The guidelines are available in several formats.
- SQUIRE Guidelines is an online resource for authors, reviewers, and editors that provides an overview of the items in the SQUIRE checklist.
- SQUIRE Guidelines checklist in PDF is available for downloading.
- SQUIRE Explanation and Elaboration (E&E) is a series of web pages for authors, editors, and reviewers that provides one or more example(s) for each of the items in the SQUIRE checklist. Each example from existing literature is accompanied by a detailed explanation of how that item may be addressed in a manuscript.
- Explanation and Elaboration (E&E) in PDF is available for downloading from Quality and Safety in Healthcare.
07 Mar, 2012
Frank Davidoff, MD, MACP, will be speaking on Heterogeneity is not always noise - Converting noise to signal: new research methodologies for improvement science. A free webinars will take place on the 29 March 2012 at 15:00 GMT and registration is now open https://registration.livegroup.co.uk/iswebinar3/
In quality improvement work, results are not just about the intervention itself, therefore traditional methodologies to test clinical interventions such as randomised double blind trail need to be re-assessed in relation to improvement science.
Biological variation – heterogeneity – makes it difficult to show that clinical interventions work. Context – everything other than the intervention itself – largely accounts for this heterogeneity, and clinical studies are therefore designed to control out context-derived “noise.” Unfortunately, failure to recognize heterogeneity results in the “ecological fallacy” – the simplistic assumption that cause-effect relationships established in populations hold true at the level of their individual members. In fact, analysis of clinical trial data using techniques sensitive to biological variation (e.g., “risk stratification” and “number needed to treat”) clearly shows that study of biologic heterogeneity can deepen our understanding of causal relationships.
No clear distinction is possible between context and interventions designed to change human performance, because such interventions must first be filtered through people (“adaptive work”), and the interventions evolve in response to feedback (“reflexiveness”). In evaluating QI and other such programs it is therefore impossible to control out context; moreover, given the wide variation of social contexts, QI program effectiveness often varies widely across sites. Although frustrating, this variation can also be an important source of testable hypotheses about mechanisms of performance change. Studies of program effectiveness can be designed so that context heterogeneity becomes an asset (signal) rather than a liability (noise).