Reporting and publishing quality improvement projects.

Abstract

One of the goals of the Australian Journal of Rural Health (AJRH) is to promote scholarly discourse on research, policy and rural health projects and through this promote and improve the health of rural communities. In addition to systematic reviews and original research, the AJRH welcomes reports on initiatives intended to improve healthcare. This editorial provides additional suggestions and advice to complement the information provided in the journal's author submission guidelines (https://onlinelibrary.wiley.com/page/journal/14401584/homepage/forauthors.html). It also forms part of a series of editorials designed to help authors plan, conduct and report research in rural health. It complements previous editorials on authorship,1 reviewing2 and qualitative research.3 Original research often has a larger sample size and a series of controls that are important to the accurate reporting of reliable, valid and meaningful results. This type of research has been classified across a spectrum including cohort studies, random controlled trials, controlled clinical trials, waitlist controls, effectiveness trials, quasi-experimental, case study, observational, cross-sectional and survey designs. Quality improvement (QI) initiatives can include aspects of each of these types of research but most resemble effectiveness trials. QI is any activity where the main purpose is to improve or evaluate the quality of service delivered by an individual, team or organisation. Other terms often used interchangeably with QI include ‘practice improvement,’ ‘evaluation,’ ‘audit,’ ‘quality assurance,’ ‘quality activity’ and ‘plan-do-study-act’ studies. In this editorial, the term ‘QI’ is used to refer to these sorts of activities. QI activities are often initiated and conducted by clinicians or clinical leaders to gauge the impact of new initiatives designed to improve the safety, quality or value of healthcare. Not every journal accepts QI reports for peer review. At the AJRH, we recognise and value the sharing of experience and learning that arises from reporting initiatives designed to improve healthcare. The sharing of key learnings in implementation and design enables others to build on previous work, rather than simply duplicate, the missteps of previous QI initiatives. Due to the large number of papers submitted for review at the AJRH, not every QI paper submitted will be allocated for review or be accepted after review. The submission and review process is outlined in a previous issue of the journal.2 To maximise your chances of getting published, we strongly recommend you consult the Standards for Quality Improvement and Reporting Excellence (SQUIRE) guidelines, and the accompanying Explanation and Elaboration Document. Further, we strongly suggest you do this before starting your QI project, as it will greatly assist in the design and planning of your project. Also, bear in mind the SQUIRE guidelines form the criteria that reviewers will use when assessing your paper, so following these guidelines will optimise the chances of your paper not being rejected or requiring a major revision. Some of the areas that the SQUIRE invite you to consider are the problem you are trying to solve, the practice and previous research context, the approach to addressing the problem, your findings and their meaning, interpretation, limitations and implications of these findings. The AJRH expects reports to relate the project to issues of rural health and the rural health context. Simply being conducted in a rural hospital is not sufficient grounds for publication in the AJRH. It must relate to issues of rural health service delivery, policy and practice. Further, in this respect, it is important to relate your work to previous rural health research published in reputable journals such as the AJRH. The integrity and quality of the AJRH are very important.4 They reflect the impact that papers published in the journal will have, and the confidence that readers will have in the published articles. At the AJRH, we require the authors of all research and QI reports to complete an ethics declaration before the editors consider sending the paper for peer review. The SQUIRE guidelines require a discussion of the ethical aspects of implementing the study and intervention and how these are addressed, in addition to formal ethics review and disclosure of potential conflicts of interest. There are several triggers for ethical review,5 such as gathering data which is not routinely collected, testing non-standard protocols and secondary use of evaluation data. State and territory jurisdictions often have guidelines for ethical review of QI projects,6 as does the National Health and Medical Research Council.7 We note that some health service ethics committees do not require formal submission or ethics approval before a QI project begins at that health service. However, the National Health and Medical Research Council (NHMRC) states that ‘irrespective of whether an activity is QA, evaluation or research the activity must be conducted in a way that is ethical,5 (p2) and organisations must provide the appropriate level of oversight for such activities. At the AJRH, we require all intervention studies to provide evidence of ethical review and approval by a properly constituted ethics committee, or a statement from the appropriate designated officer from the ethics committee indicating formal ethics review is not required. This is consistent with NHMRC guidelines, which suggest that if full ethical review by a human research ethics committee (HREC) is not required, organisations should consider providing correspondence indicating that an alternative approach to ethical review was considered to be appropriate for the project/initiative. We look forward to the submission of QI reports, as we believe they support an evidence-based, ‘scientist-practitioner’ approach to health care and a shared commitment to enhancing the healthcare and health outcomes for rural Australians.