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Publication Guidelines for Quality Improvement Studies in Health Care: Evolution of the SQUIRE Project

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An Erratum to this article was published on 25 October 2008


In 2005 we published draft guidelines for reporting studies of quality improvement interventions as the initial step in a consensus process for development of a more definitive version. The current article contains the revised version, which we refer to as SQUIRE (Standards for QUality Improvement Reporting Excellence). We describe the consensus process, which included informal feedback, formal written commentaries, input from publication guideline developers, review of the literature on the epistemology of improvement and on methods for evaluating complex social programs, and a meeting of stakeholders for critical review of the guidelines’ content and wording, followed by commentary on sequential versions from an expert consultant group. Finally, we examine major differences between SQUIRE and the initial draft, and consider limitations of and unresolved questions about SQUIRE; we also describe ancillary supporting documents and alternative versions under development, and plans for dissemination, testing, and further development of SQUIRE.

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Some of the work reported in this paper was done at the SQUIRE Advisory Committee Meeting, April 3–5, 2007, which was supported in part by a grant from the Robert Wood Johnson Foundation ((RWJF grant number 58073).

We are grateful to Rosemary Gibson and Laura Leviton for their unflagging support of this project, and to Joy McAvoy for her invaluable administrative work in coordinating the entire development process.


The following people contributed critical input to the guidelines during their development: Kay Dickersin, Donald Goldmann, Peter Goetzsche, Gordon Guyatt, Hal Luft, Kathryn McPherson, Victor Montori, Dale Needham, Duncan Neuhauser, Kaveh Shojania, Vincenza Snow, Ed Wagner, and Val Weber.


The following participants in the consensus process also provided critical input on the guidelines and endorsed the final version. Their endorsements are personal and do not imply endorsement by any group, organization, or agency: David Aron, Virginia Barbour, Jesse Berlin, Steven Berman, Donald Berwick, Maureen Bisognano, Andrew Booth, Isabelle Boutron, Peter Buerhaus, Marshall Chin, Benjamin Crabtree, Linda Cronenwett, Mary Dixon-Woods, Brad Doebbling, Denise Dougherty, Martin Eccles, Susan Ellenberg, William Garrity, Lawrence Green, Trisha Greenhalgh, Linda Headrick, Susan Horn, Julie Johnson, Kate Koplan, David Korn, Uma Kotegal, Seth Landefield, Elizabeth Loder, Joanne Lynn, Susan Mallett, Peter Margolis, Diana Mason, Don Minckler, Brian Mittman, Cynthia Mulrow, Eugene Nelson, Paul Plsek, Peter Pronovost, Lloyd Provost, Philippe Ravaud, Roger Resar, Jane Roessner, John-Arne Røttingen, Lisa Rubenstein, Harold Sox, Ted Speroff, Richard Thomson, Erik von Elm, Elizabeth Wager, Doug Wakefield, Bill Weeks, Hywel Williams, and Sankey Williams.

Financial support

The SQUIRE project was supported in part by a grant from the Robert Wood Johnson Foundation (RWJF grant number 58073).

Conflicts of interest

None disclosed.

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Correspondence to Frank Davidoff MD.

Additional information

Members of the SQUIRE development group who provided input during the development process and endorsed the SQUIRE guidelines are listed at the end of this article

Editors Note: The SQUIRE Guidelines are intended to advance research in quality improvement. Quality of care and patient safety are at the heart of general internal medicine and consequently, the readers of the Journal of General Internal Medicine. A longer, more detailed explanation of the development of the SQUIRE consensus development effort appears in the October supplement to the journal Quality and Safety in Health Care. Because of the importance of the topic and its relevance to our readership, we are publishing this portion of that supplement.

An erratum to this article can be found at

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Davidoff, F., Batalden, P., Stevens, D. et al. Publication Guidelines for Quality Improvement Studies in Health Care: Evolution of the SQUIRE Project . J GEN INTERN MED 23, 2125–2130 (2008).

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