Medicare's Quality Improvement Organization Program Maximizing Potential (2006) / Chapter Skim
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Appendix C Approaches to Evaluation Design
Appendix C Approaches to Evaluation Design
Pages 466-472
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From page 466... ...
, refined definition of the "disease" (quality improvement) , and confounding factors (such as the voluntary nature of the program)
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From page 467... ...
One would thus need to make sure that the cases and the controls match on variables that are related to improvements in quality, such as participation in other quality improvement efforts or willingness to participate. (This might mean that both cases and controls would have to be sampled from a population of providers who volunteered to work with QIOs.)
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The use of a randomized controlled trial design in the evaluation of quality improvement interventions faces other challenges. First, the unit of intervention is often at the provider, clinic, or hospital level, so the level of randomization must also be at this higher level.
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From page 469... ...
Other limitations of confounding factors may be applicable, as may the factor of "readiness for change." The literature includes a growing number of examples of randomized controlled trials of quality improvement interventions. Kiefe and colleagues performed a successful randomized controlled trial of provider feedback among clinicians in Alabama (Kiefe et al., 2001)
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470 APPENDIX C could be initiated with nursing homes in one region of the state that could act as the experimental group and nursing homes in another region that could act as the control group by not participating in the intervention. This might also be applied to the comparison of the results for a region in one state with the results for a region in another state.
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From page 471... ...
of particular interventions, and second, to assess the "fidelity" of the intervention in comparison with the intent of the intervention. For example, if a QIO uses a collaborative to promote quality improvement activities on a specific aspect of performance, it would be useful to document exactly how the collaborative operated, including how the institutions and the participants in the collaboratives were recruited, the content of their interactions with the QIO and with each other, and the experiences that they report as a result of their participation.
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1995. Methodologic guidelines for systematic reviews of randomized control trials in health care from the Potsdam consultation on meta-analysis.
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