Kringos Dionne S, Sunol Rosa, Wagner Cordula, Mannion Russell, Michel Philippe, Klazinga Niek S, Groene Oliver
Department of Public Health, Academic Medical Center (AMC) - University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
Avedis Donabedian Research Institute, University Autonomous of Barcelona, C/Provenza 293, Pral. 08037, Barcelona, Spain.
BMC Health Serv Res. 2015 Jul 22;15:277. doi: 10.1186/s12913-015-0906-0.
It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual factors in the literature on the effectiveness of quality improvement strategies, (ii) assess the relationship between effectiveness and contextual factors, and (iii) analyse the importance of contextual factors.
We conducted an umbrella review of systematic reviews searching the following databases: PubMed, Cochrane Database of Systematic Reviews, Embase and CINAHL. The search focused on quality improvement strategies included in the Cochrane Effective Practice and Organisation of Care Group taxonomy. We extracted data on quality improvement effectiveness and context factors. The latter were categorized according to the Model for Understanding Success in Quality tool.
We included 56 systematic reviews in this study of which only 35 described contextual factors related with the effectiveness of quality improvement interventions. The most frequently reported contextual factors were: quality improvement team (n = 12), quality improvement support and capacity (n = 11), organization (n = 9), micro-system (n = 8), and external environment (n = 4). Overall, context factors were poorly reported. Where they were reported, they seem to explain differences in quality improvement effectiveness; however, publication bias may contribute to the observed differences.
Contextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system. Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance.
目前人们普遍认为，改善医疗保健质量和安全策略的综合效果及成功率部分归因于干预措施规划和实施的不同背景。本研究的目的是：（i）描述质量改进策略有效性文献中对背景因素的报告情况；（ii）评估有效性与背景因素之间的关系；（iii）分析背景因素的重要性。
我们对系统评价进行了一项汇总分析，检索了以下数据库：PubMed、Cochrane系统评价数据库、Embase和CINAHL。检索重点是Cochrane有效实践与护理组织小组分类法中包含的质量改进策略。我们提取了质量改进有效性和背景因素的数据。后者根据理解质量成功模型工具进行分类。
本研究纳入了56项系统评价，其中只有35项描述了与质量改进干预措施有效性相关的背景因素。报告最频繁的背景因素有：质量改进团队（n = 12）、质量改进支持与能力（n = 11）、组织（n = 9）、微观系统（n = 8）和外部环境（n = 4）。总体而言，背景因素报告不足。在有报告的情况下，它们似乎可以解释质量改进有效性的差异；然而，发表偏倚可能导致了观察到的差异。
背景因素可能会影响质量改进干预措施的有效性，尤其是在临床微观系统层面。未来关于质量改进干预措施实施和有效性的研究应强调形成性评价，以获取有关背景因素的信息，并以更系统的方式报告这些因素，以便更好地理解它们的相对重要性。
