1. Taxonomy of quality improvement (QI) strategies.

Strategy	Definition
QI strategies targeting health systems
Case management (CM)	Any system for co‐ordinating diagnosis, treatment or routine management of patients (e.g. arrangement for referrals, follow‐up of test results) by a person or multidisciplinary team in collaboration with, or supplementary to, the primary care clinician. For a randomised controlled trial to qualify, the case management has to have happened more than once. If the study calls the intervention ‘case management,’ we classify it as such.   Example: Home blood pressure telemonitoring plus frequent telephone‐based nurse case management. The intervention is delivered by HHC nurses who have real‐time access to patients’ EHRs and are in communication with their providers. The nurse case manager had access to the patients’ home BP data via a secure website, where the readings are displayed in easy‐to‐read charts and figures that highlight the control rate for each week. This information was used by the nurse case manager as a basis for counselling sessions with the patient (Grilo 2015).
Team changes (TC)	Changes to the structure or organisation of the primary healthcare team are defined as present if they meet the following criteria: Adding a team member or shared care ‐ e.g. routine visits with people other than the primary physician (including physician or nurse specialists in diabetic care, pharmacists, nutritionists, podiatrists). Use of multidisciplinary teams ‐ i.e. active participation of professionals from more than one discipline (e.g. medicine, nursing, pharmacy, nutrition) in the primary, routine management of patients. Expansion or revision of professional roles (e.g. nurse or pharmacist had a more active role in monitoring of the patient or adjusting drug regimens). To ensure that every study we classify as case management does not also qualify as a team change, we classify a study of case management also as a study of team changes only if at least two of the above conditions are met. Team changes involve more communication. If the study called the intervention ‘joint visits’ or ‘shared care,’ we classify it as a team change. To qualify, the intervention has to have been done by a health care professional and has to have happened more than once. Example: Professional nurses who successfully completed the educational outreach were authorised by the district manager to prescribe an additional seven medications for NCDs previously restricted to doctors (Fairall 2016).
Electronic patient registry (EPR)	General electronic medical record system or electronic tracking system for patients with diabetes. We do not include websites unless patients were tracked over time. To qualify, the system has to have been part of the clinical trial as an intervention (i.e. not pre‐existing infrastructure unless used more actively).   Example: Patients (and their healthcare team) could review laboratory data and recommendations from their physicians and nurses online (Yoon 2008).
Facilitated relay of clinical information (FR)	Clinical information collected from patients and transmitted to clinicians by means other than the existing medical record. We exclude conventional means of correspondence between clinicians. For example, if the results of routine visits with a pharmacist were sent in a letter to the primary care physician, the use of routine visits with a pharmacist counts as a ‘team change,’ but the intervention does not count as ‘facilitated relay.’ However, if the pharmacist issued structured diaries for patients to record self‐monitored glucose values, which were then taken to office visits to review with the primary physician, we count the intervention as facilitated relay. Other examples include electronic or web‐based methods through which patients provide self‐care data and which clinicians reviewed, as well as point‐of‐care testing supplying clinicians with immediate HbA1c values. We include passports, referral systems and dietary information (versus purely clinical information). In general, the patient should be facilitating the relay. To be included, the information must have got to someone with prescribing or ordering ability. For example, if the nurse’s role was expanded to make drug changes, the patient had a portable personal record or ‘diabetes passport,’ and the nurse could directly make a change, we classify the intervention as case management and facilitated relay of clinical information (depending on the study and situation). If the nurse alerted the primary care provider that the patient had run out of drugs, we do not deem this facilitated relay of information because that is a normal part of a nurse’s role.    Example: The internet program consisted of a central data repository that the patient or healthcare provider could access via a confidential password. Patients had their own unique profile, where they were able to enter data on BG measurements, diet, exercise, insulin and oral medications (Tjam 2006).
Continuous quality improvement (CQI)	Interventions explicitly identified as involving the techniques of continuous QI, total quality management, or plan‐do‐study‐act, or any iterative process for assessing quality problems, developing solutions to those problems, testing their effects and then reassessing the need for further action.   Example: A seven‐step QI process used involved a sequential "tests‐of‐ change" approach (O'Connor 2005).
QI strategies targeting health care providers
