Table 2.
Overview of effectiveness of quality improvement collaboratives in included controlled studies
| Study, reference, study outcome measures | No of measures (No of significant measures)† | Significant outcomes* (post measurement intervention group v control group) |
|---|---|---|
| 1, Pierce-Bulger et alw72 | ||
| Infant mortality | 1 (1) | Annual days between deaths: increase from pre-programme average of 55 days (1989-94) to an average of 114 days (1995-2000)‡ |
| 2, Baier et alw61 | ||
| Residents with pain | 1 (1) | Prevalence: 7.2% v 11.2% patients |
| 3, Benedetti et alw62 | ||
| End organ surveillance or therapy | 5 (3) | Eye examination annually (NS); foot examination annually (NS); patients aged >40 years taking acetylsalicylic acid (NS) |
| Glycaemic control | 2 (1) | Haemoglobin A1C <9.5 (NS) |
| Dyslipidaemia therapy | 2 (1) | Low density lipoprotein test <130 (75% v 45% patients) |
| Hypertension control | 2 (1) | Blood pressure <130/85 (49% v 35% patients) |
| 4, Landon et alw63 | ||
| Antiretroviral therapy | 2 (0) | |
| Screening and prophylaxis | 5 (0) | |
| Access to care | 1 (0) | |
| 5, Homer et alw64 | ||
| Primary study outcomes: | ||
| Written asthma management plan | 1 (0) | |
| Daily use of inhaled steroids, | 1 (0) | |
| Daily use of controller drugs [Author: Please clarify dash] | 1 (0) | |
| Secondary study outcomes: | ||
| Asthma attack | 1 (0) | |
| Parent report of limited activities | 1 (0) | |
| Parents’ experience of care | 1 (0) | |
| Parent reported functional status | 1 (0) | |
| Admission to hospital or emergency department for asthma | 1 (0) | |
| 6, Mangione-Smith et alw65 | ||
| Medical records process indicators | 9 (7) | Peak expiratory flow rate measured annually (49% v 4% patients); written action plan (42% v 3% patients); ≥2 follow-up visits annually (86% v 78% patients); educated in self management (41% v 17% patients); instructed in use of metered dose inhalers (30% v 9% patients); collaborative goal setting between patient and provider (10% v 0% patients); overall asthma process of care summary score (56% v 40% patients) |
| Quality of life | 3 (2) | General quality of life (80.2 v 77.0); asthma specific quality of life: treatment problems (88.6 v 85.3) |
| Patient self management | 3 (2) | Peak flow monitoring (70% v 43% patients); written action plan (41% v 22% patients) |
| Satisfaction with care, impact on family functioning, acute care service use, missed school days, parent lost work days, asthma knowledge, use of long term drugs for control | 2 (0), 1 (0), 1 (0), 1 (0), 1 (0), 1 (0), 1 (0) | |
| 6, Schonlau et alw66 | ||
| Medical records process indicators | 9 (5) | Peak expiratory flow rate measured annually (28% v 14% patients); written action plan (27% v 0% patients); instructed in use of metered dose inhalers (22% v 7% patients); collaborative goal setting between patient and provider (7% v 0% patients); overall asthma process of care summary score (46% v 38% patients) |
| Self management | 4 (1) | Attended educational session (20% v 5% patients) |
| Satisfaction with communication | 1 (1) | With clinician or lay educator communication (overall score 62% v 39% patients) |
| Quality of life, use of acute care, bed days resulting from asthma related illness, asthma knowledge, drugs for asthma control | 2 (0), 1 (0), 1 (0), 1 (0), 1 (0) | |
| 7, Asch et alw67 | ||
| Counselling indicators | 8 (7) | Drugs (44% v 17% patients); diet (46% v 11% patients); exercise (42% v 12% patients); weight loss (42% v 7% patients); disease management (61% v 23% patients); water weight management (42% v 4% patients); goal setting (5% v 4% patients) |
| Drug indicators | 4 (2) | Angiotensin converting enzyme inhibitor for left ventricular ejection fraction ≤40% (93% v 87% patients); lipid lowering therapy for coronary artery disease (66% v 64% patients) |
| Outcome indicators, diagnostic indicators, follow-up indicators | 4 (0), 4 (0), 5 (0) | |
| 7, Baker et alw68 | ||
| Knowledge | 15 (8) | Not to drink more fluids than normal (69% v 53% patients); check weight (84% v 44% patients); heart not pumping blood as well as it should (64% v 53% patients); high salt food (canned vegetables) (89% v 85% patients); high salt food (cheese) (76% v 68% patients); shortness of breath (61% v 55% patients); swelling of legs or ankles (80% v 70% patients); weight gain (76% v 61% patients) |
| Educational components received | 14 (5) | Not to add salt (91% v 83% patients); avoid drinking large amounts (59% v 38% patients); weigh yourself (87% v 34% patients); regular exercise (90% v 83% patients); use pillbox (58% v 49% patients) |
| Communication | 4 (4) | Given choices and options about treatment (3.9 v 3.7); have given me confidence (4.1 v 3.9); are interested (4.2 v 4.1); review self management (4.0 v 3.9) |
| Self management behaviours | 4 (2) | Have functioning scale at home (93% v 81% patients); how frequently weighed oneself (4.2 v 3.2) |
| Healthcare use | 3 (2) | Emergency department visits (adjusted difference −0.25); number of admissions to hospital (0.85 v 0.95) |
| Quality of life, self efficacy, satisfaction, heart failure symptoms | 2 (0), 3 (0), 4 (0), 7 (0) | |
| 8, Horbar et alw69 | ||
| Rates of infection | 2 (1) | Coagulase negative staphylococcal infection rate (12.3% v 16.5% infants) |
| Rates of oxygen supplementation | 1 (1) | Oxygen supplementation rate (34% v 38.7% infants) |
| Death | 1 (0) | |
| 8, Rogowski et alw70 | ||
| Median treatment cost per infant | 2 (1) | Median treatment cost per infant ($57 606 before measurement v $45 874 after measurement) |
| 9, Horbar et alw71 | ||
| Primary study outcomes: | ||
| Surfactant treatment in delivery room | 1 (1) | Surfactant treatment in delivery room (54.7% v 18.2%) |
| First dose surfactant given after 2 hours | 1 (1) | First dose surfactant given after two hours (9.4% v 24.9%) |
| Mortality (death before discharge), pneumothorax | 1 (0), 1 (0) | |
| Secondary study outcomes: | ||
| Delivery room resuscitation | 7 (1) | Endotracheal intubation (78% v 69.8%) |
| Respiratory | 6 (1) | Surfactant given at any time (85.1% v 79.5%) |
| Neurological | 3 (1) | Severe intraventricular haemorrhage (10.1% v 14.2%) |
| Infection, other | 4 (0), 3 (0) | |
NS=not specified.
£1 (€1.27; $1.97).
*P<0.05.
†Number of measures with significant improvement at intervention sites.
‡Since clinic and home visiting services began.