![]() ![]() It is based on a narrative literature review 3 using English language articles selected through a systematic search strategy ( box 1) and reflection based on our experience in the field.īox 1 Literature search strategies employedīibliographic search in PUBMED - articles published in English from 2005: ![]() This is the task to which this paper is directed it is intended to offer an introductory overview and bibliography, particularly for those new to the field. In a rapidly evolving field, and with the task of designing, testing, implementing and evaluating quality improvement interventions, as well as producing generalisable knowledge growing in complexity, 2 it is helpful to characterise the kinds of study designs that can be used to study improvement interventions. 1 How improvement interventions can best be studied, however, has remained contested as with most new fields, many of the key terms, concepts and techniques currently escape consensus. Improvement interventions, which can be defined broadly as purposeful efforts to secure positive change, have become an increasingly important focus of activity within healthcare. ![]() Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. Quality improvement projects tend to be applied and, in some senses, self-evaluating. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. This article offers an overview of possible methods for the study of improvement interventions. Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare.
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