Audit and feedback (AF)	Summary of clinical performance of health care delivered by an individual clinician or clinic over a specified period, transmitted back to the clinician (e.g. the percentage of a clinician’s patients who achieved a target HbA1c concentration or who underwent dilated‐eye examinations with a specified frequency). This strategy is strictly based on clinical data and excludes clinical skills. It can include the number of patients with missing tests and dropouts.   Example: Physicians received a printed list of all their patients living with diabetes every 4 months, prioritised based on distance from each patient’s A1C or LDL cholesterol goal (O'Connor 2009a).
Clinician education (CE)	Interventions designed to promote increased understanding of principles guiding clinical care or awareness of specific recommendations for a target disorder or population of patients. Subcategories of clinician education include conferences or workshops, distribution of educational materials (e.g. written, video or other), and educational outreach visits (i.e. academic detailing). We exclude teaching how to educate patients, counselling skills, motivational interviewing, self‐directed learning and skills related to the intervention (e.g. teaching how to use the website for the randomised controlled trial). We include all health care providers. If the education was part of the individual’s role (e.g. teaching a case manager about diabetes), we do not categorise it as clinician education.   Example: Nurses received half‐day training to review the evidence for patient‐centred consulting and a further full day in which to practice the skills learned. Doctors received only the first half day training (Kinmonth 1998).
Clinician reminders (CR)	Paper‐based or electronic systems intended to prompt a health professional to recall patient‐specific information (e.g. most recent HbA1c value) or to do a specific task (e.g. foot examination). If the strategy was accompanied by a recommendation, we sub‐classify it as decision support (e.g. giving targets to health care providers). An example is a yellow piece of paper clipped to the medical record with the patient’s information on it. This approach has to have been systematic and part of the implementation of the intervention ‐ we exclude ad hoc clinician reminders.   Example: A computerised decision support system with diagnostic and treatment algorithms based on the guidelines (Cleveringa 2008).
Financial incentives (FI)	Interventions with positive or negative financial incentives directed at providers (e.g. linked to adherence to some process of care or achievement of some target outcome). This strategy also includes positive or negative financial incentives directed at patients or system‐wide changes in reimbursement (e.g. capitation, prospective payment, or a shift from fee‐for‐service to salary pay structure).    Example: pay‐for‐performance programme was designed to create incentives for providers to deliver adequate care, especially regular checkups, for patients with diabetes (Hsu 2014).
QI strategies targeting patients
Patient education (PE)	Interventions designed to promote greater understanding of a target disorder or to teach specific prevention or treatment strategies, or specific in‐person education (e.g. individual or group sessions with diabetes nurse educator, distribution of printed or electronic educational materials). Interventions with education of patients are included only if they also include at least one other strategy related to clinician or organisational change. We do not include occasions of optional education.    Example: Patients attended a group educational session (Wagner 2001).
Promotion of self‐management (PSM)	Provision of equipment (e.g. home glucose meters) or access to resources (e.g. system for electronically transmitting home glucose measurements and receiving insulin dose changes based on those data) to promote self‐management. Interventions promoting self‐management are included only if they also include at least one other strategy related to clinician or organisational change. We also include established goals or a print off of a self‐management plan (i.e. did not necessarily require equipment or resources). If the study called the intervention promotion of self‐management, personalised goal‐setting or action‐planning, it is included here. In general, we perceive this as a more active strategy than education of patients.   Example: The intervention group was also given and taught how to use a pill box and a blood glucose meter to conduct self‐monitoring of blood glucose at home and to record their readings (Chung 2014).
Patient reminders (PR)	Any effort (e.g. postcards or telephone calls) to remind patients about upcoming appointments or important aspects of self‐care (e.g. reminders to monitor glucose). Interventions with reminders are included only if they also included at least one other strategy related to clinician or organisational change. If the intervention included case management, patient reminders need to be explicit and to represent an extra task as compared to normal case management.   Example: A central database system identified when patients were due for review and generated a letter to the patients (Eccles 2007).

Pre‐defined QI strategies in previous review versions (Shojania 2006; Tricco 2012).

BG: blood glucose; BP: blood pressure; EHR: electronic health record; HHC: home health care; LDL: low‐density lipoprotein; NCD: non‐communicable disease; QI: quality improvement