Does quality improvement face a legitimacy crisis? Poor quality studies, small effects.

摘要

Efforts to improve quality and safety in health care have a long history and can demonstrate important achievements. Considerable progress has been made in implementing quality improvement strategies, understood to embrace the set of interacting activities, methods and procedures used to direct, control and improve the quality and safety of care within institutions. Such strategies include, for example, organizational accreditation and management systems, and clinical practice guidelines. Despite the introduction of these strategies, poor quality and safety problems persist and the debate on how to accelerate and sustain quality improvement is more relevant than ever. This is the focus of a new field of research labeled quality improvement research and/or implementation science. Its objectives are to assess the effectiveness of existing quality improvement strategies, detect underlying mechanisms for their effect, identify the contextual factors that facilitate or hinder implementation, and generate generalizable evidence to guide implementation of research evidence to improve quality and safety. Quality improvement research and implementation science are not synonymous terms but they overlap in terms of their objectives and methods.