Abstract
BackgroundThe evidence base for quality improvement (QI) interventions is expanding rapidly. The diversity of the initiatives and the inconsistency in labeling these as QI interventions makes it challenging for researchers, policymakers, and QI practitioners to access the literature systematically and to identify relevant publications.MethodsWe evaluated search strategies developed for MEDLINE (Ovid) and PubMed based on free text words, Medical subject headings (MeSH), QI intervention components, continuous quality improvement (CQI) methods, and combinations of the strategies. Three sets of pertinent QI intervention publications were used for validation. Two independent expert reviewers screened publications for relevance. We compared the yield, recall rate, and precision of the search strategies for the identification of QI publications and for a subset of empirical studies on effects of QI interventions.ResultsThe search yields ranged from 2,221 to 216,167 publications. Mean recall rates for reference publications ranged from 5% to 53% for strategies with yields of 50,000 publications or fewer. The 'best case' strategy, a simple text word search with high face validity ('quality' AND 'improv*' AND 'intervention*') identified 44%, 24%, and 62% of influential intervention articles selected by Agency for Healthcare Research and Quality (AHRQ) experts, a set of exemplar articles provided by members of the Standards for Quality Improvement Reporting Excellence (SQUIRE) group, and a sample from the Cochrane Effective Practice and Organization of Care Group (EPOC) register of studies, respectively. We applied the search strategy to a PubMed search for articles published in 10 pertinent journals in a three-year period which retrieved 183 publications. Among these, 67% were deemed relevant to QI by at least one of two independent raters. Forty percent were classified as empirical studies reporting on a QI intervention.ConclusionsThe presented search terms and operating characteristics can be used to guide the identification of QI intervention publications. Even with extensive iterative development, we achieved only moderate recall rates of reference publications. Consensus development on QI reporting and initiatives to develop QI-relevant MeSH terms are urgently needed.
Highlights
The evidence base for quality improvement (QI) interventions is expanding rapidly
Researchers have only recently begun to develop a common understanding of quality improvement interventions, to recognize the features that distinguish these from other interventions, and to promote the need for reporting standards [1,2]
We aim to facilitate literature syntheses, and expect that future reviews may use parts or all of our approaches to suit specific needs, such as identifying quality improvement interventions for particular conditions, clinical fields, contexts, or outcomes by adding search terms directed at these targets
Summary
The evidence base for quality improvement (QI) interventions is expanding rapidly. The diversity of the initiatives and the inconsistency in labeling these as QI interventions makes it challenging for researchers, policymakers, and QI practitioners to access the literature systematically and to identify relevant publications. Researchers have only recently begun to develop a common understanding of quality improvement interventions, to recognize the features that distinguish these from other interventions, and to promote the need for reporting standards [1,2]. Reaching agreement on how to define and apply a common label that sufficiently captures such interventions is difficult [3,4]; quality improvement interventions can cover a diverse range of approaches that variously target patients, healthcare providers, clinical teams, and organizations across clinical fields. While the common goal of the strategies may be to improve how care is delivered in healthcare settings, neither the interventions and intervention components, nor the outcomes are standardized, precluding a simplistic search strategy for identifying interventions [5]. Quality improvement approaches often include multiple intervention components [6]
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