{"title":"质量改进和研究:它们能协同工作吗?","authors":"G. D. Taylor","doi":"10.1111/ipd.70014","DOIUrl":null,"url":null,"abstract":"<p>Quality improvement (QI) and research are both essential and necessary for advancing patient care. Unfortunately, they are often misinterpreted for one another, which can lead to ethical, practical, and regulatory challenges [<span>1</span>]. Despite these two activities serving distinct purposes, they can work synergistically and form part of a translational continuum of evidence-informed practice and innovation [<span>2</span>]. It is not uncommon that QI reveals questions that are worthy of formally researching.</p><p>This article will explore what QI and research are, and how they can be misinterpreted. This will be followed by a brief discussion on how they can co-exist, using a case study focusing on the management of compromised first permanent molars (cFPM), to demonstrate this.</p><p>Quality improvement is an overarching term used to describe a systematic continuous approach to improving healthcare outcomes. Once a problem is identified, QI processes work towards findings solutions that aim to improve service provision, and ultimately patient outcomes [<span>2</span>]. Rather than a single method, QI methods include audit, service evaluation and quality improvement project (QIP). Research, in contrast, is hypothesis-driven, methodologically rigorous, and designed to generate findings that are generalisable beyond the local context [<span>3</span>]. Research requires ethical approval (rather than local oversight in QI) and is governed by strict standards to ensure their reliability and validity. The three QI approaches and research will now be discussed in more detail.</p><p>Research and QI approaches are frequently conflated. This could have significant ramifications given the ethical and legal requirement differences between the two.</p><p>As described above, research tests a new idea and aims to generate generalisable evidence [<span>3, 5</span>]. Any project that meets these criteria is research. Labelling research as ‘QI’ incorrectly is relatively common [<span>2, 5</span>]. It is likely to be naivety; however, it can be deliberate to avoid the ethical and regulatory scrutiny required in research studies [<span>5</span>]. Any project that tests a novel intervention (e.g., success of restorative material) or collects new knowledge from patients (e.g., opinions on discolouration following placement of silver diamine fluoride) is research, and should be treated as such. Incorrectly labelling a research project as a QI initative runs the risk of ethical breaches, especially if patient data is used without appropriate consent. Similarly, findings may be invalid as the methods employed are likely not to be as robust and rigorous as they should be. In contrast, research can be labelled incorrectly, when in fact it is QI. In these cases, it is often a mistake; however, it could be that clinical teams wish to promote the project as research, instead of QI, as it seems more prestigious or publishable [<span>5</span>]. Misinterpreting QI as research is of less concern than the converse. However, in doing so, the iterative nature of QI approaches might be lost or unnecessary delays are result from the often protracted ethical review and regulatory approval processes [<span>3</span>].</p><p>There are some simple ways to avoid misinterpretation. The easiest method is to use established decisions tools. The UK's Health Research Authority provides an online decision aid to determine if a project is research, audit, or service evaluation [<span>8</span>]. Alternatively, teams can seek early advice from local research and development departments to help determine the correct classification.</p><p>In reality, QI and research regularly co-exist, often complementing one another in a translational loop (see Figure 1) [<span>2, 4, 5</span>]. QI initiatives help identify research-worthy questions and/or provide insights, grounded in clinical relevance, that help shape the design of the research study. In converse, research findings which lead to evidence-based changes of practice [<span>7</span>] can then be adapted and tested locally through QI approaches, ensuring uptake and sustainability [<span>2, 7</span>]. In practice, translating evidence is challenging in dentistry with variable and complex health conditions and diversity of practice settings being cited as the main obstacles to implementation [<span>7</span>]. Despite this, when done well, the co-existence can promote faster translation of evidence into practice, supporting the continuous improvement and innovation across healthcare systems [<span>1, 2, 7</span>].</p><p>The question of how best to manage cFPM—whether to restore or extract—was identified as a key clinical challenge, leading to the initiation of the DECIDE project. A combination of QI approaches were undertaken to (a) establish whether the acknowledged direct impacts associated with cFPM in children were being discussed as part of the patient assessment process [<span>9</span>], and (b) what treatment options were being discussed and offered. The results of these QI initiatives highlighted the commonly reported impacts (pain, eating, sleep loss and daily activities) were mostly being recorded [<span>9</span>]; however, there was variation and lack of consensus in the management options being used in the local context. While useful, the QI approaches highlighted unresolved clinical questions. Following the translational loop, shown in Figure 1, a follow-on