Available online 19 April 2024, 151900

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Quality improvement (QI) has become an integral part of healthcare. Despite efforts to improve the reporting of QI through frameworks such as the SQUIRE 2.0 guidelines, there is no standard or well-accepted guide to evaluate published QI for rigor, validity, generalizability, and applicability. User's Guides for evaluation of published clinical research have been employed routinely for over 25 years; however, similar tools for critical appraisal of QI are limited and uncommonly used. In this article we propose an approach to guide the critical review of QI reports focused on evaluating the methodology, improvement results, and applicability and feasibility for implementation in other settings. The resulting Quality Improvement Critical Knowledge (QUICK) Tool can be used by those reviewing manuscripts submitted for publication, as well as healthcare providers seeking to understand how to apply published QI to their local context.

Section snippetsBackground

Spurred by landmark publications such as the Institute of Medicine's To Err is Human and Crossing the Quality Chasm, quality improvement (QI) science has become a routine part of healthcare practice over the past 25 years1,2. This is evident by an increasing focus on QI and patient safety within local hospital systems, expectations of participation in QI work by physicians and staff, national educational requirements by the Accreditation Council for Graduate Medical Education (ACGME) for

Critical Appraisal of Traditional Research

Conducting a critical appraisal of published evidence is an important step in implementing peer-reviewed research into clinical practice. To practice evidence-based medicine, clinicians must combine their own anecdotal experiences with research evidence that has been deemed relevant, valid, and applicable. In Evidence-Based Medicine, author David Sackett breaks down the practice of evidence-based medicine into five categories shown in Figure 24. This standardized process for obtaining answers

Importance of Critical Appraisal in QI

As changes in clinical practice are now being increasingly influenced by published QI, it is important that an equal level of rigor be applied to assessment of QI literature as is currently done with traditional research studies. To date only one suggested framework for appraising QI has been published, the Quality Improvement Minimum Quality Criteria Set (QI-MQCS)8. While traditional research aims to generate new knowledge about the ways in which therapies, diagnostic tests, and application of

Guidelines for Reporting Exist, but Do Not Specifically Address Critical Appraisal

There has been a long-standing effort to ensure transparent and accurate reporting of research in the medical literature. The EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network is an international initiative that is the first coordinated attempt to address the problem of inadequate research reporting in the published health research literature systematically and on a global scale9. The EQUATOR network has advanced the work done by many individual groups to develop

Suggested Approach for Critical Appraisal of QI

The QI-MQCS instrument, to our knowledge, is the only known proposed framework for critical appraisal of QI. This tool was designed to appraise the quality of QI-specific aspects of QI publications and uses a very broad definition of “QI interventions”8. This instrument was developed by an expert workgroup and provides minimum standards that should be present to determine whether publications are ‘high quality’. Potential challenges with using this in practice include that it has insufficient

Conclusion

At the conclusion of a critical review of QI work, clinicians must ultimately decide whether they are prepared to adopt interventions described, adapt interventions described to better fit their setting, patient population, or unique problem, or whether to abandon the proposed interventions entirely based on analysis of the QI work or recognition that it is not applicable to their own unit. QI is relatively new to be accepted as robust, scholarly work in healthcare, and therefore it is

Disclosures

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Author Contributions

Dr. Day prepared the first manuscript draft, drafted the critical appraisal tool, and edited each subsequent draft.

Dr. Meyers conceptualized the work, assisted with manuscript preparation, and edited each subsequent draft.

Dr. Kaplan assisted with manuscript design, preparation, and edited each subsequent draft.

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© 2024 Published by Elsevier Inc.