Development of the Quality Improvement Minimum Quality Criteria Set (QI-MQCS): A Tool for Critical Appraisal of Quality Improvement Intervention Publications

Objective: Valid, reliable critical appraisal tools advance quality improvement (QI) intervention impacts by helping stakeholders identify higher quality studies. QI approaches are diverse and differ from clinical interventions. Widely used critical appraisal instruments do not take unique QI features into account and existing QI tools (e.g., SQUIRE) are intended for publication guidance rather than critical appraisal. This study developed and psychometrically tested a critical appraisal instrument, the Quality Improvement Minimum Quality Criteria Set (QIMQCS) for assessing QI-specific features of QI publications. Methods: Approaches to developing the tool and ensuring validity included a literature review, in-person and online survey expert panel input, and application to empirical examples. We investigated psychometric properties in a set of diverse QI publications (N=54) by analyzing reliability measures and item endorsement rates and explored sources of disagreement between reviewers. Results: The QIMQCS includes 16 content domains to evaluate QI intervention publications: Organizational Motivation, Intervention Rationale, Intervention Description, Organizational Characteristics, Implementation, Study Design, Comparator Description, Data Sources, Timing, Adherence / Fidelity, Health Outcomes, Organizational Readiness, Penetration / Reach, Sustainability, Spread, and Limitations. Median inter-rater agreement for QIMQCS items was kappa 0.57 (83% agreement). Item statistics indicated sufficient ability to differentiate between publications (median quality criteria met 67%). Internal consistency measures indicated coherence without excessive conceptual overlap (absolute mean inter-item correlation = 0.19). The critical appraisal instrument is accompanied by a user manual detailing What to consider, Where to look, and How to rate. Conclusions: We developed a ready-to-use, valid, and reliable critical appraisal instrument applicable to healthcare QI intervention publications, but recognize scope for continuing refinement.