research study was designed and undertaken to ascertain how cFPM were being managed across the United Kingdom by general dentists and specialists in paediatric dentistry. The findings identified substantial differences between, and within, these professional groups [<span>10</span>]. The findings from this research were unable, in isolation, to inform a change in clinical practice. As a result, a wider programme of research (funded as part of an NIHR doctoral research fellowship) was undertaken to (a) establish adolescents' and adults' views and experiences around managing cFPM using semi-structured interviews, (b) elicit the public's preferences for managing cFPM, including determining societal willingness to pay (WTP), using a discrete choice experiment and (c) determine the most efficient way of managing cFPM over the lifetime of a patient using mathematical modelling [<span>11</span>]. The findings of these studies are reported elsewhere [<span>12-14</span>]; however, it was clear that making the decision to restore or extract is not binary. Instead, the need to make shared decisions jointly between the patient, parent and healthcare professional for cFPM became abundantly clear [<span>13-15</span>]. Despite disseminating this message through publications [<span>13-15</span>] and regional and international presentations, it was felt at a local departmental meeting that shared decision making was not routinely being undertaken for cFPM. As part of a QIP, following PDSA principles, ‘planned’ baseline data showed that shared-decision making was not common practice. For the ‘Do’ stage, age-appropriate information is currently being developed by colleagues at Newcastle Dental Hospital for both children and parents to help facilitate this process. Data will be collected to ‘study’ whether the intervention was effective, before ‘acting’ on what to do next. This QIP will continue whilst a further research study looking to explore how these interventions can be embedded into a decision-aid to support decision-making of cFPM across multiple settings will then follow.</p><p>The isolated case study demonstrates the intricate and intimate relationship QI and research can have.</p><p>Despite QI and research often being misinterpreted for one another, they can and should co-exist as part of translational continuum of evidence-informed practice.</p><p>The author declares no conflicts of interest.</p>","PeriodicalId":14268,"journal":{"name":"International journal of paediatric dentistry","volume":"35 S1","pages":"S48-S51"},"PeriodicalIF":1.9000,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ipd.70014","citationCount":"0","resultStr":"{\"title\":\"Quality Improvement and Research: Can They Work Synergistically?\",\"authors\":\"G. 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This will be followed by a brief discussion on how they can co-exist, using a case study focusing on the management of compromised first permanent molars (cFPM), to demonstrate this.</p><p>Quality improvement is an overarching term used to describe a systematic continuous approach to improving healthcare outcomes. Once a problem is identified, QI processes work towards findings solutions that aim to improve service provision, and ultimately patient outcomes [<span>2</span>]. Rather than a single method, QI methods include audit, service evaluation and quality improvement project (QIP). Research, in contrast, is hypothesis-driven, methodologically rigorous, and designed to generate findings that are generalisable beyond the local context [<span>3</span>]. Research requires ethical approval (rather than local oversight in QI) and is governed by strict standards to ensure their reliability and validity. The three QI approaches and research will now be discussed in more detail.</p><p>Research and QI approaches are frequently conflated. This could have significant ramifications given the ethical and legal requirement differences between the two.</p><p>As described above, research tests a new idea and aims to generate generalisable evidence [<span>3, 5</span>]. Any project that meets these criteria is research. Labelling research as ‘QI’ incorrectly is relatively common [<span>2, 5</span>]. It is likely to be naivety; however, it can be deliberate to avoid the ethical and regulatory scrutiny required in research studies [<span>5</span>]. Any project that tests a novel intervention (e.g., success of restorative material) or collects new knowledge from patients (e.g., opinions on discolouration following placement of silver diamine fluoride) is research, and should be treated as such. Incorrectly labelling a research project as a QI initative runs the risk of ethical breaches, especially if patient data is used without appropriate consent. Similarly, findings may be invalid as the methods employed are likely not to be as robust and rigorous as they should be. In contrast, research can be labelled incorrectly, when in fact it is QI. In these cases, it is often a mistake; however, it could be that clinical teams wish to promote the project as research, instead of QI, as it seems more prestigious or publishable [<span>5</span>]. Misinterpreting QI as research is of less concern than the converse. However, in doing so, the iterative nature of QI approaches might be lost or unnecessary delays are result from the often protracted ethical review and regulatory approval processes [<span>3</span>].