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Both quality Improvement (QI) projects and research studies can result in publications. However, the language the author uses in the publication is different in QI than the language used in research. This article outlines the differences in language usage between research and QI publications.

QI versus Research – How to Write for Publication

There are significant differences in the written language used when publishing a Quality Improvement (QI) paper versus a research paper. The QI paper often begins by describing a problem that is difficult to solve. The suggested solutions often refer to pre-existing evidence – hence the term Evidence Based Practice (EBP) and how evidence was applied in a clinical setting.  In contrast, research studies are focused on creating new knowledge to answer questions where the answer was previously unknown.

Key Points: Both QI and research can result in publications. However, the language descriptors and the steps differ between the two. This article outlines the differences in language usage between research and QI publications.

The QI Problem versus the Research Hypothesis

The introduction of a QI paper typically describes a problem that the authors want to solve. The problem and its details are specific to a particular hospital setting. For example: decreasing wait-times in the emergency department (ED), or increasing the numbers of patients discharged from the hospital by 11 am. These problems are local, and the solutions are likely to be local as well. This is a QI maxim, even though every hospital in the country struggles with these issues. There is not a universal solution for all hospitals, and it generally involves multiple QI steps and stakeholders within the organization. Most QI publications describe successful interventions. Unsuccessful projects are almost never published.

In contrast, a research study might use a hypothesis such as “there is a positive correlation between short wait-times in the ED waiting room and satisfaction with medical and nursing treatment.”  The intent here is not to improve the patient’s experience, but to determine whether wait time is associated with satisfaction and the care provided. The research methods used to answer this question can be surveys, qualitative interviews, video-interactions or even randomization into two groups.

Key Points: A QI paper describes a problem that was solved and uses problem-solving language.  A research paper creates evidence to answer a question or hypothesis and uses specific research-based language.

QI Frameworks versus Research Frameworks

Both QI projects and research studies follow a systematic process, but the theoretical frameworks and steps are very different.  There are many theoretical models that underpin QI projects.  Well known examples include PDSA (Plan-Do-Say-Act), Six-Sigma, and Lean (A3 planning). The authors typically state which QI model was used to formulate the improvement process and describe the subsequent steps according to the selected model. There are numerous QI planning tools that are used to share the improvement vision and gain stakeholder input. The planning tools might include flowcharts, and an A3 diagram/tool.  The authors may describe a “small test of change” and how their process was altered, refined and repeated. QI studies allow the processes to be “tweaked” and adjusted to achieve a desired outcome. These changes are described in the paper.

Research studies establish a research protocol using a specific methodology and the procedures do not change during data collection. In this way, a research project is less flexible than a QI project.

Key Points: Both QI papers and research papers use theoretical frameworks. The QI framework is flexible, process-orientated and encourages input from key stakeholders (examples are PDSA and LEAN). The research framework may be derived from the data (exploratory or qualitative studies) and is driven by a structured research protocol.

QI Outcomes versus Research Results

In QI projects, the intent is not to “prove” but to “improve.” The outcomes are presented in tables or as a “run chart” to show improvement over time (i.e. 6 months or 4 quarters). QI outcomes are descriptive but often not statistical. The intent is to improve a process and to sustain the change.  Real world language is used such as “patients” and “nurses.”

In quantitative research, the intent is to “prove” or “disprove” a hypothesis. Answers are described as “results” and typically statistics are employed to demonstrate a causation between variables.  Research specific language is used such as “subjects” or “participants.”

Key Points:  QI projects report outcomes and demonstrate improvement over time. Research studies report results often using statistics, without the necessity of demonstrating a sustained effect. QI projects use real-world language in the publication.

Summary

Both QI projects and research studies can be published as an abstract, poster, or manuscript.  Using the appropriate language will improve the chances of a successful publication.

QI Writing Guidelines:

More detailed guidelines for publishing QI projects can be found at the Standards for QUality Improvement Reporting Excellence website, (SQUIRE). The SQUIRE 2.0 guidelines provide a helpful checklist for QI publication: http://squire-statement.org/index.cfm?fuseaction=Page.ViewPage&PageID=471

Research Writing Guidelines:

For research studies, there are several writing guideline checklists depending on the research methodology. Examples include:

Randomized controlled trials: CONSORT  http://www.consort-statement.org

Observational Studies: STROBE  https://www.strobe-statement.org/index.php?id=available-checklists

Systematic Reviews: PRISMA  http://www.prisma-statement.org

Qualitative Research: COREQ https://academic.oup.com/intqhc/article/19/6/349/1791966

Economic Evaluations: CHEERS  http://www.equator-network.org/wp-content/uploads/2013/04/Revised-CHEERS-Checklist-Oct13.pdf

Diagnostic Accuracy Studies: STARD https://www.equator-network.org/wp-content/uploads/2015/03/STARD-2015-checklist.pdf

An extremely helpful central resource for many research reporting guidelines is the EQUATOR Network website. It is really worth a visit!

https://www.equator-network.org

Another helpful resource is the Stanford ORPCS (Office of Research Patient Care Services).  We are always available for consultation to help you write an excellent QI or research paper. Use the email below to request a consultation. We are also really worth a visit!!

Office of Research, Patient Care Services Website http://orpcs.org

Office of Research Email Contact research@stanfordhealthcare.org

Article By: Mary Lough

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