Table 1. Quality Improvement (QI) Taxonomy*.
| QI Strategy | Definition | Examples of Methods | Surgical Examples | |
|---|---|---|---|---|
| Articles reporting any QI intervention (1–9) must include 1 additional item (10 & 11) from Table 1. | ||||
| 1. | Provider reminder systems | Any "clinical encounter-specific" information intended to prompt a clinician to recall information or consider a specific process of care | Decision aids Reminders | MEWS The WHO Surgical Safety Checklist |
| 2 | Facilitated relay of clinical data to providers | Transfer of clinical information from patients to the provider (not during a patient visit) | Telephone call Postal contact | Relay of BP measurements to the preassessment team |
| 3 | Provider education | Dissemination of information | Educational outreach visits Distribution of
educational material Clinical guideline information |
Component separation training and recurrence rates Cadaveric training and surgeon confidence |
| 4 | Patient education | Dissemination of information | Distribution of educational
material Individual or group sessions |
Trimodal pre-habilitation programs compliance and effect on LOS |
| 5 | Promotion of self-management | Access to a resource that enhances the patients' ability to manage their condition | BP devices Patient diaries | Follow-up phone calls with recommended adjustments to care |
| 6 | Patient reminders | Any methods of encouraging patient compliance to self-management | Appointment reminders | SMS exercise reminders before bariatric surgery |
| 7 | Organizational change | Any change in organizational structure | Multidisciplinary teams Communication Health records | Changes to staff rota to facilitate early patient mobilization after elective arthroplasty |
| 8 | Financial, regulatory, or legislative incentives | Any financial bonus, reimbursement, or provider-licensure scheme | Positive or negative incentives for providers or patients | 18-week wait target for elective orthopedic surgery |
| 9 | Feedback | Any feedback of clinical performance | Distribution of feedback via staff education sessions or e-mails; can occur as part of SPC or audit and feedback | Percentage of patients achieving target LOS |
| Articles reporting any QI technique (10 & 11) | ||||
| 10 | Audit and feedback | Any feedback of clinical performance summarizing percentages of patients who have achieved a target outcome that has been measured at intervals over time | PROMs LOS Morbidity and Mortality |
Percentage of patients achieving target LOS |
| 11 | QI methods | Systematic techniques for identifying defects in clinical systems and making improvements, typically involving process measurement and remeasurement | PDSA, Six Sigma, TQM, CQI, SPC, Lean | Improving processes for acetabular cup placement in minimally invasive hip surgery |
MEWS, Modified Early Warning System; WHO; World Health Organization; BP, blood pressure; LOS, length of stay; SMS, surgeon-monitored sedation; SPC, statistical process control; PROM, Patient-Reported Outcome Measure; PDSA, Plan-Do-Study-Act; TQM, total quality management, CQI, continuous quality management.
* Adapted from Shojania K, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 1: Series Overview and Methodology). Technical Reviews, Rockville (MD): Agency for Healthcare Research and Quality, 2004.