Authors : Shweta P. Khare; Deepika Kanyal

Volume/Issue : Volume 9 - 2024, Issue 6 - June

Google Scholar : https://tinyurl.com/mt22mvzd

Scribd : https://tinyurl.com/2s3sr372

DOI : https://doi.org/10.38124/ijisrt/IJISRT24JUN386

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Reorganizing the structure and delivery of services has been a typical focus of initiatives to improve the standard, safety, and effectiveness of health care delivery. Continuous quality improvement (CQI), a technique commonly used in the manufacturing and industrial sectors, has been applied to the health sector. Given the complexity and diversity of health systems, questions about CQI's efficacy persist despite its increased focus. This review evaluates CQI's efficacy in various healthcare environments and looks into the significance of the approach's many elements. Twenty- eight RCTs assessed the effectiveness of different approaches to CQI in a variety of scenarios using a non- CQI comparison. The methodologies used, the duration of the meetings, the participants, and the type of training provided varied throughout the interventions. It was believed that bias might taint any RCT and affect the results. The benefits of CQI compared to a non-CQI comparison on clinical process, patient, and other outcomes were not great, as evidenced by the fact that less than half of RCTs showed any effect. Benefits were usually demonstrated in clinical process metrics; these were impacted by the frequency (weekly), the type of meeting (leaders discussing implementation), and the methodology (Plan-Do-Study-Act, improvement methodology). Studying health disparities caused by socioeconomic status.

Keywords : Healthcare, Clinical Process, Continuous Quality Improvement.

References :

