+1 Recommend
0 collections
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      How can we recognize continuous quality improvement?


      Read this article at

          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.



          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.


          Previous work with a 12-member international expert panel identified reliably abstracted CQI methodological features. We tested which features met rigorous a priori standards as essential features of CQI using a three-phase online modified-Delphi process.


          Primarily United States and Canada.


          119 QI experts randomly assigned into four on-line panels.


          Participants rated CQI features and discussed their answers using online, anonymous and asynchronous discussion boards. We analyzed ratings quantitatively and discussion threads qualitatively.

          Main outcome measure(s)

          Panel consensus on definitional CQI features.


          Seventy-nine (66%) panelists completed the process. Thirty-three completers self-identified as QI researchers, 18 as QI practitioners and 28 as both equally. The features ‘systematic data guided activities,’ ‘designing with local conditions in mind’ and ‘iterative development and testing’ met a priori standards as essential CQI features. Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI.


          We found consensus among a broad group of CQI researchers and practitioners on three features as essential for identifying QI work more specifically as ‘CQI.’ All three features are needed as a minimum standard for recognizing CQI methods.

          Related collections

          Most cited references27

          • Record: found
          • Abstract: found
          • Article: not found

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

          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.
            • Record: found
            • Abstract: not found
            • Article: not found

            The genealogy of lean production

              • Record: found
              • Abstract: found
              • Article: not found

              Quality improvement in chronic illness care: a collaborative approach.

              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.

                Author and article information

                Int J Qual Health Care
                Int J Qual Health Care
                International Journal for Quality in Health Care
                Oxford University Press
                February 2014
                4 December 2013
                4 December 2013
                : 26
                : 1
                : 6-15
                [1 ]The RAND Corporation , 1776 Main Street, PO Box 2138, Santa Monica, CA 90401, USA
                [2 ]Veterans Affairs Greater Los Angeles at Sepulveda , 16111 Plummer Street (152), North Hills, CA 91343, USA
                [3 ]Department of Medicine and School of Public Health, University of California , Los Angeles, CA 90024, USA
                [4 ]Independent Consultant, HealthCare Quality Initiatives , Newton, MA 02459, USA
                [5 ]Leeds Institute of Health Sciences, University of Leeds , Leeds LS2 9JT, UK
                [6 ]Feinberg School of Medicine, Northwestern University , Arthur J. Rubloff Building 420 East Superior Street, Chicago, IL 60611, USA
                [7 ]Veterans Affairs Greater Los Angeles Healthcare System , 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
                Author notes
                Address reprint requests to: Susanne Hempel, The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401, USA.; Fax: +1-310-260-8157; E-mail: susanne_hempel@ 123456rand.org ; amotala@ 123456rand.org
                © The Author 2013. Published by Oxford University Press in association with the International Society for Quality in Health Care.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Pages: 10
                Editor's choice

                continuous quality improvement,quality improvement,health care organization,consultants


                Comment on this article