Structured Abstract

Substantial evidence suggests that there is a wide gap between evidence-based best practices and those treatment practices actually used in day-to-day clinical medicine. To bring data to bear on this “quality gap” and the opportunities that exist to bridge it, the Agency for Healthcare Research and Quality (AHRQ) engaged the Stanford-UCSF Evidence-based Practice Center (EPC) to compile a critical analysis of the existing literature on quality improvement (QI) strategies for a selection of 20 disease and practice priorities identified in a 2003 Institute of Medicine report.

In Volume 1 of Closing the Quality Gap, we provide an overview of our methods and the theoretical underpinnings of the field, which we will rely on to review and analyze the literature on the quality gap in a number of the IOM-identified priority areas that will appear in subsequent volumes. We describe the genesis of the quality implementation field, providing some historical perspective on the science of translating research into practice. We then set forth our methodology: our reviews generally are restricted to studies that are likely to have strong validity (randomized controlled trials, well controlled before-after studies, and interrupted time series studies). To ensure consistency across our reviews, we introduce a taxonomy for nine QI strategies (provider reminder systems; facilitated relay of clinical data to providers; audit and feedback; provider education; patient education; promotion of self-management; patient reminders; organizational change; and financial, regulatory, or legislative incentives).

We hope the volumes in this series will be an essential source of accessible and critical analyses of the evidence regarding QI strategies that can help close the quality gap.

Contents

• Preface
• Acknowledgments
• Summary
• 1. An Introduction to the Report
  • The Genesis of Closing the Quality Gap
  • Origins of the Quality Movement
  • Translating Research into Practice: What do we Know?
  • The Theoretic Underpinnings of Quality Improvement Efforts
  • What Conclusions can be Drawn from the Report's Evidence?
  • The Organizational Framework of this Series
• 2. Evidence-based Review Methodology for the Closing the Quality Gap Series
  • Definition and Scope
  • Taxonomy of Quality Improvement Strategies
  • Identification of Quality Improvement Strategies for Evaluation
  • Evaluation of Quality Improvement Strategies
  • Quantitative Synthesis of Quality Improvement Strategies
• 3. Toward a Theoretic Basis for Quality Improvement Interventions
  • Introduction
  • Hierarchy of Theories and Models
  • Conceptual Models and Grand Theories of Implementation Phenomena
  • Conclusion
  • Chapter 3 Notes
• Appendixes
  • Appendix A National Priority Areas Summary with Key Associated Goals
  • Appendix B Search Strategy Exemplar: Quality Improvement and Hypertension
  • Appendix C Article Review Triage Forms (Exemplar: Diabetes)
  • Appendix D Full Article Review Abstraction Forms Stages 3 and 4 (Exemplar: Diabetes)
• References

Managing Editor: Amy J Markowitz, JD.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.¹ Contract No. 290-02-0017. Prepared by: Stanford-UCSF Evidence-based Practice Center.

Suggested citation:

Shojania KG, McDonald KM, Wachter RM, Owens DK. Closing The Quality Gap: A Critical Analysis of Quality Improvement Strategies, Volume 1—Series Overview and Methodology. Technical Review 9 (Contract No. 290-02-0017 to the Stanford University-UCSF Evidence-based Practices Center). AHRQ Publication No. 04-0051-1. Rockville, MD: Agency for Healthcare Research and Quality. August 2004.

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