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Systematic reviews of the effectiveness of quality improvement strategies and programmes
  1. J Grimshaw1,
  2. L M McAuley2,
  3. L A Bero3,
  4. R Grilli4,
  5. A D Oxman5,
  6. C Ramsay6,
  7. L Vale7,
  8. M Zwarenstein8
  1. 1Clinical Epidemiology Program, Ottawa Health Research Institute and Senior Scientist, Institution of Population Health, University of Ottawa, Canada
  2. 2Cochrane Effective Practice and Organisation of Care Group, Institution of Population Health, University of Ottawa, Canada
  3. 3Department of Clinical Pharmacy, School of Pharmacy and Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
  4. 4Department of Clinical Governance, Regional Agency for Health Care of Emilia-Romagna, Bologna, Italy
  5. 5Department of Health Services Research, Directorate for Health and Social Welfare, Oslo, Norway
  6. 6Health Services Research Unit, University of Aberdeen, UK
  7. 7Health Services Research Unit and Health Economics Research Unit, University of Aberdeen, UK
  8. 8Institute for Clinical Evaluation Sciences, Toronto; Clinical Epidemiology Unit, Sunnybrook & Women’s Hospital, Toronto; Department of Health Policy, Management and Evaluation, University of Toronto, Toronto; Knowledge Translation Programme, Continuing Education, University of Toronto, Toronto, Canada; Health Systems Research Unit, Medical Research Council, Cape Town, South Africa; Nuffield Department of Clinical Medicine, University of Oxford, UK
  1. Correspondence to:
 Dr J Grimshaw, Director of the Clinical Epidemiology Programme, Ottawa Health Research Institute, 1053 Carling Avenue, Ottawa ON K1Y 4E9, Canada; 


Systematic reviews provide the best evidence on the effectiveness of healthcare interventions including quality improvement strategies. The methods of systematic review of individual patient randomised trials of healthcare interventions are well developed. We discuss methodological and practice issues that need to be considered when undertaking systematic reviews of quality improvement strategies including developing a review protocol, identifying and screening evidence sources, quality assessment and data abstraction, analytical methods, reporting systematic reviews, and appraising systematic reviews. This paper builds on our experiences within the Cochrane Effective Practice and Organisation of Care (EPOC) review group.

  • quality improvement research
  • systematic reviews

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  • Conflicts of interest: The authors are all associated with the Cochrane Effective Practice and Organisation of Care group.

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