Itri Jason N, Bakow Eric, Probyn Linda, Kadom Nadja, Duong Phuong-Anh T, Gettle Lori Mankowski, Mendiratta-Lala Mishal, Scali Elena P, Winokur Ronald S, Zygmont Matthew E, Kung Justin W, Rosenkrantz Andrew B
Department of Radiology, University of Virginia, 1215 Lee Street, Box 800170, Charlottesville, CA 22908.
UPMC Health Plan, Pittsburgh, Pennsylvania.
Acad Radiol. 2017 Mar;24(3):253-262. doi: 10.1016/j.acra.2016.05.010.
Scientific rigor should be consistently applied to quality improvement (QI) research to ensure that healthcare interventions improve quality and patient safety before widespread implementation. This article provides an overview of the various study designs that can be used for QI research depending on the stage of investigation, scope of the QI intervention, constraints on the researchers and intervention being studied, and evidence needed to support widespread implementation. The most commonly used designs in QI studies are quasi-experimental designs. Randomized controlled trials and cluster randomized trials are typically reserved for large-scale research projects evaluating the effectiveness of QI interventions that may be implemented broadly, have more than a minimal impact on patients, or are costly. Systematic reviews of QI studies will play an important role in providing overviews of evidence supporting particular QI interventions or methods of achieving change. We also review the general requirements for developing quality measures for reimbursement, public reporting, and pay-for-performance initiatives. A critical part of the testing process for quality measures includes assessment of feasibility, reliability, validity, and unintended consequences. Finally, publication and critical appraisal of QI work is discussed as an essential component to generating evidence supporting QI initiatives in radiology.
科学严谨性应始终应用于质量改进（QI）研究，以确保医疗保健干预措施在广泛实施之前能够提高质量和患者安全。本文概述了根据调查阶段、QI干预的范围、研究人员和所研究干预措施的限制以及支持广泛实施所需的证据，可用于QI研究的各种研究设计。QI研究中最常用的设计是准实验设计。随机对照试验和整群随机试验通常用于评估可能广泛实施、对患者有较大影响或成本较高的QI干预措施有效性的大规模研究项目。QI研究的系统评价将在提供支持特定QI干预措施或实现变革方法的证据概述方面发挥重要作用。我们还回顾了为报销、公开报告和绩效付费计划制定质量指标的一般要求。质量指标测试过程的一个关键部分包括对可行性、可靠性、有效性和意外后果的评估。最后，讨论了QI工作的发表和批判性评价，这是生成支持放射学QI倡议证据的重要组成部分。
