Table 1

 Draft proposed guidelines for stronger quality improvement evidence*

ItemPaper sectionDescriptor and topic
*Although each section of the text of a quality improvement report in the Introduction, Methods, Results, and Discussion (IMRaD) format (for example, the Introduction) generally needs to contain at least some information about all of the guidelines items listed for that section, individual items from one guideline section are often needed in various sections of the text.
1 Title and abstract Indication that this is a quality improvement article
2BackgroundCurrent organizational and clinical knowledge about the problem area
3ProblemNature and severity of specific local dysfunction or failure
4Purpose of change(s)Specific aim(s) of proposed changes, i.e. questions to be answered
5SettingRelevant details of geographic location, local organization, staffing
6FunctionPurpose, processes, and activities of department, team, unit, program
7Intervention(s)Precise details of initial strategy for intended changes/improvements
8MeasuresBalance of methods used to assess dysfunction/failure and outcomes of changes, including measurement perspective (e.g. patients, staff, administration, cost, etc); methods used to validate measures
9Analytical methodsStatistical and time series techniques used; specific software (if any)
10Situation analysisInitial assessment of local context of the care system (e.g. specifics of the patient population, local experience with change, etc) and how that assessment helped understand the problem
11OutcomesHow the initial improvement plan evolved over time (if it did), including alternative change strategies considered and rejected, with reasons; how and why this evolution occurred and who was responsible for it
What effects the changes/improvements actually had on clinical and/or organizational and professional outcomes and processes including benefits, harms, unexpected results, problems, failures
12SummaryKey findings, lessons learned from evolution of changes, outcomes achieved
13ContextComparison and contrast of results with the findings of others; broad formal review of the literature is desirable
14InterpretationInferences about mechanisms of changes/improvements, including prior changes, change making in this setting
15LimitationsSources of bias or imprecision; factors affecting generalizability, particularly unique features of local setting, and potential confounders; efforts made to minimize and correct for limitations; effect of limitations on interpretation and application of results
16ConclusionsImplications for practice and further study; plans for maintenance of improvement and for follow up to assess maintenance; next steps