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Synthesizing Evidence for Quality Improvement


Background. Systematic reviews have become a mainstay for guideline groups, professional societies, and policymakers in determining which interventions are effective. Traditional systematic reviews may not provide sufficient information for leaders in Learning Health Systems (LHS) to make optimal decisions about the use of quality improvement (QI) interventions because important details about implementation and context frequently are missing.

Purpose. The purpose of this project is to develop a framework to guide Evidence-based Practice Centers (EPCs) in the synthesis and presentation of QI interventions to make EPC reports more usable and applicable to health systems.

Methods. Representatives from EPCs, the Scientific Resource Center (SRC), and the Agency for Healthcare Research and Quality (AHRQ) are participating in teleconferences to accomplish several goals:

  1. Identify triggers for deviating from standard evidence synthesis methods to use approaches specific to examining QI interventions
  2. Identify examples of systematic reviews of QI interventions
  3. Develop novel Summary of Findings (SOF) tables for reviews of QI interventions
  4. Pilot SOF table approaches using QI review examples
  5. Consider new approaches to developing key questions for QI interventions (for example, instead of asking "Does it work?", asking "Under what conditions does it work?")
  6. Identify sources of grey literature examining QI interventions
  7. Establish a LHS panel to inform workgroup approaches and products.

To guide this project, the workgroup identified several definitions of QI interventions from the literature, and selected two definitions from AHRQ1 and Standards for Quality Improvement Reporting Excellence (SQUIRE)2 that were most applicable to the EPC program, and could be used to trigger a deviation from the standard evidence synthesis approach.

AHRQ Report from Closing the Quality Gap Series1

Title: Closing the Quality Gap: Revisiting the State of the Science. Quality Improvement Interventions to Address Health Disparities

"We defined a QI intervention as a change process in health care systems, services, or suppliers for the purpose of increasing the likelihood of optimal clinical quality of care, measured by positive health outcomes for individuals and populations."
SQUIRE 2.02 "Healthcare improvement:

Any systematic effort intended to raise the quality, safety and value of healthcare services, usually done at the system level. We encourage the use of this phrase rather than 'quality improvement,' which often refers to more narrowly defined approaches."

A consolidated SoF table will be derived from relevant reporting elements of Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0);2 Standards for Reporting Implementation Studies (StaRI);3 Template for Intervention Description and Replication (TIDieR);4 and Preferred Reporting Items in Systematic Reviews and Meta-Analyses—Complex Interventions (PRISMA-CI).5


  1. McPheeters ML, Kripalani S, Peterson NB, et al. Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities). Evidence Report/Technology Assessment. 2012(2083):1–475.
  2. Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. Standards for Quality Improvement Reporting Excellence 2.0: revised publication guidelines from a detailed consensus process. Journal of Surgical Research. 2016;200(2):676–682.
  3. Pinnock H, Barwick M, Carpenter CR, et al. Standards for Reporting Implementation Studies (StaRI): explanation and elaboration document. BMJ Open. 2017;7(4).
  4. Hoffmann T, Glasziou P, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 348: g1687. In:2014.
  5. Guise J-M, Butler ME, Chang C, Viswanathan M, Pigott T, Tugwell P. AHRQ series on complex intervention systematic reviews—paper 6: PRISMA-CI extension statement and checklist. Journal of Clinical Epidemiology. 2017;90:43–50.