Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
Center for Research and Policy in Diabetes, The Gertner Institute for Epidemiology and Health Policy, Sheba Medical Center, Tel-Hashomer, Israel.
BMJ Qual Saf. 2018 Mar;27(3):226-240. doi: 10.1136/bmjqs-2017-006926. Epub 2017 Oct 21.
Quality improvement collaboratives (QIC) have proliferated internationally, but there is little empirical evidence for their effectiveness.
We searched Medline, Embase, CINAHL, PsycINFO and the Cochrane Library databases from January 1995 to December 2014. Studies were included if they met the criteria for a QIC intervention and the Cochrane Effective Practice and Organisation of Care (EPOC) minimum study design characteristics for inclusion in a review. We assessed study bias using the EPOC checklist and the quality of the reported intervention using a subset of SQUIRE 1.0 standards.
Of the 220 studies meeting QIC criteria, 64 met EPOC study design standards for inclusion. There were 10 cluster randomised controlled trials, 24 controlled before-after studies and 30 interrupted time series studies. QICs encompassed a broad range of clinical settings, topics and populations ranging from neonates to the elderly. Few reports fully described QIC implementation and methods, intensity of activities, degree of site engagement and important contextual factors. By care setting, an improvement was reported for one or more of the study's primary effect measures in 83% of the studies (32/39 (82%) hospital based, 17/20 (85%) ambulatory care, 3/4 nursing home and a sole ambulance QIC). Eight studies described persistence of the intervention effect 6 months to 2 years after the end of the collaborative. Collaboratives reporting success generally addressed relatively straightforward aspects of care, had a strong evidence base and noted a clear evidence-practice gap in an accepted clinical pathway or guideline.
QICs have been adopted widely as an approach to shared learning and improvement in healthcare. Overall, the QICs included in this review reported significant improvements in targeted clinical processes and patient outcomes. These reports are encouraging, but most be interpreted cautiously since fewer than a third met established quality and reporting criteria, and publication bias is likely.
质量改进合作（QIC）在国际上迅速发展，但几乎没有证据证明其有效性。
我们检索了 Medline、Embase、CINAHL、PsycINFO 和 Cochrane 图书馆数据库，检索时间为 1995 年 1 月至 2014 年 12 月。如果研究符合 QIC 干预标准和 Cochrane 有效实践和组织护理（EPOC）纳入综述的最低研究设计标准，则纳入研究。我们使用 EPOC 清单评估研究偏倚，并使用 SQUIRE 1.0 标准的一个子集评估报告干预措施的质量。
符合 QIC 标准的 220 项研究中，有 64 项符合 EPOC 研究设计标准。其中包括 10 项群组随机对照试验、24 项对照前后研究和 30 项中断时间序列研究。QIC 涵盖了广泛的临床环境、主题和人群，从新生儿到老年人。很少有报告充分描述了 QIC 的实施和方法、活动强度、现场参与程度和重要的背景因素。按医疗环境划分，39 项研究中有 32 项（82%的医院基础、17 项（85%）门诊护理、4 项（100%）疗养院和一项单独的救护车 QIC）报告了一项或多项研究主要效果指标的改善。有 8 项研究描述了协作结束后 6 个月至 2 年内干预效果的持续性。报告成功的协作通常涉及到护理相对简单的方面，有坚实的证据基础，并注意到在公认的临床路径或指南中存在明显的证据-实践差距。
QIC 已被广泛采用作为医疗保健共享学习和改进的一种方法。总体而言，本综述纳入的 QIC 报告了目标临床过程和患者结局的显著改善。这些报告令人鼓舞，但必须谨慎解释，因为只有不到三分之一的研究符合既定的质量和报告标准，而且可能存在发表偏倚。
