Turner M, Carr T, John R, Ramaswamy R. A scoping review of the use of quality improvement methods by community organizations in the United States, Australia, New Zealand, and Canada to improve health and well-being in community settings.
IJQHC COMMUNICATIONS 2022. [PMCID:
PMC9450045 DOI:
10.1093/ijcoms/lyab019]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background
Health-care facilities have used quality improvement (QI) methods extensively to
improve quality of care. However, addressing complex public health issues such as
coronavirus disease 2019 and their underlying structural determinants requires
community-level innovations beyond health care. Building community organizations’
capacity to use QI methods is a promising approach to improving community health and
well-being.
Objectives
We explore how community health improvement has been defined in the literature, the
extent to which community organizations have knowledge and skill in QI and how
communities have used QI to drive community-level improvements.
Methods
Per a published study protocol, we searched Scopus, Web of Science, and Proquest Health
management for articles between 2000 and 2019 from USA, Australia, New Zealand, and
Canada. We included articles describing any QI intervention in a community setting to
improve community well-being. We screened, extracted, and synthesized data. We performed
a quantitative tabulation and a thematic analysis to summarize results.
Results
Thirty-two articles met inclusion criteria, with 31 set in the USA. QI approaches at
the community level were the same as those used in clinical settings, and many involved
multifaceted interventions targeting chronic disease management or health promotion,
especially among minority and low-income communities. There was little discussion on how
well these methods worked in community settings or whether they required adaptations for
use by community organizations. Moreover, decision-making authority over project design
and implementation was typically vested in organizations outside the community and did
not contribute to strengthening the capability of community organizations to undertake
QI independently.
Conclusion
Most QI initiatives undertaken in communities are extensions of projects in health-care
settings and are not led by community residents. There is urgent need for additional
research on whether community organizations can use these methods independently to
tackle complex public health problems that extend beyond health-care quality.
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