that are not thought to signify high or low quality but that nevertheless may have systematic effects on outcomes.
- Present results to an evidence review panel comprising expert stakeholders to achieve consensus on (a) an operational definition of CQI; (b) a set of methodological features, if any, with systematic effects on outcomes; and (c) a parsimonious set of criteria judged by the panel to be important for identifying valid, useful published CQI evaluations.
A report is expected in late 2009.
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