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The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time
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Are quality improvement collaboratives effective? A systematic review.

Susan Wells1, Orly Tamir2, Jonathon Gray3,4

  • 1Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.

BMJ Quality & Safety
|October 23, 2017
PubMed
Summary

Quality improvement collaboratives (QICs) show promise in healthcare, with most studies reporting improvements in clinical processes and patient outcomes. However, cautious interpretation is needed due to limited reporting quality and potential publication bias.

Keywords:
collaborative, breakthrough groupsimplementation sciencequality improvement

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Area of Science:

  • Healthcare Improvement Science
  • Evidence-Based Practice
  • Health Services Research

Background:

  • Quality Improvement Collaboratives (QICs) are widely adopted internationally for healthcare improvement.
  • Empirical evidence for the effectiveness of QICs remains limited.

Purpose of the Study:

  • To systematically review the empirical evidence for the effectiveness of Quality Improvement Collaboratives.
  • To assess the quality of study designs and reporting in QIC evaluations.

Main Methods:

  • A comprehensive literature search was conducted across multiple databases (Medline, Embase, CINAHL, PsycINFO, Cochrane Library) from 1995 to 2014.
  • Studies meeting QIC intervention criteria and Cochrane Effective Practice and Organisation of Care (EPOC) design standards were included.
  • Study bias and intervention reporting quality were assessed using EPOC and SQUIRE 1.0 standards, respectively.

Main Results:

  • Of 220 QIC studies identified, 64 met EPOC design standards, including 10 cluster randomized trials, 24 controlled before-after studies, and 30 interrupted time series studies.
  • Improvements in primary effect measures were reported in 83% of studies across various care settings (hospital, ambulatory, nursing home).
  • Few reports adequately described QIC implementation, engagement, or contextual factors; persistence of effects was reported in only eight studies.

Conclusions:

  • Quality Improvement Collaboratives are associated with reported improvements in clinical processes and patient outcomes.
  • Findings should be interpreted cautiously due to suboptimal study quality and reporting in most evaluations.
  • Publication bias may influence the observed positive results, highlighting the need for more rigorous research designs and transparent reporting.