DUQUE

Deepening our understanding of quality improvement in Europe

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 Obiettivo del progetto (Objective)

'Context Hospitals in European countries apply a wide range of quality improvement strategies; however, knowledge on the effectiveness of these strategies is limited. Objectives We propose to study the effectiveness of quality improvement systems in European hospitals. Specific research objectives are: a) to develop a maturity classification model for the assessment of organizational quality improvement systems in EU hospitals; b) to investigate associations between the maturity of quality improvement systems and measures of organizational culture, professional involvement and patient empowerment (at hospital level); c) to investigate associations between the maturity of quality improvement systems and measures of clinical effectiveness, patient safety and patient involvement (at patient and departmental level); d) to identify factors influencing the uptake of quality improvement activities by hospitals including external pressure as enforced by accreditation, certification or external assessment programmes. Design DUQUE will apply multi-method approaches to data collection, measurement and analysis. Data will be collected at hospital, departmental, professional and patient level. We will employ a multi-level study design in which patient-level data is nested in hospital departments, which are nested in hospitals in different EU countries. Setting We will collect data at hospital and departmental level in the Czech Republic, France, Germany, Poland, Portugal, Spain, Turkey and the United Kingdom in 30 randomly selected hospitals. In each country, for 12 of these 30 hospitals we will carry out additional data collection at the patient-level. Expected outcomes The products of DUQUE will include a catalogue of instruments to build a department and/or hospital specific quality and safety programme and an appraisal scheme to assess the maturity of the quality improvement system.'

Introduzione (Teaser)

A number of leading organisations in Europe's health-care quality field form part of a consortium studying the effectiveness of quality improvement systems in hospitals. The overall goals are to help hospitals develop their own effective safety and quality improvement programmes, and to support purchasing agencies and policymakers in assessing hospital quality.

Descrizione progetto (Article)

Various issues affect the quality of health care in Europe, underlining the need for more evidence on the actual outcomes of investments in improvement systems. At European level, such research is highly relevant, given that cross-border care contracting can only to a limited extent be based on outcome measures.

It is in within this context that the EU-funded project 'Deepening our understanding of quality improvement in Europe' (DUQUE) is working across eight countries to produce relevant knowledge and insights. Project objectives include the development of a 'maturity classification model' for assessing organisational quality improvement systems in EU hospitals.

Partners will investigate associations between the maturity of quality improvement systems and measures of organisational culture, professional involvement and patient empowerment at the hospital level. They will also examine associations between the maturity of quality improvement systems and measures of clinical effectiveness, patient safety and patient involvement at patient and care pathway levels. A fourth objective is to identify factors influencing the uptake of quality improvement activities by hospitals. One example is external pressure, in the form of accreditation, certification or other external assessment programmes.

To begin with, hospital, pathway and patient level measures were selected and developed. A literature review and consultations with experts and country-level stakeholders helped assess existing measures and options for translation and adaptation. Efforts in these areas also helped identify, where necessary, the need to develop new measures.

DUQUE has produced a comprehensive set of 12 tools to assess quality improvement systems and outcomes in European hospitals. The tools have been translated and are available in eight languages. Among others, tasks related to the project's development of an appraisal scheme give participating hospitals the opportunity to compare their results with the overall project results. All measures are available on http://www.duque.eu (the project website) .

Headway made by the project will positively impact the field, provided that the knowledge produced is used and endorsed by stakeholders throughout Europe. Outcomes will also contribute to decisions regarding contracting of hospital quality services, thanks to DUQUE's final products offering guidance for the assessment of quality improvement systems.