Evidence for the impact of quality improvement collaboratives: systematic review
BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39570.749884.BE (Published 26 June 2008) Cite this as: BMJ 2008;336:1491
- Loes M T Schouten, senior consultant1,
- Marlies E J L Hulscher, senior researcher2,
- Jannes J E van Everdingen, senior consultant1,
- Robbert Huijsman, professor3,
- Richard P T M Grol, professor and director2
- 1Dutch Institute for Healthcare Improvement, PO Box 20064, 3502 LB Utrecht, Netherlands
- 2Centre for Quality of Care Research, University Medical Centre St Radboud, Nijmegen
- 3Institute of Health Policy and Management, Erasmus MC, University Medical Centre Rotterdam
- Correspondence to: L M T Schouten l.schouten{at}cbo.nl
- Accepted 21 April 2008
Abstract
Objective To evaluate the effectiveness of quality improvement collaboratives in improving the quality of care.
Data sources Relevant studies through Medline, Embase, PsycINFO, CINAHL, and Cochrane databases.
Study selection Two reviewers independently extracted data on topics, participants, setting, study design, and outcomes.
Data synthesis Of 1104 articles identified, 72 were included in the study. Twelve reports representing nine studies (including two randomised controlled trials) used a controlled design to measure the effects of the quality improvement collaborative intervention on care processes or outcomes of care. Systematic review of these nine studies showed moderate positive results. Seven studies (including one randomised controlled trial) reported an effect on some of the selected outcome measures. Two studies (including one randomised controlled trial) did not show any significant effect.
Conclusions The evidence underlying quality improvement collaboratives is positive but limited and the effects cannot be predicted with great certainty. Considering that quality improvement collaboratives seem to play a key part in current strategies focused on accelerating improvement, but may have only modest effects on outcomes at best, further knowledge of the basic components effectiveness, cost effectiveness, and success factors is crucial to determine the value of quality improvement collaboratives.
Footnotes
The Centre for Quality of Care Research, University Medical Centre St Radboud, Nijmegen is now called IQ healthcare, Radboud University Nijmegen Medical Centre.
Contributors: LMTS and MEJLH analysed the data. JJEvE, RH, and RPTMG interpreted the data. All authors conceived and designed the study, drafted and revised the manuscript, and approved the final version. LMTS is guarantor.
Funding: None.
Competing interests: LMTS and JJEvE work at the Dutch Institute for Quality Improvement. The views and opinions expressed are those of the authors and do not necessarily reflect those of the institute.
Ethical approval: Not required.
Provenance and peer review: Not commissioned; externally peer reviewed.