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Table 1 Study characteristics

From: The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews

Quality improvement strategy Author(s) Year AMSTAR score out of 11 points Number of studies included Countries included Number of participants
Accreditation of health care services Alkhenizan, Shaw [33] 2011 6 26 South Africa, Zambia, Australia, Denmark, United States, Egypt, Philippines, Japan, Canada. Hospitals (N = 13), Units (N = 8), Patients (N = 2), Facilities (N = 1), Employees (N = 1), Program (N = 1)
  Flodgren, Pomey, Taber et al. [31] 2011 9 2 England, South Africa England: all acute hospital trusts. South Africa: 18 hospitals
  Greenfield, Braithwaite [34] 2008 7 66 Ireland, United Kingdom, Australia, France, Italy, Spain, Canada, U.S. Not specified.
Local leadership Thomson O’Brien, Oxman, Haynes et al. [27] 2000 6 8 United States, Canada, China Health professionals (N > 296), US communities (providing care for patients with cancer; N = 6), Hospitals (deliveries; N = 20), Hong Kong hospital (N = 1), Canadian Community hospitals (deliveries; N = 16); US hospitals (AMI; N = 37), US hospitals (rheumatoid arthritis; N = 6), US hospitals (chronic obstructive pulmonary disease; N = 16), US hospitals (osteoarthritis; N = 6).
Continuing medical education Bloom [28] 2005 3 26 Not specified Not specified
  Lam-Antoniades, Ratnapalan, Tait [58] 2009 5 15 Not specified Nursing facility managers (N = 45), Physicians/Nurses (N = 2172)
  O’Brien, Freemantle, Oxman et al. [59] 2001 8 32 United States (N = 24), United Kingdom (N = 2), Australia (N = 1), Brazil (N = 1), France (N = 1), Indonesia (N = 1), Sri Lanka (N = 1), Zambia (N = 1) 2995 health professionals
Promoting a consistent positive patient safety culture across the hospital Morello, Lowthian, Barker [20] 2013 9 21 United States (N = 15), UK (N = 3), Canada (N = 1), Europe (N = 1), Australia (N = 1) Not specified
  Weaver, Lubomski, Wilson et al. [41] 2013 7 33 United States, United Kingdom, Canada. Australia. N not specified by country. Not specified. Study sample sizes ranged from 5461 persons working in 144 units in a single hospital to 28 individuals working within a single hospital unit.
Promoting a consistent positive organizational culture across the hospital Griffiths, Renz, Hughes et al. [21] 2009 6 30 Argentina (N = 1), Canada (N = 2), England (N = 6), France (N = 1), Malta (N = 1), Switzerland (N = 1), Thailand (N = 1), United Kingdom (N = 3), United States (N = 5), Not specified (N = 9) Nurse managers (N = 91), patients (N = 1070), nurses (N = 2013), physicians (N = 188), managerial staff (N = 144), hospitals (N = 301), not specified (N = 3)
  Parmelli, Flodgren, Beyer et al. [60] 2011 7 2 USA (N = 2) Not specified.
  Scott, Mannion, Marshall et al. [61] 2003 8 10 UK (N = 2), United States (N = 8), Canada (N = 1) Patients (N = 7605), managers (N = 77), management teams (N = 536), nurses (N = 899), physicians (N = 2504), not specified (N = 1)
Computerised clinical decision support systems Brand, Barker, Morello et al. [62] 2012 4 57 Not specified. Not specified.
  Bright, Wong, Dhurjati et al. [63] 2012 10 148 United States (N = 189), Europe (N = 62), Canada (N = 24), Multi-country (N = 10), Brazil (N = 1), Australia (N = 1), New Zealand (N = 1), Not specified (N = 5) Not specified.
  Chan, Chan, Cafazzo et al. [22] 2012 10 18 North America (N = 17), Europe (N = 1) Patients (N = 44529)
  Chaudhry, Wang, Wu et al. [64] 2006 6 257 Not specified. Not specified.
  Damiani, Pinnarelli, Scopelliti et al. [65] 2009 5 22 United States (N = 15), United Kingdom (N = 2), Italy (N = 1), Switzerland (N = 1), Canada (N = 1), Australia (N = 1), Costa Rica (N = 1) Not specified.
  Damiani, Pinnarelli, Colosimo et al. [49] 2010 8 45 Europe (N = 11), United States (N = 33), Oceania (N = 1) Inpatient patients (N = not specified); outpatient patients (N = not specified); physicians (N = not specified); other care givers (N = not specified).
