title: The Science of Quality Improvement.
abstract: Scientific rigor should be consistently applied to quality improvement (QI) research to ensure that healthcare interventions improve quality and patient safety before widespread implementation. This article provides an overview of the various study designs that can be used for QI research depending on the stage of investigation, scope of the QI intervention, constraints on the researchers and intervention being studied, and evidence needed to support widespread implementation. The most commonly used designs in QI studies are quasi-experimental designs. Randomized controlled trials and cluster randomized trials are typically reserved for large-scale research projects evaluating the effectiveness of QI interventions that may be implemented broadly, have more than a minimal impact on patients, or are costly. Systematic reviews of QI studies will play an important role in providing overviews of evidence supporting particular QI interventions or methods of achieving change. We also review the general requirements for developing quality measures for reimbursement, public reporting, and pay-for-performance initiatives. A critical part of the testing process for quality measures includes assessment of feasibility, reliability, validity, and unintended consequences. Finally, publication and critical appraisal of QI work is discussed as an essential component to generating evidence supporting QI initiatives in radiology.
authors.affiliation: Department of Radiology, University of Virginia, 1215 Lee Street, Box 800170, Charlottesville, CA 22908. Electronic address: Jason.Itri@Virginia.edu.
authors.forename: Jason N
authors.initials: JN
authors.lastname: Itri
authors.affiliation: UPMC Health Plan, Pittsburgh, Pennsylvania.
authors.forename: Eric
authors.initials: E
authors.lastname: Bakow
authors.affiliation: Sunnybrook Health Sciences Centre, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Probyn
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Nadja
authors.initials: N
authors.lastname: Kadom
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Phuong-Anh T
authors.initials: PT
authors.lastname: Duong
authors.affiliation: Division of Abdominal Imaging and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Lori Mankowski
authors.initials: LM
authors.lastname: Gettle
authors.affiliation: Abdominal and Cross-sectional Interventional Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan.
authors.forename: Mishal
authors.initials: M
authors.lastname: Mendiratta-Lala
authors.affiliation: Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Elena P
authors.initials: EP
authors.lastname: Scali
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Winokur
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Zygmont
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Kung
authors.affiliation: Department of Radiology, NYU School of Medicine, New York, New York.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
mesh_terms: D006801:Humans; D058996:Quality Improvement / Q000592:standards*; D015203:Reproducibility of Results; D012107:Research Design
keywords: Quality improvement; metrics; pay-for-performance; public reporting; research methods