title: Identifying continuous quality improvement publications: what makes an improvement intervention 'CQI'?
abstract: BACKGROUND
  The term continuous quality improvement (CQI) is often used to refer to a method for improving care, but no consensus statement exists on the definition of CQI. Evidence reviews are critical for advancing science, and depend on reliable definitions for article selection.
  
  
  METHODS
  As a preliminary step towards improving CQI evidence reviews, this study aimed to use expert panel methods to identify key CQI definitional features and develop and test a screening instrument for reliably identifying articles with the key features. We used a previously published method to identify 106 articles meeting the general definition of a quality improvement intervention (QII) from 9427 electronically identified articles from PubMed. Two raters then applied a six-item CQI screen to the 106 articles.
  
  
  RESULTS
  Per cent agreement ranged from 55.7% to 75.5% for the six items, and reviewer-adjusted intra-class correlation ranged from 0.43 to 0.62. 'Feedback of systematically collected data' was the most common feature (64%), followed by being at least 'somewhat' adapted to local conditions (61%), feedback at meetings involving participant leaders (46%), using an iterative development process (40%), being at least 'somewhat' data driven (34%), and using a recognised change method (28%). All six features were present in 14.2% of QII articles.
  
  
  CONCLUSIONS
  We conclude that CQI features can be extracted from QII articles with reasonable reliability, but only a small proportion of QII articles include all features. Further consensus development is needed to support meaningful use of the term CQI for scientific communication.
authors: RAND Corporation, Santa Monica, California, USA. soneill@fsm.northwestern.edu
authors: Sean M
authors: SM
authors: O'Neill
authors: Susanne
authors: S
authors: Hempel
authors: Yee-Wei
authors: YW
authors: Lim
authors: Marjorie S
authors: MS
authors: Danz
authors: Robbie
authors: R
authors: Foy
authors: Marika J
authors: MJ
authors: Suttorp
authors: Paul G
authors: PG
authors: Shekelle
authors: Lisa V
authors: LV
authors: Rubenstein
mesh_terms: D016247:Information Storage and Retrieval; D011642:Publications; D017749:Total Quality Management