</p><p>There are some simple ways to avoid misinterpretation. The easiest method is to use established decisions tools. The UK's Health Research Authority provides an online decision aid to determine if a project is research, audit, or service evaluation [<span>8</span>]. Alternatively, teams can seek early advice from local research and development departments to help determine the correct classification.</p><p>In reality, QI and research regularly co-exist, often complementing one another in a translational loop (see Figure 1) [<span>2, 4, 5</span>]. QI initiatives help identify research-worthy questions and/or provide insights, grounded in clinical relevance, that help shape the design of the research study. In converse, research findings which lead to evidence-based changes of practice [<span>7</span>] can then be adapted and tested locally through QI approaches, ensuring uptake and sustainability [<span>2, 7</span>]. 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The results of these QI initiatives highlighted the commonly reported impacts (pain, eating, sleep loss and daily activities) were mostly being recorded [<span>9</span>]; however, there was variation and lack of consensus in the management options being used in the local context. While useful, the QI approaches highlighted unresolved clinical questions. Following the translational loop, shown in Figure 1, a follow-on research study was designed and undertaken to ascertain how cFPM were being managed across the United Kingdom by general dentists and specialists in paediatric dentistry. The findings identified substantial differences between, and within, these professional groups [<span>10</span>]. The findings from this research were unable, in isolation, to inform a change in clinical practice. 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Despite disseminating this message through publications [<span>13-15</span>] and regional and international presentations, it was felt at a local departmental meeting that shared decision making was not routinely being undertaken for cFPM. As part of a QIP, following PDSA principles, ‘planned’ baseline data showed that shared-decision making was not common practice. For the ‘Do’ stage, age-appropriate information is currently being developed by colleagues at Newcastle Dental Hospital for both children and parents to help facilitate this process. Data will be collected to ‘study’ whether the intervention was effective, before ‘acting’ on what to do next. 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Quality Improvement and Research: Can They Work Synergistically?
Quality improvement (QI) and research are both essential and necessary for advancing patient care. Unfortunately, they are often misinterpreted for one another, which can lead to ethical, practical, and regulatory challenges [1]. Despite these two activities serving distinct purposes, they can work synergistically and form part of a translational continuum of evidence-informed practice and innovation [2]. It is not uncommon that QI reveals questions that are worthy of formally researching.
This article will explore what QI and research are, and how they can be misinterpreted. This will be followed by a brief discussion on how they can co-exist, using a case study focusing on the management of compromised first permanent molars (cFPM), to demonstrate this.
Quality improvement is an overarching term used to describe a systematic continuous approach to improving healthcare outcomes. Once a problem is identified, QI processes work towards findings solutions that aim to improve service provision, and ultimately patient outcomes [2]. Rather than a single method, QI methods include audit, service evaluation and quality improvement project (QIP). Research, in contrast, is hypothesis-driven, methodologically rigorous, and designed to generate findings that are generalisable beyond the local context [3]. Research requires ethical approval (rather than local oversight in QI) and is governed by strict standards to ensure their reliability and validity. The three QI approaches and research will now be discussed in more detail.
Research and QI approaches are frequently conflated. This could have significant ramifications given the ethical and legal requirement differences between the two.
As described above, research tests a new idea and aims to generate generalisable evidence [3, 5]. Any project that meets these criteria is research. Labelling research as ‘QI’ incorrectly is relatively common [2, 5]. It is likely to be naivety; however, it can be deliberate to avoid the ethical and regulatory scrutiny required in research studies [5]. Any project that tests a novel intervention (e.g., success of restorative material) or collects new knowledge from patients (e.g., opinions on discolouration following placement of silver diamine fluoride) is research, and should be treated as such. Incorrectly labelling a research project as a QI initative runs the risk of ethical breaches, especially if patient data is used without appropriate consent. Similarly, findings may be invalid as the methods employed are likely not to be as robust and rigorous as they should be. In contrast, research can be labelled incorrectly, when in fact it is QI. In these cases, it is often a mistake; however, it could be that clinical teams wish to promote the project as research, instead of QI, as it seems more prestigious or publishable [5]. Misinterpreting QI as research is of less concern than the converse. However, in doing so, the iterative nature of QI approaches might be lost or unnecessary delays are result from the often protracted ethical review and regulatory approval processes [3].
