Explanation & Elaboration

6. Study question

• States precisely the primary improvement-related question and any secondary questions that the study of the intervention was designed to answer

Example

"In this article, we describe a generally applicable computer simulation model to analyze access times for hospital services and to investigate the capacity needed to reduce these access times. We give both the analytical model and the simulation model, including the results following implementation in two outpatient departments of the AMC [Academic Medical Center]. The questions that guided our study were:

• To what extent are analytical models appropriate and when is simulation essential for more insight?
• Is it possible to generalize the models and results to other departments?" [22]

Elaboration

The study questions are a fundamental component of the introduction because they clarify the study of the intervention and note the relationship that these questions have to the aim of the study. The study questions are in contrast to the improvement aim that would be stated in 5. Intended Improvement. The aim specifies the intended clinical (or system) change while the study questions focus on the mechanism(s) by which the intervention works and how effective the intervention is, or can be. In the example, the authors make this distinction by outlining the goal of the intervention, the performance gaps that motivated it, then outlining the study questions in terms of how and why the authors evaluated the intervention. The detail provided by the study questions also lend insight into the context issues that impact the study (for whom it works, under what circumstances, and why), so the study questions should flow naturally from the description of the context.

Study questions provide a synopsis of the investigator's thinking about the local quality gap. The questions provide an important link between the perceived causes of that gap and the methodology selected to close the gap. In the above example, the investigators hypothesized that a mismatch between supply and demand was causing lengthy waits for new patients. Their clearly defined study questions served to focus the improvement intervention which is described in detail in their methods section. Study questions can help introduce the data that were used, which may include a blend of process and outcome measures from both quantitative and qualitative methods. Additionally, these study questions address the generalizability of the intervention, which in this case refers to the applicability of their models to other clinics. These generalizable concepts are addressed further in the discussion sections 16b. Limitations and 17b. Interpretation.

References

22. Elkhuizen SG, Das SF, Bakker PJ, Hontelez JA. Using computer simulation to reduce access time for outpatient departments. Quality & safety in health care. 2007;16(5):382-386.

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