Do Quality Improvement Collaboratives Improve Antimicrobial Prophylaxis in Surgical Patients?
Authors: Stephen K. Liu
Journal: Annals of Internal Medicine (2009)

Letters3 March 2009Do Quality Improvement Collaboratives Improve Antimicrobial Prophylaxis in Surgical Patients?Stephen K. Liu, MD, MPH, Karen Homa, PhD, Paul Batalden, MD, and Frank Davidoff, MDStephen K. Liu, MD, MPHFrom The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, and Institute for Healthcare Improvement, Cambridge, MA 02138.Search for more papers by this author, Karen Homa, PhDFrom The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, and Institute for Healthcare Improvement, Cambridge, MA 02138.Search for more papers by this author, Paul Batalden, MDFrom The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, and Institute for Healthcare Improvement, Cambridge, MA 02138.Search for more papers by this author, and Frank Davidoff, MDFrom The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, and Institute for Healthcare Improvement, Cambridge, MA 02138.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-5-200903030-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The conclusions stated in the abstract of the article by Kritchevsky and colleagues (1) do not accurately represent the study's findings. In fact, there is substantial reason to conclude that the collaborative was of meaningful clinical value. For example, improvement was statistically significant in 4 of the 6 mean performance measures in the intervention group but in only 3 of 6 measures in the feedback-only (control) group. Moreover, improvement in the mean “all-or-none” measure was 15.6% greater in the intervention group than the control group, which exceeds the 15% difference sought in the power calculation for the ...References1. Kritchevsky SB, Braun BI, Bush AJ, Bozikis MR, Kusek L, Burke JP, et al; TRAPE Study Group. The effect of a quality improvement collaborative to improve antimicrobial prophylaxis in surgical patients: a randomized trial. Ann Intern Med. 2008;149:472-80, W89-93. [PMID: 18838727] LinkGoogle Scholar2. Heng HH. The conflict between complex systems and reductionism. JAMA. 2008;300:1580-1. [PMID: 18827215] CrossrefMedlineGoogle Scholar3. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review—a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005;10 Suppl 1 21-34. [PMID: 16053581] CrossrefMedlineGoogle Scholar4. Vandenbroucke JP. Observational research, randomised trials, and two views of medical science. PLoS Med. 2008;5:67. [PMID: 18336067] CrossrefMedlineGoogle Scholar5. Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney S; SQUIRE Development Group. Publication guidelines for improvement studies in health care: evolution of the SQUIRE Project. Ann Intern Med. 2008;149:670-6. [PMID: 18981488] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Stephen K. Liu, MD, MPH; Karen Homa, PhD; Paul Batalden, MD; Frank Davidoff, MDAffiliations: From The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, and Institute for Healthcare Improvement, Cambridge, MA 02138.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Effect of a Quality Improvement Collaborative to Improve Antimicrobial Prophylaxis in Surgical Patients Stephen B. Kritchevsky , Barbara I. Braun , Andrew J. Bush , Michele R. Bozikis , Linda Kusek , John P. Burke , Edward S. Wong , John Jernigan , Cralen C. Davis , and Bryan Simmons , for the TRAPE Study Group* Publication Guidelines for Improvement Studies in Health Care: Evolution of the SQUIRE Project Frank Davidoff , Paul Batalden , David Stevens , Greg Ogrinc , and Susan Mooney , for the SQUIRE Development Group* Do Quality Improvement Collaboratives Improve Antimicrobial Prophylaxis in Surgical Patients? Stephen B. Kritchevsky , Barbara I. Braun , and Bryan Simmons Metrics 3 March 2009Volume 150, Issue 5Page: 358KeywordsAntimicrobialsConflicts of interestForecastingHealth carePerformance measuresProphylaxisQuality improvement ePublished: 3 March 2009 Issue Published: 3 March 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...