Improving the evaluation of quality improvement

 
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The use of quality improvement approaches (known as “QI”) to improve health care service outcomes has spread rapidly in recent years. Although QI has contributed to the achievement of measurably significant results as diverse as decreasing maternal mortality from post-partum hemorrhage to increasing compliance with HIV standards of care, its evidence base remains questioned by researchers. The scientific community understandably wants rigorously designed evaluations, consistency in results measurement, proof of attribution of results to specific interventions, and generalizability of findings so that evaluation can help to elevate QI to the status of a “science”. However, evaluation of QI remains a challenge and not everyone agrees on the appropriate methodology to evaluate QI efforts.

In this post, we begin by reviewing a generic model of quality improvement and explore relevant evaluation questions for QI efforts. We then look at the arguments made by improvers and researchers for evaluation methods. We conclude by presenting an initial evaluation framework for QI developed at a recent international QI conference.