Study Question. Continuous quality improvement (CQI) has been implemented a
t least to some degree in many health care settings, yet randomized control
led trials (RCTs) of CQI are rare. We ask whether, when, and how RCTs of CQ
I might be designed.
Study Design. We consider two applications of CQI: as a general philosophy
of management and (by analogy with the use of conceptual models from the be
havioral sciences) as a conceptual model for developing specific interventi
ons. The example of warfarin therapy for stroke prevention among patients w
ith atrial fibrillation is used throughout.
Principal Findings. While it is impractical to use RCTs to study CQI as a g
eneral management philosophy, RCT methodology is appropriate for studying C
QI as a conceptual model for generating interventions. RCTs of CQI might be
considered when the process change under consideration is very large, its
implications (e.g., in terms of cost, outcomes of care, etc.) are very grea
t, and the best approach is uncertain. When designing RCTs of CQI, critical
decisions include (1) the unit of randomization; (2) whether the focus is
on CQI as a method for generating interventions or, instead, is on specific
interventions in and of themselves; and (3) the flexibility available to l
ocal personnel to modify the intervention's operational details.
Conclusions. RCTs of CQI as a conceptual model for generating interventions
are feasible.