  Garg, Adhikari, McDonald et al. [23] 2005 9 100 United States (N = 69), United Kingdom (N = 14), Canada (N = 5), Autralia (N = 4), Italy (N = 2), Austria (N = 1), France (N = 1), Germany (N = 1), Israel (N = 1), Norway (N = 1), Switzerland (N = 1) Practitioners or practices (N > 3826); patients (N > 92,895).
  Hemens, Holbrook, Tonkin et al. [66] 2011 8 65 United States (N = 44), EU/EEA countries (N = 13), Canada (N = 3), other/multiple countries (N = 5) Health professionals (N = 8,932); patients (N = 1,246,686)
  Jamal, McKenzie, Clark [67] 2009 7 23 United States (N = 14), United Kingdom (N = 3), France (N = 3), Norway (N = 1), The Netherlands (N = 1), Canada (N = 1) Health professionals (N = not specified)
  Kaushal, Shojania, Bates [29] 2003 7 12 USA (N = 12) Patients (N = ranging from 17 to 7490 per study)
  Kawamoto, Houlihan, Balas et al. [68] 2005 7 70 Not specified. Clinicians (N = 6000); patients (N = 130,000)
  Main, Moxham, Wyatt et al. [35] 2010 9 24 United States (N = 17), United Kingdom (N = 2), Spain (N = 2), France (N = 1), The Netherlands (N = 1), Belgium (N = 1) Patients (N = 264,405); Physicians (N = 2,363)
  Pearson, Moxey, Robertson et al. [30] 2009 7 56 North America (N = 39), Europe (N = 15), other (N = 2) Health professionals (N = not specified)
  Sahota, Lloyd, Ramakrishna et al. [69] 2011 9 36 United States (N = 22), The Netherlands (N = 4), United Kingdom (N = 3), Germany (N = 2), New Zealand (N = 2), Australia (N = 2), Brazil (N = 1), Canada (N = 1), Denmark (N = 1), Israel (N = 1), Lithuania (N = 1), Norway (N = 1), Portugal (N = 1). Note: Some of the studies were performed in multiple countries. Health professionals (N = 3,417); patients (N = 202,491)
  Shojania, Jennings, Mayhew et al. [70] 2009 11 28 United States (N = 19), United Kingdom (N = 2), Italy (N = 1), Norway (N = 1), Australia (N = 1), Canada (N = 2), New Zealand (N = 1), The Netherlands (N = 1) Provider teams (N = 10); providers (N = 1,138)
  Wong, Yu, Holbrook [71] 2010 6 4 Canada (N = 1), Israel (N = 1), United States (N = 2) Patient visits (N = 80,471)
Guidelines dissemination and implementation Grimshaw, Eccles, Thomas et al. [72] 2006 9 235 United States (N = 167); Other countries (N = 68) Not specified.
  Grimshaw, Thomas, MacLennan [38] 2004 9 235 United States (N = 167), United Kingdom (N = 26), Canada (N = 14), Australia (N = 2), The Netherlands (N = 1), Denmark (N = 1), France (N = 1), Germany (N = 1), Israel (N = 1), Mexico (N = 1), New Zealand (N = 1), Norway (N = 1), Norway (N = 1), Sweden (N = 1), Thailand (N = 1), Physicians (N = not specified)
Interventions to improve handovers Arora, Manjarrez, Dressler et al. [73] 2009 4 10 Not specified. Nurses (N = 38); patients (N = 3843); medical residents (N = 107)
  Gordon, Findley [74] 2011 5 10 Not specified. Health professionals (N = 343)
  Mistianen, Francke, Poot [75] 2007 9 15 Not specified. Patients (N = not specified)
  Ong, Coiera [24] 2011 6 24 United Kingdom (N = 1); Autralia (N = 1); Other (N = 22) Malpractice claims (N = 444); handover incidents (N = 334); critical incidents (N = 176); transfers (N = 323); nurses (N = 579); clinicians (N = 458); patients (N = 3974)
  Shepperd, Parkes, McClaran et al. [47] 2004 9 11 United States (N = 5), United Kingdom (N = 3), Canada (N = 2), Denmark (N = 1) Patients (N = 5448)
Patient-centred care interventions Coulter, Ellins [76] 2007 2 129 Not specified. Not specified.
