title: Quality improvement interventions in public health systems: a systematic review.
abstract: BACKGROUND
  Public health leaders are making difficult decisions about how to maximize the effectiveness of public health services with diminishing funds. Quality improvement (QI) interventions seek to improve the efficiency and effectiveness of public health programs, services, or organizations. The purpose of this study was to review the literature to describe public health system QI interventions and their impact on public health practices and health outcomes.
  
  
  METHODS
  A systematic review was conducted using PRISMA guidelines. Three databases were searched for peer-reviewed articles that included public health quality improvement-related terms in their abstracts. Articles published in 1990-2010 that described results from QI interventions conducted within the U.S. public health system were included.
  
  
  RESULTS
  Fifteen studies were identified, reporting on 18 separate QI interventions. Studies fell naturally into three functional categories: organization-wide QI, program- or service-specific QI, and administrative or management function QI. Few of the studies linked their improvements directly to a health outcome or predictors of health outcomes. Studies generally were implemented in state-level or large local public health departments.
  
  
  CONCLUSIONS
  Formally published QI interventions may not be representative of typical, smaller-scale QI activities. Collection and distribution of QI results associated with proven, effective public health interventions and that quantify the benefits of QI practices in public health should be a goal. More research is needed to definitively "connect the dots" between QI efforts, resulting practice improvements, and actual (or predictors of) health outcome improvements. Future studies should examine QI in diverse public health systems.
authors.affiliation: Multnomah County Health Department/Oregon Health Authority, Portland, Oregon, USA. Julia.Dilley@state.or.us
authors.forename: Julia A
authors.initials: JA
authors.lastname: Dilley
authors.forename: Betty
authors.initials: B
authors.lastname: Bekemeier
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Harris
mesh_terms: D016206:Databases, Bibliographic; D040361:Healthy People Programs; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011634:Public Health / Q000191:economics / Q000592:standards* / Q000639:trends; D011635:Public Health Administration / Q000191:economics / Q000592:standards* / Q000639:trends; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards* / Q000639:trends; D014481:United States