Draft proposed guidelines for stronger quality improvement evidence*
| Item | Paper section | Descriptor 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 |
| Introduction: | ||
| 2 | Background | Current organizational and clinical knowledge about the problem area |
| 3 | Problem | Nature and severity of specific local dysfunction or failure |
| 4 | Purpose of change(s) | Specific aim(s) of proposed changes, i.e. questions to be answered |
| Methods: | ||
| 5 | Setting | Relevant details of geographic location, local organization, staffing |
| 6 | Function | Purpose, processes, and activities of department, team, unit, program |
| 7 | Intervention(s) | Precise details of initial strategy for intended changes/improvements |
| 8 | Measures | Balance 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 |
| 9 | Analytical methods | Statistical and time series techniques used; specific software (if any) |
| Results: | ||
| 10 | Situation analysis | Initial 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 |
| 11 | Outcomes | How 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 | ||
| Discussion: | ||
| 12 | Summary | Key findings, lessons learned from evolution of changes, outcomes achieved |
| 13 | Context | Comparison and contrast of results with the findings of others; broad formal review of the literature is desirable |
| 14 | Interpretation | Inferences about mechanisms of changes/improvements, including prior changes, change making in this setting |
| 15 | Limitations | Sources 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 |
| 16 | Conclusions | Implications for practice and further study; plans for maintenance of improvement and for follow up to assess maintenance; next steps |