DNP 830 Topic 2 Discussion Question One
DNP 830 Topic 2 Discussion Question One
The Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines provide some guidance on the evaluation of quality improvement efforts. They are used as both grant proposal and manuscript preparation guides. Use the “Revised Standards for Quality Improvement Reporting Excellence: SQUIRE 2.0” resource to respond to the following:
Many publication guidelines, including CONSORT (randomized trials), STROBE (observational studies), and PRISMA (systematic reviews) focus on a particular study methodology (www.equator-network.org). In contrast, SQUIRE 2.0 is designed to apply across the many approaches used for systematically improving the quality, safety, and value of health care. Methods range from iterative changes using Plan-Do-Study-Act (PDSA) cycles in single settings to retrospective analyses of large-scale programs to multisite randomized
trials. We encourage authors to apply other publication guidelines—particularly those that focus on specific study methods—along with SQUIRE, as appropriate. Authors should carefully consider the relevance of each SQUIRE item but recognize that it is sometimes not necessary, nor even possible, to include each item in a particular manuscript.
SQUIRE 2.0 retains the IMRaD (Introduction, Methods, Results, and Discussion) structure.23 Although used primarily for reporting research within a spectrum of study designs, this structure expresses the underlying logic of most systematic investigations and is familiar to authors, editors, reviewers, and readers. We continue to use A Bradford Hill’s four fundamental questions for writing: Why did you start? What did you do? What did you find? What does it mean?24 In our evaluation of SQUIRE 1.0, novice authors found these questions to be straightforward, clear, and useful.
SQUIRE 2.0 contains 18 items but omits the multiple subitems that were a source of confusion for SQUIRE 1.0 users.19 A range of approaches exists for improving health care, and SQUIRE may be adapted for reporting any of these. As stated above, authors should consider every SQUIRE item, but it may be inappropriate or unnecessary to include every SQUIRE item in a particular manuscript. In addition, authors need not use items in the order in which they appear. Major changes between SQUIRE 1.0 and 2.0 are concentrated in four areas: 1) terminology, 2) theory, 3) context, and 4) studying the intervention(s).
Terminology
The elaborate detail in SQUIRE 1.0 was seen by users as both a blessing and a curse19: helpful in designing and executing quality-improvement work but less useful in the writing process. The level of detail sometimes led to confusion about what to include or not include in a manuscript. Consequently, we made the items in SQUIRE 2.0 shorter and more direct.
A major challenge in the reporting of systematic efforts to improve health care is the multiplicity of terms used to describe the work, which is challenging for novices and experts alike. Improvement work draws on the epistemology of a variety of fields, and depending on one’s field of study, the same words can carry different connotations, a particularly undesirable state of affairs. Terms such as “quality improvement,” “implementation science,” and “improvement science” refer to approaches that have many similarities but can also connote important (and often-debated) differences. Other terms such as “health care delivery science,” “patient safety,” and even simply “improvement” are also subject to surprising variation in interpretation. To address this problem in semantics, we created a glossary of terms used in SQUIRE 2.0 (see Sidebar: Glossary of Key Terms Used in SQUIRE 2.0).
The glossary provides the intended meaning of certain key terms as we have used them in SQUIRE 2.0 (Table 1). These definitions may be helpful in other endeavors but are not necessarily intended to be adopted for use in other contexts. Overall, we sought terms and definitions that would be useful to the largest possible audience. For example, we chose “intervention(s)” to refer to the changes that are made. We decided not to use the word “improvement” in the individual items (although it remains in the SQUIRE acronym) to encourage authors to report efforts that did not lead to changes for the better. Reporting well-done, negative studies is vital for the learning in this discipline.