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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

Abstract

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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References

  1. Davidoff F, Batalden P. Toward stronger evidence on quality improvement. Draft publication guidelines: the beginning of a consensus project. Qual Saf Health Care. 2005;14:319–25.

    Article  PubMed  CAS  Google Scholar 

  2. EQUATOR Network. Enhancing the QUality And Transparency Of health Research. Available at: http://www.equator-network.org. Accessed May 9, 2008.

  3. Janisse T. A next step: reviewer feedback on quality improvement publication guidelines. Permanente Journal. 2007;11:1.

    Google Scholar 

  4. Guidelines for authors: guidelines for submitting more extensive quality research. Quality and Safety in Health Care. Available at: http://qshc.bmj.com/ifora/article_type.dtl#extensive

  5. Berwick D. Broadening the view of evidence-based medicine. Qual Saf Health Care. 2005;14:315–6.

    Article  PubMed  CAS  Google Scholar 

  6. Thomson RG. Consensus publication guidelines: the next step in the science of quality improvement? Qual Saf Health Care. 2005;14:317–8.

    Article  PubMed  CAS  Google Scholar 

  7. Chin MH, Chien AT. Reducing racial and ethnic disparities in health care: an integral part of quality improvement scholarship. Qual Saf Health Care. 2006;15:79–80.

    Article  PubMed  CAS  Google Scholar 

  8. Baker GR. Strengthening the contribution of quality improvement research to evidence based health care. Qual Saf Health Care. 2006;15:150–1.

    Article  PubMed  CAS  Google Scholar 

  9. Pronovost P, Wachter R. Proposed standards for quality improvement research and publication: one step forward and two steps back. Qual Saf Health Care. 2006;15:152–3.

    Article  PubMed  CAS  Google Scholar 

  10. Gawande A. The checklist. The New Yorker. December 10, 2007, pp. 86–95.

  11. Rennie D. Reporting randomized controlled trials. An experiment and a call for responses from readers. JAMA. 1995;273:1054–5.

    Article  PubMed  CAS  Google Scholar 

  12. Williams JW, Holleman JR, Samsa GP, Simel DL. Randomized controlled trial of 3 vs 10 days of timethoprim/sulfamethoxazole for acute maxillary sinusitis. JAMA. 1995;273:1015–21.

    Article  PubMed  Google Scholar 

  13. Rutledge A. On Creativity. Available at http://www.alistapart/articles/oncreativity. Accessed on May 9, 2008.

  14. Shadish WR, Cook TD, Campbell DT. Experimental and Quasi-Experimental Designs for Generalized Causal Inference. New York: Houghton Mifflin Company; 2002.

    Google Scholar 

  15. Day RA. The origins of the scientific paper: the IMRaD format. J Am Med Writ Assoc. 1989;4:16–8.

    Google Scholar 

  16. Huth EJ. The research paper: general principles for structure and content. In Writing and Publishing in Medicine, 3rd edn. Philadelphia: Williams & Wilkins; 1999, pp. 63–73.

  17. Jadad AR, Enkin MW. Randomized Controlled Trials. Questions, Answers, and Musings. 2London: Blackwell Publishing/BMJ Books; 2007.

    Google Scholar 

  18. Batalden P, Davidoff F. Teaching quality improvement. The devil is in the details. JAMA. 2007;298:1059–61.

    Article  PubMed  CAS  Google Scholar 

  19. Kolb DA. Experiential Learning. Experience as the Source of Learning and Development. Englewood Cliffs, NJ: Prentice-Hall; 1984.

    Google Scholar 

  20. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review - a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005;10Suppl 121–34.

    Article  PubMed  Google Scholar 

  21. Pawson R, Tilley N. Realistic Evaluation. Thousand Oaks, CA: SAGE Publications; 1997.

    Google Scholar 

  22. Evaluation for the 21st Century. In: E Chelimsky, William Shadish, eds. Thousand Oaks, CA: SAGE Publications; 1997.

  23. Health Care Quality Improvement: Ethical and Regulatory Issues. In: Jennings B, Baily MA, Bottrell M, Lynn J, eds. Garrison, NY: The Hastings Center; 2007.

  24. Glouberman S, Zimmerman B. Complicated and complex systems: What would succesful reform of medicine look like? In: Forest PG, McKintosh K, Marchilden G, eds. Health Care Services and the Process of Change. Toronto: University of Toronto Press; 2004.

    Google Scholar 

  25. von Elm E, Altman DG, Egger M, Pocock S, Gotzsche PC, Vandenbroucke JP, for the STROBE initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573–7.

    Google Scholar 

  26. Ogrinc G, Mooney SE, Estrada C, et al. The SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Qual Saf Health Care 2008; Supplement, in press.

  27. Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, Goetzsche PC, Lang T, CONSORT GROUP (Consolidated Standards of Reporting Trials). The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001;134:663–94.

    PubMed  CAS  Google Scholar 

  28. Bossuyt PM, Reitsma JB, Bruns DE, Gastonis CA, Glasziou PP, Irwig LM, Moher D, Rennie D, de Vet HCW, Lijmer JG. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Clin Chem. 2003;49:7–18.

    Article  PubMed  CAS  Google Scholar 

  29. Vandenbroucke JP, von Elm E, Altman DG, Gotzsche P, Mulrow CD, Pocock SJ, for the STROBE initiative, et al.. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147:W–164.

    Google Scholar 

  30. Keech A, Gebski V, Pike R. Interpreting and Reporting Clinical Trials. A Guide to the CONSORT Statement and the Principles of Randomized Trials. Sydney: Australian Medical Publishing Company; 2007.

    Google Scholar 

  31. Plint AC, Moher D, Morrison A, Schulz K, Altman DG, Hill C, et al. Does the CONSORT checklist improve the quality of reports of randomized controlled trials? A systematic review. Med J Aust. 2006;185:263–7.

    PubMed  Google Scholar 

  32. Egger M, Juni P, Bartlett C. Value of flow diagrams in reports of randomized controlled trials. JAMA. 2001;285:1996–9.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

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.

Contributors

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.

Endorsement

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 http://dx.doi.org/10.1007/s11606-008-0836-1

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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). https://doi.org/10.1007/s11606-008-0797-4

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