1. NHS England. NHS five year forward view. England: NHS; 2014.
2. Academy of Medical Royal Colleges. Quality improvement–training for better outcomes. 2016.
3. Ham C, Berwick D, Dixon J. Improving quality in the English NHS a strategy for action. London: The Kings fund; 2016.
4. Schneider A. How quality improvement in health care can help to achieve the millennium development goals. World Health Organization. 2006;84(4): 257–336.
5. Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q. 2001; 79(2):281–315.
6. Cox S, Wilcock P, Young J. Improving the repeat prescribing process in a busy general practice. A study using continuous quality improvement methodology. Qual Health Care. 1999;8(2):119.
7. Rokoske FS, Schenck AP, Hanson LC. The potential use of autopsy for continuous quality improvement in hospice and palliative care. Medscape J Med. 2008;10(12):289.
8. Manyazewal T, Mekonnen A, Demelew T, Mengestu S, Abdu Y, Mammo D, et al. Improving immunization capacity in Ethiopia through continuous quality improvement interventions: a prospective quasi-experimental study. Infect Dis Poverty. 2018;7(1):119.
9. Werth GR, Connelly DP. Continuous quality improvement and medical informatics: the convergent synergy. Proc Annu Symp Comput Appl Med Care. 1992:631–5.
10. Wallin L, Bostrom AM, Wikblad K, Ewald U. Sustainability in changing clinical practice promotes evidence-based nursing care. J Adv Nurs. 2003;41(5):509–18.
11. Larson JS, Muller A. Managing the quality of healthcare. J Health Health Serv Adm. 2002;25(3):261–80.
12. Zhan L, Finch L. Accelerated education in nursing: challenges, strategies, and future directions. New York: Springer; 2012.
13. Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE. Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Qual Saf. 2014;23(4):290.
14. Card AJ, Ward J, Clarkson PJ. Successful risk assessment may not always lead to successful risk control: a systematic literature review of risk control after root cause analysis. J Healthc Risk Manag. 2012;31(3):6–12.
15. Deblois S, Lepanto L. Lean and six sigma in acute care: a systematic review of reviews. Int J Health Care Qual Assur. 2016;29(2):192–208.
16. Cheung YY, Riblet NBV, Osunkoya TO. Use of iterative cycles in quality improvement projects in imaging; systematic review. J Am Coll Radiol. 2018; 15(11):1587–602.
17. O'Neill SM, Hempel S, Lim YW, Danz MS, Foy R, Suttorp MJ, et al. Identifying continuous quality improvement publications: what makes an improvement intervention ‘CQI’? BMJ Qual Saf. 2011;20(12):1011–9.
18. Hempel S, Shekelle PG, Liu JL, Sherwood Danz M, Foy R, Lim YW, et al. Development of the Quality Improvement Minimum Quality Criteria Set (QIMQCS): a tool for critical appraisal of quality improvement intervention publications. BMJ Qual Saf. 2015;24(12):796–804.
19. Whitehead M, Bambra C, Barr B, Bowles J, Caulfield R, Doran T, et al. Due north: report of the inquiry on health equity for the north. 2014.
20. NIHR CLAHRC North West Coast. NIHR CLAHRC North West Coast Health Inequalities Assessment Toolkit (HIAT). 2017.
21. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions: Wiley; 2011.
22. Marshall IJ, Kuiper J, Wallace BC. Robot Reviewer: evaluation of a system for automatically assessing bias in clinical trials. J Am Med Inform Assoc. 2015; 23(1):193–201
23. Rubenstein L, Khodyakov D, Hempel S, Danz M, Salem-Schatz S, Foy R, et al. How can we recognize continuous quality improvement? Int J Qual Health Care. 2014;26(1):6–15.
24. Hunter SB, Rutter CM, Ober AJ, Booth MS. Building capacity for continuous quality improvement (CQI): a pilot study. J Subst Abus Treat. 2017; 81:44–52
25. Kane RL, Huckfeldt P, Tappen R, Engstrom G, Rojido C, Newman D, et al. Effects of an intervention to reduce hospitalizations from nursing homes: a randomized implementation trial of the INTERACT program. JAMA Intern Med. 2017;177(9):1257–64.
26. Rubenstein LV, Meredith LS, Parker LE, Gordon NP, Hickey SC, Oken C, et al. Impacts of evidence-based quality improvement on depression in primary care: a randomized experiment. J Gen Intern Med. 2006;21(10):1027–35.
27. Carlhed R, Bojestig M, Wallentin L, Lindström G, Peterson A, Åberg C, et al. Improved adherence to Swedish national guidelines for acute myocardial infarction: the Quality Improvement in Coronary Care (QUICC) study. Am Heart J. 2006;152(6):1175–81.
28. Solomon DH, Losina E, Lu B, Zak A, Corrigan C, Lee SB, et al. Implementation of treat-to-target in rheumatoid arthritis through a learning collaborative: results of a randomized controlled trial. Arthritis Rheum. 2017; 69(7):1374–80.
29. Kennedy C, Ioannidis G, Thabane L, Adachi JD, Marr S, Giangregorio LM, et al. Successful knowledge translation intervention in long-term care: final results from the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. Trials. 2015; 16:214.
30. Barceló A, Cafiero E, de Boer M, Mesa AE, Lopez MG, Jiménez RA, et al. Using collaborative learning to improve diabetes care and outcomes: the VIDA project. Prim Care Diabetes. 2010;4(3):145–53.
31. Noël PH, Romero RL, Robertson M, Parchman ML. Key activities used by community based primary care practices to improve the quality of diabetes care in response to practice facilitation. Qual Prim Care. 2014;22(4):211–9
32. Canovas J, Hernandez P, Botella J. Effectiveness of internal quality assurance programmes in improving clinical practice and reducing costs. J Eval Clin Pract. 2009; 15:813–9.
33. Meropol SB, Schiltz NK, Sattar A, Stange KC, Nevar AH, Davey C, et al. Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial. Pediatrics. 2014;133(6): e1664–75.
34. Coronado GD, Vollmer WM, Petrik A, Taplin SH, Burdick TE, Meenan RT, et al. Strategies and opportunities to STOP colon cancer in priority populations: design of a cluster-randomized pragmatic trial. Contemp Clin Trials. 2014; 38(2):344–9.
35. Vecchi S, Agabiti N, Mitrova S, Cacciani L, Amato L, Davoli M, et al. Audit and feedback, and continuous quality improvement strategies to improve the quality of care for type 2 diabetes: a systematic review of literature. Epidemiol Prev. 2016;40(3–4):215–23.
36. Knudsen SV, Laursen HVB, Johnsen SP, Bartels PD, Ehlers LH, Mainz J. Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Serv Res. 2019;19(1):683.
37. Gardner K, Sibthorpe B, Chan M, Sargent G, Dowden M, McAullay D. Implementation of continuous quality improvement in aboriginal and Torres Strait islander primary health care in Australia: a scoping systematic review. BMC Health Serv Res. 2018;18(1):541.
38. Nunes JW, Seagull FJ, Rao P, Segal JH, Mani NS, Heung M. Continuous quality improvement in nephrology: a systematic review. BMC Nephrol. 2016;17(1):190.
39. Candas B, Jobin G, Dube C, Tousignant M, Abdeljelil AB, Grenier S, et al. Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review. Endosc Int Open. 2016;4(2):E118–33.
40. Care Quality Commission. Quality improvement in hospital trusts: sharing learning from trust on a journey of QI. 2018.
41. Kellams A, Parker MG, Geller NL, Moon RY, Colson ER, Drake E, et al. TodaysBaby quality improvement: safe sleep teaching and role modeling in 8 US maternity units. Pediatrics. 2017;140(5).
42. Jones B, Horton T, Warburton W. The improvement journey. Why organisation wide improvement in health care matters, and how to get started; 2019.
43. Boonyasai R, Windish D, Chakraborti C, Feldman L, Rubin H, Bass E. Effectiveness of teaching quality improvement to clinians: a systematic review. JAMA. 2007;298(9):1023–37.
44. Flottorp S, Jamtvedt G, Gibis B, McKee M. Using audit and feedback to health professionals to improve the quality and safetty of health care, Policy summary prepared for the Belgian EU Presidency Conference on Investing in Europe’s health workforce of tomorrow: scope for innovation and collaboration (La Hulpe, 9–10 September 2010): European Obervatory on Health Systems and Policies; 2010. Contract No.: Policy Summary 3.
45. Geboers H, Grol R, Bosch W, Hoogen H, Mokkink H, Montfort P, et al. A model for continuous quality improvement in small scale practice. Qual Health Care. 1999;8(1):43–8.
46. Solberg LI, Kottke TE, Brekke ML. Will primary care clinics organize themselves to improve the delivery of preventive services? A randomized controlled trial. Prev Med. 1998;27(4):623–31.
47. Dawda P, Jenkins R, Varnam R. Quality improvement in general practice. An inquiry into the quality of general practice in England. Discussion paper. 2010.
48. Boaden R, Harvey G, Moxham C, Proudlove N. Quality improvement: theory and practice in healthcare.: NHS Institute for Innovation and Improvement; 2008.
49. Braithwaite J, Churruca K, Long J, Ellis L, Herkes J. When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC Med. 2018;16.
50. Lipsitz L. Understanding Helth care as a complex system. The foundation of unintended consequences. JAMA. 2012; 308:243.