RT Journal Article SR Electronic T1 How to study improvement interventions: a brief overview of possible study types JF BMJ Quality & Safety JO BMJ Qual Saf FD BMJ Publishing Group Ltd SP 325 OP 336 DO 10.1136/bmjqs-2014-003620 VO 24 IS 5 A1 Margareth Crisóstomo Portela A1 Peter J Pronovost A1 Thomas Woodcock A1 Pam Carter A1 Mary Dixon-Woods YR 2015 UL http://qualitysafety.bmj.com/content/24/5/325.abstract AB Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare. This article offers an overview of possible methods for the study of improvement interventions. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. Quality improvement projects tend to be applied and, in some senses, self-evaluating. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made.