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The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews.

Kringos DS, Sunol R, Wagner C, Mannion R, Michel P, Klazinga NS, Groene O, DUQuE Consorti - BMC Health Serv Res (2015)

Bottom Line: It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented.Contextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system.Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, Academic Medical Center (AMC) - University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. d.s.kringos@amc.uva.nl.

ABSTRACT

Background: It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual factors in the literature on the effectiveness of quality improvement strategies, (ii) assess the relationship between effectiveness and contextual factors, and (iii) analyse the importance of contextual factors.

Methods: We conducted an umbrella review of systematic reviews searching the following databases: PubMed, Cochrane Database of Systematic Reviews, Embase and CINAHL. The search focused on quality improvement strategies included in the Cochrane Effective Practice and Organisation of Care Group taxonomy. We extracted data on quality improvement effectiveness and context factors. The latter were categorized according to the Model for Understanding Success in Quality tool.

Results: We included 56 systematic reviews in this study of which only 35 described contextual factors related with the effectiveness of quality improvement interventions. The most frequently reported contextual factors were: quality improvement team (n = 12), quality improvement support and capacity (n = 11), organization (n = 9), micro-system (n = 8), and external environment (n = 4). Overall, context factors were poorly reported. Where they were reported, they seem to explain differences in quality improvement effectiveness; however, publication bias may contribute to the observed differences.

Conclusions: Contextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system. Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance.

No MeSH data available.


Study selection process. Legend: Figure 1 indicates the study selection process of the systematic literature review
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Fig1: Study selection process. Legend: Figure 1 indicates the study selection process of the systematic literature review

Mentions: The review strategy was guided by a manual for performing systematic literature reviews on a health services research topic [14]. The results from the databases were checked for duplicates using Reference Manager. This was followed by a three-step screening procedure. Studies were excluded if they did not focus on the effectiveness, performance or impact of quality management strategies in hospital settings. An initial screening of studies was based on titles and abstract, performed by two reviewers (OG, DK) independently. In the second screening, the full texts of the reviews were assessed for inclusion by OG and DK independently. In the third step, the final list of included studies was evaluated for their completeness by a panel of quality management experts from European countries, comprised of mostly senior researchers and medical professionals who participated in a European Commission (EC) funded research project (Deeping our understanding of quality improvement in Europe (DUQuE), see www.duque.eu and acknowledgment section). This evaluation led to five additions to the publication list. Only systematic literature reviews with a focus on the effectiveness, performance or impact of quality management strategies in hospital settings were included. This covered both qualitative and qualitative reviews and meta-analyses. Figure 1 shows the complete study selection process, including the number of disagreements among reviewers which were resolved by a third independent reviewer (RS).Fig. 1


The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews.

Kringos DS, Sunol R, Wagner C, Mannion R, Michel P, Klazinga NS, Groene O, DUQuE Consorti - BMC Health Serv Res (2015)

Study selection process. Legend: Figure 1 indicates the study selection process of the systematic literature review
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4508989&req=5

Fig1: Study selection process. Legend: Figure 1 indicates the study selection process of the systematic literature review
Mentions: The review strategy was guided by a manual for performing systematic literature reviews on a health services research topic [14]. The results from the databases were checked for duplicates using Reference Manager. This was followed by a three-step screening procedure. Studies were excluded if they did not focus on the effectiveness, performance or impact of quality management strategies in hospital settings. An initial screening of studies was based on titles and abstract, performed by two reviewers (OG, DK) independently. In the second screening, the full texts of the reviews were assessed for inclusion by OG and DK independently. In the third step, the final list of included studies was evaluated for their completeness by a panel of quality management experts from European countries, comprised of mostly senior researchers and medical professionals who participated in a European Commission (EC) funded research project (Deeping our understanding of quality improvement in Europe (DUQuE), see www.duque.eu and acknowledgment section). This evaluation led to five additions to the publication list. Only systematic literature reviews with a focus on the effectiveness, performance or impact of quality management strategies in hospital settings were included. This covered both qualitative and qualitative reviews and meta-analyses. Figure 1 shows the complete study selection process, including the number of disagreements among reviewers which were resolved by a third independent reviewer (RS).Fig. 1

Bottom Line: It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented.Contextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system.Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, Academic Medical Center (AMC) - University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. d.s.kringos@amc.uva.nl.

ABSTRACT

Background: It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual factors in the literature on the effectiveness of quality improvement strategies, (ii) assess the relationship between effectiveness and contextual factors, and (iii) analyse the importance of contextual factors.

Methods: We conducted an umbrella review of systematic reviews searching the following databases: PubMed, Cochrane Database of Systematic Reviews, Embase and CINAHL. The search focused on quality improvement strategies included in the Cochrane Effective Practice and Organisation of Care Group taxonomy. We extracted data on quality improvement effectiveness and context factors. The latter were categorized according to the Model for Understanding Success in Quality tool.

Results: We included 56 systematic reviews in this study of which only 35 described contextual factors related with the effectiveness of quality improvement interventions. The most frequently reported contextual factors were: quality improvement team (n = 12), quality improvement support and capacity (n = 11), organization (n = 9), micro-system (n = 8), and external environment (n = 4). Overall, context factors were poorly reported. Where they were reported, they seem to explain differences in quality improvement effectiveness; however, publication bias may contribute to the observed differences.

Conclusions: Contextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system. Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance.

No MeSH data available.