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The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration
  1. G Ogrinc1,
  2. S E Mooney2,
  3. C Estrada3,
  4. T Foster4,
  5. D Goldmann5,
  6. L W Hall6,
  7. M M Huizinga7,
  8. S K Liu8,
  9. P Mills9,
  10. J Neily10,
  11. W Nelson11,
  12. P J Pronovost12,
  13. L Provost13,
  14. L V Rubenstein14,
  15. T Speroff15,
  16. M Splaine16,
  17. R Thomson17,
  18. A M Tomolo18,
  19. B Watts19
  1. 1
    Quality Literature Program, The Dartmouth Institute for Health Policy and Clinical Practice; Office of Research and Innovation in Medical Education, Dartmouth Medical School, Hanover, New Hampshire, and White River Junction VA Hospital, White River Junction, Vermont, USA
  2. 2
    Alice Peck Day Memorial Hospital, Lebanon, New Hampshire, USA
  3. 3
    General Internal Medicine; VA National Quality Scholars Program, Birmingham VA Medical Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
  4. 4
    Dartmouth Hitchcock Leadership and Preventive Medicine Residency, Obstetrics and Gynecology and Community and Family Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
  5. 5
    Institute for Healthcare Improvement (IHI), Harvard Medical School, Boston, Massachusetts, USA
  6. 6
    University of Missouri Health Care, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
  7. 7
    General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  8. 8
    Departments of Medicine and Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA
  9. 9
    VA National Center for Patient Safety Field Office, White River Junction, Vermont, and Dartmouth Medical School, Hanover, New Hampshire, USA
  10. 10
    Field Office of VHA’s National Center for Patient Safety, White River Junction, Vermont, USA
  11. 11
    Rural Ethics Initiatives, Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, New Hampshire, USA
  12. 12
    Departments of Anesthesiology and Critical Care, Surgery, and Health Policy and Management, Center for Innovations in Quality Patient Care, Quality and Safety Research Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  13. 13
    Associates in Process Improvement, Austin, Texas, USA
  14. 14
    VA Greater Los Angeles and University of California Los Angeles, VA HSRD Center of Excellence for the Study of Healthcare Provider Behavior, RAND, VA Greater Los Angeles at Sepulveda, North Hills, California, USA
  15. 15
    Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
  16. 16
    VA National Quality Scholars Fellowship Program, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, New Hampshire, USA
  17. 17
    Institute of Health and Society Medical School, Framlington Place, Newcastle upon Tyne, UK
  18. 18
    Emergency Department, Louis Stokes Cleveland DVAMC, Case Western Reserve University SOM, Cleveland, Ohio, USA
  19. 19
    Inpatient Quality Improvement, Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
  1. Dr Greg Ogrinc, Dartmouth Medical School, 215 N Main Street, White River Junction, VT 05009, USA; greg.ogrinc{at}


As the science of quality improvement in health care advances, the importance of sharing its accomplishments through the published literature increases. Current reporting of improvement work in health care varies widely in both content and quality. It is against this backdrop that a group of stakeholders from a variety of disciplines has created the Standards for QUality Improvement Reporting Excellence, which we refer to as the SQUIRE publication guidelines or SQUIRE statement. The SQUIRE statement consists of a checklist of 19 items that authors need to consider when writing articles that describe formal studies of quality improvement. Most of the items in the checklist are common to all scientific reporting, but virtually all of them have been modified to reflect the unique nature of medical improvement work.

This “Explanation and Elaboration” document (E & E) is a companion to the SQUIRE statement. For each item in the SQUIRE guidelines the E & E document provides one or two examples from the published improvement literature, followed by an analysis of the ways in which the example expresses the intent of the guideline item. As with the E & E documents created to accompany other biomedical publication guidelines, the purpose of the SQUIRE E & E document is to assist authors along the path from completion of a quality improvement project to its publication. The SQUIRE statement itself, this E & E document, and additional information about reporting improvement work can be found at

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  • Funding: The material in this paper was supported through a grant from the Robert Wood Johnson Foundation and through use of facilities and materials from the White River Junction VA Hospital in White River Junction, Vermont, USA.

  • Competing interests: None.

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