Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institutions, 1830 E Monument St, Fifth Floor, Baltimore, MD 21287, USA.
JAMA. 2010 Nov 24;304(20):2279-87. doi: 10.1001/jama.2010.1692.
Quality improvement (QI) attempts to change clinician behavior and, through those changes, lead to improved patient outcomes. The methodological quality of studies evaluating the effectiveness of QI interventions is frequently low. Clinicians and others evaluating QI studies should be aware of the risk of bias, should consider whether the investigators measured appropriate outcomes, should be concerned if there has been no replication of the findings, and should consider the likelihood of success of the QI intervention in their practice setting and the costs and possibility of unintended effects of its implementation. This article complements and enhances existing Users' Guides that address the effects of interventions--Therapy, Harm, Clinical Decision Support Systems, and Summarizing the Evidence guides--with an emphasis on issues specific to QI studies. Given the potential for widespread implementation of QI interventions, there is a need for robust study methods in QI research.
质量改进（QI）试图改变临床医生的行为，并通过这些改变，导致改善患者的结果。评估质量改进干预措施有效性的研究的方法学质量通常较低。评估 QI 研究的临床医生和其他人应该意识到偏倚的风险，如果研究人员没有测量适当的结果，应该考虑是否已经复制了发现，如果没有复制发现，应该考虑 QI 干预在他们的实践环境中的成功可能性以及实施的成本和意外影响的可能性。本文通过强调与 QI 研究相关的特定问题，对现有的针对干预措施的效果的用户指南（治疗、伤害、临床决策支持系统和证据总结指南）进行补充和增强。鉴于 QI 干预措施可能广泛实施，QI 研究需要强有力的研究方法。
