Open Access Open Badges Research

Identifying quality improvement intervention publications - A comparison of electronic search strategies

Susanne Hempel1*, Lisa V Rubenstein1234, Roberta M Shanman1, Robbie Foy5, Su Golder6, Marjorie Danz1 and Paul G Shekelle123

Author Affiliations

1 RAND Corporation, Santa Monica, CA 90407, USA

2 Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA

3 David Geffen School of Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA

4 School of Public Health, University of California Los Angeles, Los Angeles, California, USA

5 University of Leeds, Leeds, LS2 9JT, UK

6 Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK

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Implementation Science 2011, 6:85  doi:10.1186/1748-5908-6-85

Published: 1 August 2011



The evidence base for quality improvement (QI) interventions is expanding rapidly. The diversity of the initiatives and the inconsistency in labeling these as QI interventions makes it challenging for researchers, policymakers, and QI practitioners to access the literature systematically and to identify relevant publications.


We evaluated search strategies developed for MEDLINE (Ovid) and PubMed based on free text words, Medical subject headings (MeSH), QI intervention components, continuous quality improvement (CQI) methods, and combinations of the strategies. Three sets of pertinent QI intervention publications were used for validation. Two independent expert reviewers screened publications for relevance. We compared the yield, recall rate, and precision of the search strategies for the identification of QI publications and for a subset of empirical studies on effects of QI interventions.


The search yields ranged from 2,221 to 216,167 publications. Mean recall rates for reference publications ranged from 5% to 53% for strategies with yields of 50,000 publications or fewer. The 'best case' strategy, a simple text word search with high face validity ('quality' AND 'improv*' AND 'intervention*') identified 44%, 24%, and 62% of influential intervention articles selected by Agency for Healthcare Research and Quality (AHRQ) experts, a set of exemplar articles provided by members of the Standards for Quality Improvement Reporting Excellence (SQUIRE) group, and a sample from the Cochrane Effective Practice and Organization of Care Group (EPOC) register of studies, respectively. We applied the search strategy to a PubMed search for articles published in 10 pertinent journals in a three-year period which retrieved 183 publications. Among these, 67% were deemed relevant to QI by at least one of two independent raters. Forty percent were classified as empirical studies reporting on a QI intervention.


The presented search terms and operating characteristics can be used to guide the identification of QI intervention publications. Even with extensive iterative development, we achieved only moderate recall rates of reference publications. Consensus development on QI reporting and initiatives to develop QI-relevant MeSH terms are urgently needed.