Review articleQuality Improvement Interventions in Public Health Systems: A Systematic Review
Section snippets
Context
Public health leaders are now making difficult decisions about how to use limited resources to maintain essential public health services and how to improve most effectively the health of their populations through the services they provide.1 Performance management, using data to improve programs with respect to established targets and goals (known as performance standards), is increasingly seen by public health leaders as a useful practice.2 Quality improvement (QI, also known as performance
Evidence Acquisition
Peer-reviewed journal articles were identified using MEDLINE (via PubMed) and Academic Search Complete/EBSCO (also applying limits for: scholarly/peer-reviewed journals; subject: public health; and geography: U.S.). The search term public health was applied in combination with any of the following terms: performance management, quality improvement, performance measurement, performance improvement, and performance standards. These terms were chosen for their description as core components of
Evidence Synthesis
The search strategies employed yielded a total of 854 articles (Figure 2). After screening titles and abstracts for articles that were specifically related to the U.S. public health system, and removing duplicates, a total of 138 articles remained. From among these 138 identified studies, abstracts were reviewed to eliminate articles that described QI in clinical practice settings, where the QI interventions were focused on clinical practice changes rather than the public health system (4).
Discussion
This review presents studies that described QI activities, including links to public health system performance or health outcomes. A large number of studies were found that describe “how” to do QI interventions, but few studies were found that documented the benefits and contributed to the evidence about “why” they should be done. The studies are organized in three categories, but these categories are not entirely discrete. In some published studies, the first category of organization-wide QI
Conclusion
A small number of studies related public health QI initiatives or projects to a range of performance improvements but provided weak evidence that QI initiatives improved public health outcomes. In the future, systematic collection of public health standards scores, when combined with public health indicators and information about QI initiatives, will support better studies to “connect the dots” between QI initiatives on the one hand, and public health practice and outcomes on the other. Future
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