Are quality improvement collaboratives effective? A systematic review

Wells, S, Tamir, O, Gray, J, Naidoo, D, Bekhit, M and Goldmann, D 2018, 'Are quality improvement collaboratives effective? A systematic review', BMJ Quality and Safety, vol. 27, no. 3, pp. 226-240.

Document type: Journal Article
Collection: Journal Articles

Title Are quality improvement collaboratives effective? A systematic review
Author(s) Wells, S
Tamir, O
Gray, J
Naidoo, D
Bekhit, M
Goldmann, D
Year 2018
Journal name BMJ Quality and Safety
Volume number 27
Issue number 3
Start page 226
End page 240
Total pages 15
Publisher B M J Group
Abstract Background: Quality improvement collaboratives (QIC) have proliferated internationally, but there is little empirical evidence for their effectiveness. Method: We searched Medline, Embase, CINAHL, PsycINFO and the Cochrane Library databases from January 1995 to December 2014. Studies were included if they met the criteria for a QIC intervention and the Cochrane Effective Practice and Organisation of Care (EPOC) minimum study design characteristics for inclusion in a review. We assessed study bias using the EPOC checklist and the quality of the reported intervention using a subset of SQUIRE 1.0 standards. Results: Of the 220 studies meeting QIC criteria, 64 met EPOC study design standards for inclusion. There were 10 cluster randomised controlled trials, 24 controlled before-after studies and 30 interrupted time series studies. QICs encompassed a broad range of clinical settings, topics and populations ranging from neonates to the elderly. Few reports fully described QIC implementation and methods, intensity of activities, degree of site engagement and important contextual factors. By care setting, an improvement was reported for one or more of the study's primary effect measures in 83% of the studies (32/39 (82%) hospital based, 17/20 (85%) ambulatory care, 3/4 nursing home and a sole ambulance QIC). Eight studies described persistence of the intervention effect 6 months to 2 years after the end of the collaborative. Collaboratives reporting success generally addressed relatively straightforward aspects of care, had a strong evidence base and noted a clear evidence-practice gap in an accepted clinical pathway or guideline. Conclusions: QICs have been adopted widely as an approach to shared learning and improvement in healthcare. Overall, the QICs included in this review reported significant improvements in targeted clinical processes and patient outcomes. These reports are encouraging, but most be interpreted cautiously since fewer than a third met established quali
Subject Public Health and Health Services not elsewhere classified
Keyword(s) collaborative
breakthrough groups
implementation science
quality improvement
DOI - identifier 10.1136/bmjqs-2017-006926
Copyright notice © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.
ISSN 2044-5415
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