Publication Guidelines for Improvement Studies in Health Care: Evolution of the SQUIRE Project

4 November 2008 | Volume 149 Issue 9 | Pages 670-676

In 2005, draft guidelines were published for reporting studies of quality improvement as the initial step in a consensus process for development of a more definitive version. The current article contains the revised version, which we refer to as Standards for QUality Improvement Reporting Excellence (SQUIRE). This narrative progress report summarizes the special features of improvement that are reflected in SQUIRE and describes major differences between SQUIRE and the initial draft guidelines. It also explains the development process, which included formulation of responses to informal feedback, written commentaries, and input from publication guideline developers; ongoing review of the literature on the epistemology of improvement and methods for evaluating complex social programs; and a meeting of stakeholders for critical review of the guidelines' content and wording, followed by commentary on sequential versions from an expert consultant group. Finally, the report discusses limitations of and unresolved questions about SQUIRE; ancillary supporting documents and alternative versions under development; and plans for dissemination, testing, and further development of SQUIRE.

Author and Article Information

From the Institute for Healthcare Improvement, Cambridge, Massachusetts, and the Dartmouth Institute for Health Policy and Clinical Practice Center for Leadership and Improvement, Lebanon, New Hampshire.

Some of the work reported in this article was done at the SQUIRE Advisory Committee Meeting, Cambridge, Massachusetts, 35 April 2007.

Note: A slightly different version of this article is being published in Quality and Safety in Health Care, 2008;17(Suppl 1):i3-10, as well as in other journals. This article is therefore not copyrighted and may be freely reproduced and distributed.

Acknowledgment: The authors thank Rosemary Gibson and Laura Leviton for their unflagging support of this project, the Institute for Healthcare Improvement for their gracious help in hosting the review meeting in Cambridge, and Joy McAvoy for her invaluable administrative work in coordinating the entire development process.

Grant Support: The SQUIRE project was supported in part by grant 58073 from the Robert Wood Johnson Foundation.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Frank Davidoff, MD, 143 Garden Street, Wethersfield, CT 06109; e-mail, fdavidoff{at}cox.net.

Current Author Addresses: Dr. Davidoff: 143 Garden Street, Wethersfield, CT 06109.

Dr. Batalden and Stevens: 30 Lafayette Street, Lebanon, NH 03766.

Dr. Ogrinc: 215 North Main Street (170), White River Junction, VT 05009.

Dr. Mooney: Alice Peck Day Memorial Hospital, 125 Mascoma Street, Lebanon, NH 03766.

^* Members of the SQUIRE Development Group who provided input during the development process and endorsed the SQUIRE guidelines are listed in the Appendix.