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Are quality improvement collaboratives effective? A systematic review
  1. Susan Wells1,
  2. Orly Tamir2,
  3. Jonathon Gray3,4,
  4. Dhevaksha Naidoo5,
  5. Mark Bekhit6,
  6. Don Goldmann7
  1. 1 Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
  2. 2 Center for Research and Policy in Diabetes, The Gertner Institute for Epidemiology and Health Policy, Sheba Medical Center, Tel-Hashomer, Israel
  3. 3 Victoria University, Wellington, New Zealand
  4. 4 South West Academic Health Science Network, Exeter, UK
  5. 5 RMIT University, Melbourne, Victoria, Australia
  6. 6 School of Medicine, University of Auckland, Auckland, New Zealand
  7. 7 Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
  1. Correspondence to Associate Professor Susan Wells, Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland 1071, New Zealand; s.wells{at}auckland.ac.nz

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 quality and reporting criteria, and publication bias is likely.

  • quality improvement
  • collaborative, breakthrough groups
  • implementation science
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Footnotes

  • Handling editor Kaveh G Shojania

  • Contributors All authors have made substantial contributions to the conception or design of the work; the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; and final approval of the version to be published. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests SW reports grants from The Stevenson Foundation, during the conduct of the study; grants from Health Research Council of New Zealand, grants from Roche Diagnostics Ltd, grants from National Heart Foundation of New Zealand, outside the submitted work; JG reports grants from Stevenson Foundation, during the conduct of the study.OT, MB, DN and DG no competing interests

  • Provenance and peer review Not commissioned; externally peer reviewed.

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