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Identifying continuous quality improvement publications: what makes an improvement intervention ‘CQI’?
  1. Sean M O'Neill1,2,
  2. Susanne Hempel1,
  3. Yee-Wei Lim1,
  4. Marjorie S Danz1,3,
  5. Robbie Foy4,
  6. Marika J Suttorp1,
  7. Paul G Shekelle1,3,5,
  8. Lisa V Rubenstein1,3,5
  1. 1RAND Corporation, Santa Monica, California, USA
  2. 2Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
  4. 4Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  5. 5David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
  1. Correspondence to Sean M O'Neill, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA; soneill{at}


Background The term continuous quality improvement (CQI) is often used to refer to a method for improving care, but no consensus statement exists on the definition of CQI. Evidence reviews are critical for advancing science, and depend on reliable definitions for article selection.

Methods As a preliminary step towards improving CQI evidence reviews, this study aimed to use expert panel methods to identify key CQI definitional features and develop and test a screening instrument for reliably identifying articles with the key features. We used a previously published method to identify 106 articles meeting the general definition of a quality improvement intervention (QII) from 9427 electronically identified articles from PubMed. Two raters then applied a six-item CQI screen to the 106 articles.

Results Per cent agreement ranged from 55.7% to 75.5% for the six items, and reviewer-adjusted intra-class correlation ranged from 0.43 to 0.62. ‘Feedback of systematically collected data’ was the most common feature (64%), followed by being at least ‘somewhat’ adapted to local conditions (61%), feedback at meetings involving participant leaders (46%), using an iterative development process (40%), being at least ‘somewhat’ data driven (34%), and using a recognised change method (28%). All six features were present in 14.2% of QII articles.

Conclusions We conclude that CQI features can be extracted from QII articles with reasonable reliability, but only a small proportion of QII articles include all features. Further consensus development is needed to support meaningful use of the term CQI for scientific communication.

  • Continuous quality improvement
  • healthcare quality improvement
  • organisation
  • PDSA
  • research

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Funding Robert Wood Johnson Foundation (RWJF, PO Box 2316, Route 1 and College Road East, Princeton, NJ 08543, USA) grants were given to LR (Grant ID 65113: Advancing the science of continuous quality improvement: A framework for identifying, classifying and evaluating continuous quality improvement studies and Grant ID 67890: Providing a framework for the identification, classification, and evaluation of quality improvement initiatives). RWJF's assistance in collecting data was limited to allowing the authors to glean definitions of continuous quality improvement from grant applications to the Advancing the Science of Continuous Quality Improvement program. RWJF played no role in the study design, in the analysis and interpretation of data, in the writing of the report, or in the decision to submit the paper for publication. Additional funding was provided by the Agency for Healthcare Research and Quality, the Veterans Health Administration, the British Healthcare Foundation and RAND Health.

  • Competing interests None to declare.

  • Ethics approval This study was conducted with the approval of the RAND Corporation Human Subjects Protection Committee.

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

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