Table 1Definitions of the nine quality improvement strategies used in the Closing the Quality Gap series

StrategyDefinition
Provider reminders Information tied to a specific clinical encounter, provided verbally, in writing, or by computer, that is intended to prompt the clinician to recall information, or to consider performing a specific process of care (e.g., to make medication adjustments or order appropriate screening tests).19
Facilitated relay of clinical data to providers Clinical information collected directly from patients is relayed to the provider in situations where the data are not generally collected during a patient visit, or when collected using a means other than the existing local medical record system (e.g., transmission of a patient's home glucose level).19
Audit and feedback Any summary of a health care provider's clinical performance or an institution's clinical performance that is reported, either publicly or confidentially, to or about the clinician or institution (e.g., the percentage of a provider's patients who have achieved or have not achieved some clinical target).19
Provider education Any intervention that includes one of the following sub-strategies: educational workshops, meetings (e.g., traditional Continuing Medical Education (CME)), and lectures; educational outreach visits (the use of a trained person who meets with providers in their practice settings to disseminate information intended to change the provider's practice); or the distribution of educational materials (published or printed recommendations for clinical care, including clinical practice guidelines, audio-visual materials and electronic publications).19
Patient education Patient education—for individuals or members of a patient group or community, presented either in person or via the distribution of printed or audio-visual educational materials.19
Promotion of self-monitoring or self-management The distribution of materials (e.g., devices for peak flow self-monitoring) or access to resources that enhances patients' ability to manage their condition, the communication of clinical test data back to the patient, or follow up phone calls from the provider to the patient with recommended adjustments to care.19
Patient reminders Any effort directed toward patients that encourages them to keep appointments or adhere to other aspects of self-care.19
Organizational change Changes in the structure or delivery of care designed to improve the efficiency or breadth and depth of clinical care. These include the use of disease management or case management tactics (coordination of assessment, treatment, and arrangement for referrals by a person or multidisciplinary team in collaboration with or supplementary to the primary care provider); other personnel or team changes; the use of telemedicine (communication and case discussion between distant health care professionals); Total Quality Management (TQM) or Continuous Quality Improvement (CQI) approaches (quality problem cycles of measurement, intervention design, implementation, and re-measurement); and changes to medical records systems or hospital information systems.19
Financial, regulatory, or legislative incentives Interventions with positive or negative financial incentives directed at providers (e.g., “pay for performance” where pay is linked to adherence to some process of care or achievement of some target patient outcome). This strategy also included positive or negative financial incentives directed at patients, system-wide changes in reimbursement (e.g., capitation, prospective payment, or a shift from fee-for-service to salary pay structure), changes to provider licensure requirements, or changes to institutional accreditation requirements.19

From: 2, Methods

Cover of Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 5: Asthma Care)
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 5: Asthma Care).
Technical Reviews, No. 9.5.
Bravata DM, Sundaram V, Lewis R, et al.

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