New research published in the Journal of the American College of Radiology suggests fewer than half of the quality improvement (QI) projects in radiology journals use iterative cycles to refine interventions.
“With increasing urgency to improve radiology systems, there is a rush to disseminate knowledge and innovation; however, system improvement practices, though familiar in manufacturing, are new to radiology,” wrote lead author Yvonne Cheung, MD, of Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, and colleagues. “As a result, many improvement projects not adhering to formal, science-based improvement methodologies have been published.”
The authors wrote that previous reviews have also reported poor adherence to specific QI methodologies. Thus far, no estimate of the prevalence of incorporation of basic scientific techniques, such as iterative cycles in QI projects, has been available.
Cheung et al. sought to provide insight on the quality of the published QI literature by determining the frequency of use of iterative cycles—a marker of proven QI methodology and to assess the association of the use of iterative cycles with characteristics of these projects.
The authors searched radiology journals that published QI studies between 2008 and 2015. Of the more than 3,100 studies, only 44 met the inclusion criteria. The researchers found:
- 46 percent of the studies used iterative cycles to refine intervention.
- 57 percent of the studies executed only a single cycle to refine intervention.
- General lack of scientific rigor was represented by failure to report baseline data (9 percent), describe unintended effects (66 percent) and discuss limitations (36 percent).
- 14 percent of publications explicitly employed terms indicative of use of iterative methodology.
- The use iterative cycles was associated with projects designed to improve processes, QI expert support, report of unintended effect and explicitly state use of iterative cycles.
The researchers noted their study indicates the need for increased emphasis on the scientific aspects of QI techniques when training residents.
“Our finding of a lack of broad adoption of science-based proven improvement methodology has important implications,” the researchers wrote. “Use of published QI projects as templates may not guarantee effectiveness and transferability. Improvement practitioners who are more knowledgeable about QI methodology, as demonstrated by attention to unintended consequences of intervention and engagement of QI experts, were more likely to utilize rigorous QI methods such as iterative methods to improve processes. The goals of avoiding harm and providing efficient health care may be harder to realize.”
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.