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Publishing QI Projects
R Robinson, MD, FACP
Hospitalist
Associate Professor of Clinical Medicine
Objectives
• Understand barriers to QI publication
• Review SQUIRE Guidelines
• Understand QI publishing process
What is QI?
Quality Improvement/Assurance (QI/QA) is a
systematic, data-guided activity designed to bring
about immediate improvement in health care,
education or other service delivery in a local
setting.
Ann Intern Med 2007;146:666-73.
Healthcare needs QI
QI Methods are Tools
• TQM
• Six Sigma
QI Plan
Do
Study
Act
QI is required for many physicians
QI is required for many physicians
Quality bonuses in 39% of practices in 2012/2013 Merritt Hawkins Survey
QI Data is Rarely Published
Barriers to QI publication• Publication biases
• Permission to publish
• Difficult to write about
• Incentive Alignment
Publication Biases
Leading Journals – QI articles
57 / 65,592
0.08% QI related
7 / 70,579
0.01% QI related
Diabetes
0
10000
20000
30000
Diabetes QI Diabetes
Diabetes
99%294, 1%
Diabetes Diabetes QI
2013 Data
Permission to publish
What kind of data?
• Process
• Efficiency
• Outcomes
• Costs
What kind of data?
• Process
• Efficiency
• Outcomes
• Costs
• Trade secrets
• Financial data
Risks of publication
• Competition
▫ Reproducible methods/processes
▫ Institutional weaknesses
• Risk management
▫ Outcomes
Permission to publish
• Define publication as an objective
• Meet with institutional leadership
▫ What will be published?
▫ What measures will be published?
▫ Will negative results be published?
• Secure written permission to publish
Writing about QI
Research vs. QIResearch QI
• Knowledge
• Linear
• Quantitative
• Fixed protocol
• Generalizable
• Controlled Experiment
• Process
• Non-linear
• Qualitative
• Malleable
• Localized
• Quasi-Experimental
Research Context
Project Fixed
Adaptable
QI Context
Project
Fixed
Adaptable
SQUIRE Guidelines• Standards for QUality Improvement Reporting Excellence
• www.squire-statement.org
• Framework for reporting QI projects
▫ Published in 2008
▫ Required by many journals that publish QI
SQUIRE Guidelines - Introduction
• Background knowledge
• Local problem
• Intended improvement
• Study question(s)
SQUIRE Guidelines - Methods
• Ethical issues
• Setting
• Planning the intervention
• Planning the study of the intervention
• Methods of evaluation
• Analysis
SQUIRE Guidelines - Results
• Outcomes
SQUIRE Guidelines - Discussion
• Summary
• Relation to other evidence
• Limitations (generalizability)
• Interpretation
• Conclusions
Incentive Alignment
Incentives to publish research
• Promotion
• Tenure
• Research funding
• Prestige
▫ Journal selection / Impact factor
Incentives to publish QI
• Promotion (?)
• Tenure (?)
• Research funding
• Prestige (?)
Academic careers
Incentives for QI work• Solving local problems
• Career advancement▫ MOC▫ Hospital / Institutional leadership
• Financial incentives
Quality bonuses in 39% of practices in 2012/2013 Merritt Hawkins Survey
Planning a project
Set Publication Goals Early
Problem
No Publication
Publication
QI Publication Pathway
Protocol IRB PDSA Publish
Develop QI project protocolEssential for submission to IRB!
Protocol Development
• Define problem(s)
• Define process
• Define measures
Protocol Development Assistance
• SIU Center for Clinical Research
• Vice Chair for Research & Scholarship
▫ Dr Jakoby
• SIU Healthcare Quality & Safety
▫ Dr Sattovia
SIU Center for Clinical Research
• Administration & Financial Management
• Clinical Research Operations
• Population Health Science
• Research & Development
• Statistics
QI Publication Pathway
Protocol IRB PDSA Publish
Institutional Review Board
IRB approval
• Many journals require approval for publication
• Visit SCHRIS website and submit the “Determination of Human Subject Research” form
IRB approval
• Many journals require approval for publication
IRB approval
• Many journals require approval for publication
• Visit SCHRIS website and submit the “Determination of Human Subject Research” form
• Submit the appropriate SCHRIS application
Types of IRB application
• Full application
• Expedited
▫ Identifiable data, no or minimal risk to subject
• Exempt
▫ Anonymous data, no risk to subject
Types of IRB application
• Full application
• Expedited
• Exempt Most QI Projects
QI Publication Pathway
Protocol IRB PDSA Publish
Plan
Do
Study
Act
QI Publication Pathway
Protocol IRB PDSA Publish
Where to publish QI data
Journal Article
Poster
Presentation
Abstract
Choosing a Journal
Leading Journals – QI articles
57 / 65,592
0.08% QI related
IF 27.75
7 / 70,579
0.01% QI related
IF 47.05
Leading Journals – QI articles
57 / 65,592
0.08% QI related
7 / 70,579
0.01% QI related
Pick a journal that routinely
publishes QI articles
Leading QI Journals
IF 3.281 IF 1.417 IF 0.30IF 5.4IF 16.7
QI Publication Pathway
Protocol IRB PDSA Publish
Writing your article
• Choose journal
• Read and understand submission criteria
▫ SQUIRE
▫ IRB
• Write article
Areas for careful attention
• Methods
▫ Setting
▫ Measures
▫ Analysis
• Discussion
▫ Limitations (generalizability)
Summary• QI projects are publishable as research
• Publishing QI can be challenging
• QI Publication requires careful planning▫ IRB▫ Generalizability