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      How can we recognize continuous quality improvement?

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          Abstract

          Continuous quality improvement (CQI) methods are foundational approaches to improving healthcare delivery. Publications using the term CQI, however, are methodologically heterogeneous, and labels other than CQI are used to signify relevant approaches. Standards for identifying the use of CQI based on its key methodological features could enable more effective learning across quality improvement (QI) efforts. The objective was to identify essential methodological features for recognizing CQI.

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          Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes.

          Simon Gilbody, Peter Bower, Janine Fletcher … (2006)
          Depression is common in primary care but is suboptimally managed. Collaborative care, that is, structured care involving a greater role of nonmedical specialists to augment primary care, has emerged as a potentially effective candidate intervention to improve quality of primary care and patient outcomes. To quantify the short-term and longer-term effectiveness of collaborative care compared with standard care and to understand mechanisms of action by exploring between-study heterogeneity, we conducted a systematic review of randomized controlled trials that compared collaborative care with usual primary care in patients with depression. We searched MEDLINE (from the beginning of 1966), EMBASE (from the beginning of 1980), CINAHL (from the beginning of 1980), PsycINFO (from the beginning of 1980), the Cochrane Library (from the beginning of 1966), and DARE (Database of Abstracts of Reviews of Effectiveness) (from the beginning of 1985) databases from study inception to February 6, 2006. We found 37 randomized studies including 12 355 patients with depression receiving primary care. Random effects meta-analysis showed that depression outcomes were improved at 6 months (standardized mean difference, 0.25; 95% confidence interval, 0.18-0.32), and evidence of longer-term benefit was found for up to 5 years (standardized mean difference, 0.15; 95% confidence interval, 0.001-0.31). When exploring determinants of effectiveness, effect size was directly related to medication compliance and to the professional background and method of supervision of case managers. The addition of brief psychotherapy did not substantially improve outcome, nor did increased numbers of sessions. Cumulative meta-analysis showed that sufficient evidence had emerged by 2000 to demonstrate the statistically significant benefit of collaborative care. Collaborative care is more effective than standard care in improving depression outcomes in the short and longer terms. Future research needs to address the implementation of collaborative care, particularly in settings other than the United States.
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            The genealogy of lean production

            Matthias Holweg (2007)
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              Quality improvement in chronic illness care: a collaborative approach.

              P Carver, Andrew McCulloch, Jennifer Davis … (2001)
              Despite rapid advances in the clinical and psycho-educational management of diabetes, the quality of care received by the average patient with diabetes remains lackluster. The "collaborative" approach--the Breakthrough Series (BTS; Institute for Healthcare Improvement [IHI]; Boston)--coupled with a Chronic Care Model was used in an effort to improve clinical care of diabetes in 26 health care organizations. Descriptive and pre-post data are presented from 23 health care organizations participating in the 13-month (August 1998-September 1999) BTS to improve diabetes care. The BTS combined the system changes suggested by the chronic care model, rapid cycle improvement, and evidence-based clinical content to assist teams with change efforts. The characteristics of organizations participating in the diabetes BTS, the collaborative process and content, and results of system-level changes are described. Twenty-three of 26 teams completed participation. Both chart review and self-report data on care processes and clinical outcomes suggested improvement based on changes teams made in the collaborative. Many of the organizations evidencing the largest improvements were community health centers, which had the fewest resources and the most challenged populations. The initial Chronic Illness BTS was sufficiently encouraging that replication and evaluation of the BTS collaborative model is being conducted in more than 50 health care systems for diabetes, congestive heart failure, depression, and asthma. This model represents a feasible method of improving the quality of care across different health care organizations and across multiple chronic illnesses.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Int J Qual Health Care
                Title: International journal for quality in health care : journal of the International Society for Quality in Health Care
                Publisher: Oxford University Press (OUP)
                ISSN (Electronic): 1464-3677
                ISSN (Print): 1353-4505
                Publication date (Electronic): Feb 2014
                Volume: 26
                Issue: 1
                Affiliations
                [1 ] The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401, USA.; susanne_hempel@rand.org; amotala@rand.org.
                Article
                Publisher Item ID: mzt085
                DOI: 10.1093/intqhc/mzt085
                PMC ID: 3914565
                PubMed ID: 24311732
                SO-VID: fb4e0c95-c22a-44cb-bba9-a96e6c782a45
                History

                Keywords: consultants,continuous quality improvement,health care organization,quality improvement
                Data availability:
                Keywords: consultants, continuous quality improvement, health care organization, quality improvement

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