BMJ  2008;336:1491-1494 (28 June), doi:10.1136/bmj.39570.749884.BE (published 24 June 2008)

Research

Evidence for the impact of quality improvement collaboratives: systematic review

¹ Dutch Institute for Healthcare Improvement, PO Box 20064, 3502 LB Utrecht, Netherlands, ² Centre for Quality of Care Research, University Medical Centre St Radboud, Nijmegen, ³ Institute of Health Policy and Management, Erasmus MC, University Medical Centre Rotterdam

Objective To evaluate the effectiveness of quality improvement collaboratives in improving the quality of care.

Data sources Relevant studies through Medline, Embase, PsycINFO, CINAHL, and Cochrane databases.

Study selection Two reviewers independently extracted data on topics, participants, setting, study design, and outcomes.

Data synthesis Of 1104 articles identified, 72 were included in the study. Twelve reports representing nine studies (including two randomised controlled trials) used a controlled design to measure the effects of the quality improvement collaborative intervention on care processes or outcomes of care. Systematic review of these nine studies showed moderate positive results. Seven studies (including one randomised controlled trial) reported an effect on some of the selected outcome measures. Two studies (including one randomised controlled trial) did not show any significant effect.

Conclusions The evidence underlying quality improvement collaboratives is positive but limited and the effects cannot be predicted with great certainty. Considering that quality improvement collaboratives seem to play a key part in current strategies focused on accelerating improvement, but may have only modest effects on outcomes at best, further knowledge of the basic components effectiveness, cost effectiveness, and success factors is crucial to determine the value of quality improvement collaboratives.

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