SQUIRE Blog

Thinking about Generalizability

Susan Mooney

For the past few weeks I have been unable to do much in the way of writing.  I have been thinking about my project - although it is a humble endeavor, it has made a difference in my clinic.  I am confident that we now routinely and reliably collect 1st trimester urine cultures on more than 90% of the women who present for prenatal care.  Part of me wants to shrug and say "about time" while another part of me knows that other places are just as deficient as we were.  This is one of those tests that is so basic and so well accepted that everyone just assumes it is getting done.  I bet no one really ever checks to see if their processes are working.  I doubt that many facilities know their rate of 1st trimester urine culture screening.  

Here's where I am - I know that I have identified and addressed a problem in my local environment.  I suspect that other places have similar issues but I can't prove it.  Further, I am betting that most people would just assume that they are getting this test done; therefore, my work will have no relevance to them.  Which brings me around to the issue of generalizability.  What have I learned that others don't know?  What transcends my clinic?  At its heart, this is a basic QI project that included all of the basics - an aim, process mapping, small tests of change as well as audit and feedback.  In my local context, I have proven a couple of things: 1) These techniques works and 2) QI projects are hard work.  I doubt that either of these things are news-flashes.

When I was in my Master's program I wrote a paper about developing a methodology to assess the quality of prenatal care at any given facility.  I always thought that someday, I would write that paper again in a way that would allow for publication.  The urine culture project was a spin off of that paper.  It was a test to see if the methodology was workable in the real world.  As I wrestle with writing up the urine culture project, i am wondering if I need to go back to the original paper.  Does the urine culture project only make sense in the context of that larger body of work?  Is it only in the two papers together that I find the material that is generalizable, that transcends APD and allows others to see a new way of thinking about high reliability prenatal care.  If this is true, I am in trouble...I barely have enough time now to reflect and write.  If I add another, more challenging, piece of work to my plate, I fear that nothing will get done.  Except for the Flu vaccination project that I am starting.  I hear that pregnant women are especially vulnerable to H1N1...

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