There are some simple ways to avoid misinterpretation. The easiest method is to use established decisions tools. The UK's Health Research Authority provides an online decision aid to determine if a project is research, audit, or service evaluation [8]. Alternatively, teams can seek early advice from local research and development departments to help determine the correct classification.
In reality, QI and research regularly co-exist, often complementing one another in a translational loop (see Figure 1) [2, 4, 5]. QI initiatives help identify research-worthy questions and/or provide insights, grounded in clinical relevance, that help shape the design of the research study. In converse, research findings which lead to evidence-based changes of practice [7] can then be adapted and tested locally through QI approaches, ensuring uptake and sustainability [2, 7]. In practice, translating evidence is challenging in dentistry with variable and complex health conditions and diversity of practice settings being cited as the main obstacles to implementation [7]. Despite this, when done well, the co-existence can promote faster translation of evidence into practice, supporting the continuous improvement and innovation across healthcare systems [1, 2, 7].
The question of how best to manage cFPM—whether to restore or extract—was identified as a key clinical challenge, leading to the initiation of the DECIDE project. A combination of QI approaches were undertaken to (a) establish whether the acknowledged direct impacts associated with cFPM in children were being discussed as part of the patient assessment process [9], and (b) what treatment options were being discussed and offered. The results of these QI initiatives highlighted the commonly reported impacts (pain, eating, sleep loss and daily activities) were mostly being recorded [9]; however, there was variation and lack of consensus in the management options being used in the local context. While useful, the QI approaches highlighted unresolved clinical questions. Following the translational loop, shown in Figure 1, a follow-on research study was designed and undertaken to ascertain how cFPM were being managed across the United Kingdom by general dentists and specialists in paediatric dentistry. The findings identified substantial differences between, and within, these professional groups [10]. The findings from this research were unable, in isolation, to inform a change in clinical practice. As a result, a wider programme of research (funded as part of an NIHR doctoral research fellowship) was undertaken to (a) establish adolescents' and adults' views and experiences around managing cFPM using semi-structured interviews, (b) elicit the public's preferences for managing cFPM, including determining societal willingness to pay (WTP), using a discrete choice experiment and (c) determine the most efficient way of managing cFPM over the lifetime of a patient using mathematical modelling [11]. The findings of these studies are reported elsewhere [12-14]; however, it was clear that making the decision to restore or extract is not binary. Instead, the need to make shared decisions jointly between the patient, parent and healthcare professional for cFPM became abundantly clear [13-15]. Despite disseminating this message through publications [13-15] and regional and international presentations, it was felt at a local departmental meeting that shared decision making was not routinely being undertaken for cFPM. As part of a QIP, following PDSA principles, ‘planned’ baseline data showed that shared-decision making was not common practice. For the ‘Do’ stage, age-appropriate information is currently being developed by colleagues at Newcastle Dental Hospital for both children and parents to help facilitate this process. Data will be collected to ‘study’ whether the intervention was effective, before ‘acting’ on what to do next. This QIP will continue whilst a further research study looking to explore how these interventions can be embedded into a decision-aid to support decision-making of cFPM across multiple settings will then follow.
The isolated case study demonstrates the intricate and intimate relationship QI and research can have.
Despite QI and research often being misinterpreted for one another, they can and should co-exist as part of translational continuum of evidence-informed practice.
期刊介绍:
The International Journal of Paediatric Dentistry was formed in 1991 by the merger of the Journals of the International Association of Paediatric Dentistry and the British Society of Paediatric Dentistry and is published bi-monthly. It has true international scope and aims to promote the highest standard of education, practice and research in paediatric dentistry world-wide.
International Journal of Paediatric Dentistry publishes papers on all aspects of paediatric dentistry including: growth and development, behaviour management, diagnosis, prevention, restorative treatment and issue relating to medically compromised children or those with disabilities. This peer-reviewed journal features scientific articles, reviews, case reports, clinical techniques, short communications and abstracts of current paediatric dental research. Analytical studies with a scientific novelty value are preferred to descriptive studies. Case reports illustrating unusual conditions and clinically relevant observations are acceptable but must be of sufficiently high quality to be considered for publication; particularly the illustrative material must be of the highest quality.