  Lewin, Skea, Entwistle [77] 2001 8 17 North America (N = 11); United Kingdom (N = 3); Switzerland (N = 1); Norway (N = 1); Trinidad and Tobago (N = 1) Health professionals (N = not specified); patients (N = not specified)
  Stone, Pogorzelska, Kunches et al. [51] 2008 5 42 United States (N = 27); Other (N = 15) Patients (N = nearly 200,000)
Six sigma and Lean for continuous quality improvement DelliFraine, Langabeer II, Nembhard [78] 2010 7 34 The Netherlands (N = 1); other countries (N = 33) Hospital departments (N = 12); hospitals (N = 11); managed care company (N = 1)
  Glasgow, Scott-Caziewell, Kaboli [32] 2010 8 47 United States (N = 45); Australia (N = 1); The Netherlands (N = 1) Hospital/department (N = 35); Other not specified.
  Nicolay, Purkayastha, Greenhalgh [39] 2012 11 34 United Kingdom (N = 1); Switzerland (N = 1); India (N = 1); Finland (N = 1); Australia (N = 1); Taiwan (N = 2); Germany (N = 2); France (N = 2); The Netherlands (N = 3); United States (N = 20) Patients (N = 293,406); hospitals (N = 8); Not specified (7 studies).
Performance information Conry, Humphries, Morgan et al. [5] 2012 9 20 Not specified. Patients (N = 17,622); nurses (N = 69); hospital (N = 2117); physician (N = 23); not specified (2 studies)
  De Vos, Graafmans, Kooistra et al. [40] 2009 5 21 United States (N = 17); Canada (N = 1); Australia (N = 1); Sweden (N = 1); Laos (N = 1) Hospitals (N = 1988)
  Ketelaar, Faber, Flottorp et al. [52] 2011 9 4 United States (N = 3); Canada (N = 1) New medicaid beneficiaries or enrolees (N = 24,856); Hospitals (N = 86); Not specified (1 study)
  Marshall, Shekelle, Leatherman et al. [79] 2000 2 21 United States (N = 21) Health care providers (N = 14); health care consumers (N = 3); health care purchasers (N = 2); health care providers and purchasers (N = 1); hospitals (N = 3)
  Schauffler and Mordavsky [25] 2001 0 32 United States (N = 32) Health care consumers (N = 14); health care providers (N = 14); health care purchasers (N = 3); health report cards (N = 1), hospitals (N = 1)
  Veloski, Boex, Grasberger et al. [36] 2006 4 41 Not specified. Not specified.
Audit and feedback Hysong [80] 2009 5 19 Not specified. Not specified.
  Ivers, Jamtvedt, Flottorp et al. [37] 2012 11 140 United States (N = 69); Canada (N = 11); UK/Ireland (N = 21); Australia/New Zealand (N = 10); Sudan (N = 2); Thailand (N = 1); Laos (N = 1); other (N = 25). clusters/groups of health providers (N = 2310); health professionals (N = 2053)
Hospital incident reporting Benn, Koutantji, Wallace et al. [26] 2009 6 23 United Kingdom (N = 4); United States (N = 13); New Zealand/ Australia (N = 3); France (N = 1); Japan (N = 1); Israel (N = 1) Not specified.
  Percarpio, Watts, Weeks [81] 2008 7 38 Not specified. Not specified.
Safety checklists Ko, Turner and Finnigan [48] 2011 11 9 Not specified. Intensive care unit (N = 5); emergency department (N = 2); Surgery (N = 1); Acute Care (N = 1)
Educational outreach visits O’Brien, Rogers, Jamtvedt et al. [82] 2007 10 69 North America (N = 23); United Kingdom (N = 22); Europe (N = 14); Australia (N = 8); Indonesia (N = 2); Thailand (N = 1) Health professionals (N > 15,000)
Multiple quality improvement strategies Aboelela, Stone, Larson [50] 2007 10 33 North America (N = 17); Europe (N = 7); South America (N = 5); Middle East/Asia (N = 4) Acute care (general units; N = 4); ICU (N = 20); entire hospital (N = 9)
  Grimshaw, Shirran, Thomas et al. [3] 2001 8 41 Not specified. Not specified.
  Scott [4] 2009 0 Not specified. Not specified. Not specified.
  1. Average AMSTAR score by year (n = # studies): yr 2000: 4.0 (n = 2); 2001: 6.0 (n = 4); 2003: 7.5 (n = 2); 2004: 9.0 (n = 2); 2005: 6.3 (n = 3); 2006: 6.3 (n = 3); 2007: 7.8 (n = 4); 2008: 6.3 (n = 3); 2009: 5.5 (n = 11); 2010: 7.6 (n = 5); 2011: 7.8 (n = 9); 2012: 9.2 (n = 6); 2013: 8.0 (n = 2)