Evidence map›Paper›PMID 31585540›Full record

SynthesisBMC health services research2019

Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects.

Søren Valgreen Knudsen, Henrik Vitus Bering Laursen, Søren Paaske Johnsen, Paul Daniel Bartels, Lars Holger Ehlers, Jan Mainz

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 99 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
99citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

99 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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39 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Søren Valgreen KnudsenDanish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Mølleparkvej 10, 9000, Aalborg, Denmark. soeren.k@rn.dk.ORCID http://orcid.org/0000-0002-3792-8983
Henrik Vitus Bering LaursenDanish Center for Healthcare Improvements (DCHI), Aalborg University, Fibigerstræde 11, 9220, Aalborg Øst, Denmark.
Søren Paaske JohnsenDanish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Mølleparkvej 10, 9000, Aalborg, Denmark.
Paul Daniel BartelsDanish Clinical Registries, Denmark, Nrd. Fasanvej 57, 2000, Frederiksberg, Denmark.
Lars Holger EhlersDanish Center for Healthcare Improvements (DCHI), Aalborg University, Fibigerstræde 11, 9220, Aalborg Øst, Denmark.
Jan MainzDanish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Mølleparkvej 10, 9000, Aalborg, Denmark.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Plan-Do-Study-Act (PDSA) method is widely used in quality improvement (QI) strategies. However, previous studies have indicated that methodological problems are frequent in PDSA-based QI projects. Furthermore, it has been difficult to establish an association between the use of PDSA and improvements in clinical practices and patient outcomes. The aim of this systematic review was to examine whether recently published PDSA-based QI projects show self-reported effects and are conducted according to key features of the method.

methodsA systematic literature search was performed in the PubMed, Embase and CINAHL databases. QI projects using PDSA published in peer-reviewed journals in 2015 and 2016 were included. Projects were assessed to determine the reported effects and the use of the following key methodological features; iterative cyclic method, continuous data collection, small-scale testing and use of a theoretical rationale.

resultsOf the 120 QI projects included, almost all reported improvement (98%). However, only 32 (27%) described a specific, quantitative aim and reached it. A total of 72 projects (60%) documented PDSA cycles sufficiently for inclusion in a full analysis of key features. Of these only three (4%) adhered to all four key methodological features.

conclusionEven though a majority of the QI projects reported improvements, the widespread challenges with low adherence to key methodological features in the individual projects pose a challenge for the legitimacy of PDSA-based QI. This review indicates that there is a continued need for improvement in quality improvement methodology.

Indexed as

Delivery of Health CareHumansQuality ImprovementResearch DesignHealth services researchPDSAPlan-do-study-actQualityQuality improvement

Identifiers

PMID31585540
PMCPMC6778385

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.