Skip to main content

Table 2 Improvement in outcomes and/or processes

From: Health outcomes measurement and organizational readiness support quality improvement: a systematic review

Author/year

Outcome measures

Significant improvement + 1/02/0a 3

RAND

QI-MQCS score

QI methods

QI focus

Dziuban et al., (1994) [39]

Risk adjusted mortality

0a

12

Benchmarking

Hospital-specific and physician-specific results published annually in cardiac surgery.

Adams et al., (1998) [43]

Ambulation/locomotion

0

10

No clear QI method

Implementation of and outcome-based quality improvement concept including two outcome reports.

Bathing

0

Management of oral medications

0

Pain

0

Dyspnoea

0

Halpin et al., (2004) [40]

Postoperative Atrial fibrillation

0a

11

Benchmarking

Implementation of a new guideline based on insights into outcomes, literature and roundtable discussion. An Outcome Center was formed and a multidisciplinary Performance Improvement Committee.

Operative mortality

0

Cardiac arrest

0

Reoperation for bleeding

0

Pneumonia

0

Deep sternal infection

0

Permanent stroke

0

Transient stroke

0

Prolonged ventilation

0

Length of stay

0

Moller et al., (2005) [38]

Overall operative

Mortality

0a

7

Benchmarking

Developed a centralized data acquisition and analysis method (through the creation of the network paediatric Cardiac Care Consortium). A uniform diagnostic and procedure classification system was created. Differences in patient populations cared for at the cardiac centres were compared.

Thomas et al., (2007) [24]

HgbA1c

0

13

IT application as feedback tool

Registry-generated audit, feedback and patient reminder targeted at residents.

LDL cholesterol

0

Blood pressure

0

Peterson et al., (2008) [27]

Mean systolic blood pressure

+

10

IT application as feedback tool

Multicomponent intervention: implementation of an electronic diabetes registry, visit reminders, and patient-specific physician alerts.

HbA1c

+

Mean LDL

+

Carlhed et al., (2009) [42]

Mortality

+

12

Collaborative Care Model

Multidisciplinary teams consisted of critical care unit nurses and cardiologists were assigned at each of the 19 volunteering hospitals. 19 teams of 4 to 5 persons met at 4 (group A) or 2 (group B) training sessions during which education by QI experts was provided, using the Breakthrough Series curricula.

Readmission rate

+

Bleeding complication

+

Jakobsen et al., (2009) [33]

1-year survival

+

5

Benchmarking

Indicators (staging, surgical procedures, complications and survival) have been registered in 5007 patients who underwent surgery. Each year the results have been audited locally, regionally and nationally and improvements have been proposed, implemented, monitored and evaluated by the audit-plenary.

2-year survival

+

5-year survival

0

30-day mortality

0a

Kraynack et al., (2009) [35]

FEV1

0a

12

Learning and Leadership Collaborative

A QI process is described from the initial team-building phase, through the assessment of care processes, standardization of care, and developing a culture of continuous improvement aiming to improve pulmonary function of the paediatric patients.

MacLean et al., (2009) [25]

Blood pressure

0

10

The Chronic Care Model

Providing decision support and patient decision support in diabetes care delivery.

BMI

0

SF-12

Physical

0a

SF-12 Mental

Quality of life

0

Exercise habit

+

 

Toh et al., (2009) [30]

Poor HbA1c (9% and above)

0a

11

IT application as feedback tool

Chronic disease management system with patient reminders based on registry data.

Good LDL-control below 2.6 mmol/L

0a

 

Baty et al., (2010) [29]

% with HbA1c < 7%

+

10

No clear QI method

Implementing a comprehensive system-based disease management process including a diabetes registry and quality reports.

% with HbA1c < 9%

+

%with LDL < 100

+

Beaulieau et al., (2010) [41]

Mortality

0a

7

Benchmarking

IT application as feedback tool

Implementing a method for linking administrative and registry data to track quality improvement initiatives through dashboards.

Infusion rate

0a

Bricker et al., (2010) [28]

A1C

0a

9

Collaborative Care Model

Implementing the Chronic Care Model through regional care learning collaborative with focus on team-based care, patient-centred care coordination, delivery of evidence-based care, patient self-management, use of a patient registry system and culturally and linguistically competent care.

Blood pressure

0a

LDL Cholesterol levels

0a

Bauer et al. (2011) [44]

Depression improved in acute phase (PHQ-9 score)

+

12

Collaborative Care Model

Implementing a collaborative care model including a web-based disease registry, care management to support treatment and organized psychiatric consultation.

A1C testing

0

10

Plan-do-check-act (PDCA)

Realizing continuous quality improvement through benchmarking in cystic fibrosis care.

Stern et al., (2011) [36]

FEV1 > 80 < 18

0a

FEV1 > 80 > 18

0a

BMI > 19

0a

WH > 90

0a

Jakobsen et al., (2013) [34]

1-year survival

+

5

Benchmarking

Indicators were established, validated, and monitored. 40,000 patients have been included in the database. Results were reported periodically and submitted to realize auditing on an annual basis.

2-year survival

+

5-year survival

+

Siracusaet al., (2014) [37]

Median FEV1

0a

13

Plan-do-check-act (PDCA)

The Chronic Care Model

Several improvement interventions implemented between 2001 and 2007 with focus on patient and family engagement in CF care, improve access and use of data, individualized scheduling, improving vaccination rates, infection control aiway clearance, standardization of care processes, and forming and QI team.

Median body mass index (BMI)

0a

Peterson et al., (2015) [26]

Systolic blood pressure

0a

13

Plan-do-check-act (PDCA)

Collaborative Care Model

The effect of 23 diabetes teams joining a quality collaborative on patient outcomes.

HbA1c

0a

LDL

0a

Han et al. (2016) [31]

Hospitalization with ambulatory care-sensitive conditions

+

7

No clear QI method

Using clinical registry data to identify patients who should receive reminders for preventive/follow-up care and send reminders to those patients. Generate a list of patients by condition to use for quality improvement.

ED visits

+

Lail et al., (2017) [32]

Disease remission

0a

13

The Chronic Care Model

Eighteen condition teams implemented interventions varying from: establishing pre-visit planning (PVP), identifying the target populations, selecting and measuring outcomes and supporting processes, building and implementing care coordination, and assessing and addressing self-management support. The teams were free to choose the interventions that they thought would work best.

Disease control

0a

Quality of life

0a

Symptom management

0a

  1. 1+ means that the result was statistically significant at a p-value of 0.05
  2. 20 means that there was no significant improvement in outcomes
  3. 30a means that there was improvement, but significance was not tested or reported