Staff at Dartmouth Medical School Develop Standards for Quality Improvement Reporting Excellence (SQUIRE)

Developing publication guidelines for quality improvement

The science and practice of quality improvement in medicine have developed rapidly, but relatively little of the resulting information has been published, and the quality of the reporting that does occur is inadequate, according to the Dartmouth Medical School Center for the Evaluative Clinical Sciences (now the Dartmouth Institute for Health Policy & Clinical Practice). The gap stems at least partly from a lack of rigorous and widely accepted guidelines for publishing research on quality improvement (QI).

To close that gap, from 2006 to 2009 staff at the center developed Standards for Quality Improvement Reporting Excellence (SQUIRE), and disseminated the guidelines widely in print and online. Project staff won acceptance of the guidelines among editors of health care journals, and created an online forum for QI practitioners and users of the guidelines.

To build on draft guidelines that the center had proposed in 2005, project staff convened some 35 journal editors, QI professionals, academic leaders, medical professionals, and foundation officers from the United States and other countries on April 3–5, 2007, in Cambridge, Mass. Project staff then used both face-to-face and e-mail contacts to solicit feedback from more than 100 people during several rounds of revisions.

Key Results: In reports to the Robert Wood Johnson Foundation (RWJF), project leaders noted the following results:

  • Project staff created the SQUIRE guidelines to inform authors and editors of the essential components of studies of quality improvement in medicine, and of reports on those efforts. By supporting complete, accurate and transparent reporting, the guidelines aim to speed development of the field.

    Toward that end, the guidelines:
    • Specify elements of study design that assess whether QI interventions work and for whom, why they work and under what circumstances
    • Provide a checklist of key items in a complete report on QI interventions as well as a framework for organizing those items
  • Project staff developed the SQUIRE website, which includes:
    • An Explanation and Elaboration document providing the rationale for each guideline
    • Examples of proper and improper reporting from the published literature
    • Commentaries, blogs and links to related information, to encourage stakeholders to "road-test" the guidelines and suggest further improvements
    Project staff subcontracted with Dynamic Diagrams, in Providence, R.I., and Nut Design, in South Strafford, Vt., to develop the website.
  • Seven journals published the guidelines with an accompanying article or editorial, and eight journals endorsed the guidelines. The guidelines were published in an "open-source format," which allows their free, unrestricted use in any medium, if a user cites the source.
  • Project staff disseminated the SQUIRE guidelines at more than 20 seminars and workshops in the United States and abroad, attended by some 1,000 QI professionals, researchers and journal editors.