Article Text

Finding order in heterogeneity: types of quality-improvement intervention publications
  1. L V Rubenstein1,2,3,4,
  2. S Hempel2,
  3. M M Farmer1,
  4. S M Asch1,2,4,
  5. E M Yano1,3,
  6. D Dougherty5,
  7. P W Shekelle1,2,4
  1. 1
    Veterans Affairs Greater Los Angeles Healthcare System at Sepulveda, California, USA
  2. 2
    RAND Corporation, Santa Monica, California, USA
  3. 3
    UCLA School of Public Health, Los Angeles, California, USA
  4. 4
    UCLA Department of Medicine, Los Angeles, California, USA
  5. 5
    Agency for Healthcare Research and Quality, Rockville, Maryland, USA
  1. Dr L Rubenstein, Veterans Affairs Greater Los Angeles Healthcare System at Sepulveda, 16111 Plummer St. (152), North Hills, CA 91343, USA; lisa_rubenstein{at}


Background: Stakeholders in quality improvement agree on the need for augmenting and synthesising the scientific literature supporting it. The diversity of perspectives, approaches, and contexts critical to advancing quality improvement science, however, creates challenges. The paper explores the heterogeneity in clinical quality improvement intervention (QII) publications.

Methods: A preliminary classification framework was developed for QII articles, aiming for categories homogeneous enough to support coherent scientific discussion on QII reporting standards and facilitate systematic review. QII experts were asked to identify articles important to QII science. The framework was tested and revised by applying it to the article set. The final framework screened articles into (1) empirical literature on development and testing of QIIs; (2) QII stories, theories, and frameworks; (3) QII literature syntheses and meta-analyses; or (4) development and testing of QII-related tools. To achieve homogeneity, category (1) required division into (1a) development of QIIs; 1(b) history, documentation, or description of QIIs; or (1c) success, effectiveness or impact of QIIs.

Results: By discussing unique issues and established standards relevant to each category, QII stakeholders can advance QII practice and science, including the scope and conduct of systematic literature reviews.

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  • Competing interests: None.

  • Funding: Agency for Healthcare Research and Quality (AHRQ) under a contract to LVR (contract no HHSP233200400717P) funded by an Interagency Agreement between AHRQ and the Centers for Disease Control and Prevention.

  • See Editorial, p 394

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