Proposed standards for quality improvement research and publication: one step forward and two steps back
- 1The Johns Hopkins University, Department of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, Baltimore, MD, USA
- 2University of California San Francisco, Department of Medicine; UCSF Medical Center, San Francisco, CA, USA
- Correspondence to: Associate Professor P Pronovost The Johns Hopkins University, Department of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, 1909 Thames Street, 2nd Floor, Baltimore, MD 21231, USA; ppronovo{at}jhmi.edu
“Dumbing down” the scientific expectation of journals and readers regarding QI research may not be the answer
The recent article by Davidoff and Batalden and the accompanying commentaries left us with mixed emotions.1–4 On the one hand we applaud the authors’ efforts to improve the evidentiary base of quality improvement (QI) through publication guidelines. These guidelines will bring structure and rigor to the field of QI, which is a necessity.
However, the author’s plea and support for more rigor was placed in the midst of an argument to “dumb down” the scientific expectation of journals and readers regarding QI research. While we are all frustrated by the slow pace of improvement in quality of care and appreciate the authors’ and commentators’ arguments to relax traditional evidence based medicine standards for QI research and publication, we fear this approach would be detrimental to the field, waste essential and scarce resources, and lead providers and organizations down too many blind alleys.
The authors frame the challenges well. In short, they argue that many reviewers of high impact journals do not fully understand the challenges QI researchers face in conducting quality improvement programs with limited or no funding. Budgetary constraints, coupled with the difficulties of adhering to scientifically acceptable designs in the real world of healthcare delivery, make it impractical to expect that QI studies will traverse the threshold of scientific rigor that is generally expected of more traditional biomedical studies. The authors feel that failing to relax these standards will rob readers of the rich fruits gleaned from those toiling in the trenches.
To be certain, we too have struggled in publishing QI studies. While we believe …
