How to attribute causality in quality improvement: lessons from epidemiology

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Title: How to attribute causality in quality improvement: lessons from epidemiology
Author(s): Poots, A
Reed, J
Woodcock, T
Bell, D
Goldmann, D
Item Type: Journal Article
Abstract: Quality improvement and implementation (QI&I) initiatives face critical challenges in an era of evidence-based, value-driven patient care. Whether front-line staff, large organisations or government bodies design and run QI&I, there is increasing need to demonstrate impact to justify investment of time and resources in implementing and scaling up an intervention. Decisions about sustaining, scaling up and spreading an initiative can be informed by evidence of causation and the estimated attributable effect of an intervention on observed outcomes. Achieving this in healthcare can be challenging, where interventions often are multimodal and applied in complex systems.1 Where there is weak evidence of causation, credibility in the effectiveness of the intervention is reduced with a resultant reduced desire to replicate. The greater confidence of a causal relationship between QI&I interventions and observed results, the greater our confidence that improvement will result when the intervention occurs in different settings. Guidance exists for design, conduct, evaluation and reporting of QI&I initiatives;2–4; the Standards for QUality Improvement Reporting Excellence (SQUIRE) and the Standards for Reporting Implementation Studies (STARI) guidelines were developed specifically for reporting QI&I initiatives.5 6 However, much of this guidance is targeted at larger formal evaluations, and may require levels of resource or expertise not available to all QI&I initiatives. This paper proposes QI&I initiatives, regardless of scope and resources, can be enhanced by applying epidemiological principles, adapted from those promulgated by Austin Bradford Hill.7
Publication Date: 2-Aug-2017
Date of Acceptance: 21-Jul-2017
URI: http://hdl.handle.net/10044/1/49089
DOI: https://dx.doi.org/10.1136/bmjqs-2017-006756
ISSN: 2044-5423
Publisher: BMJ Publishing Group
Start Page: 933
End Page: 937
Journal / Book Title: BMJ Quality & Safety
Volume: 26
Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: N/A
Keywords: evaluation methodology
health services research
quality improvement
Publication Status: Published
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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