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Health care outcome boost needs better studies
Date:6/25/2009

change in practice going on in an organisation. These often do not allow sufficient time for careful design or even selection of adequate control groups: fully 30% of the QI studies reviewed contained no comparison group, making it hard to tell whether outcomes associated with the QI change may have occurred anyway. Many studies did not take place over a sufficient time period, which means that they infer a correlation between the change and the outcome rather than causation. The lack of longer-term results also does not tell researchers whether the quality of outcomes for patients reverts to 'normal' after the dust of change has settled.

Researchers in only 14 of the 185 studies assessed how well their intervention was implemented. Without a formal assessment of intervention implementation, it is unclear whether an intervention failed to yield results because it was ineffective or just because it was poorly carried out. Cost benefit analysis was also lacking.

"The impact of QI changes may be overstated," says Alexander. "Our review highlights issues of inadequate study duration, potential selection bias of study participants, and difficulty making generalizations to other organizations due to unique study contexts or variation in intervention characteristics."

Short-term studies simply do not provide enough information to ascertain whether changes are going to have long-term effects on quality in these organizational settings. Also, many complex QI interventions, such as those requiring simultaneous, multiple changes in organizational process and structure, may need extended periods to actually demonstrate intended results.

The authors suggest that QI research needs to make use of theoretical and conceptual frameworks relevant to group relationships, organizational change, organizational learning, or innovation adoption and implementation to get on track. They recommend applying systems theory to QI research, and say that stu
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Contact: Mithu Mukherjee
mithu.mukherjee@sagepub.co.uk
44-207-324-2223
SAGE Publications UK
Source:Eurekalert

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