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Neither is further statistical testing of change or trends appropriate given the variation in facilities sampled and sampling approaches.
Application of PDSA cycles was assessed against key features of the method, including documentation characteristics, use of iterative cycles, prediction-based testing of change, initial small-scale testing and use of data over time.
A review of the historic development and rationale behind PDSA cycles has informed the development of a theoretical framework to guide the evaluation of PDSA cycles against use of iterative cycles, initial small-scale testing, prediction-based testing of change, use of data over time and documentation.
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Plan do study act (PDSA) cycles provide a structure for iterative testing of changes to improve quality of systems.
If the objective is to improve care in patients with progressive multiple sclerosis, then iterative testing of changes, and learning from these tests, may be more valuable than testing the effectiveness of a "set intervention".
Multiple small-scale tests of change are integral to changing practice in a high-risk environment.
We prefer the 2011 2015 3-county analysis for a more definitive test of change over time.
In addition, the competing needs of registry activities (e.g., complete case ascertainment) versus QI efforts (e.g., incremental tests of change) must be balanced.
Note: p values are from a within-group test of change from baseline, based on two-sided paired t test.
The IHI Model for Improvement forms the theoretical basis for making practice changes, as we have found that small, rapid cycle tests of change work well in physician practices.
‡ p < 0.0001 – t-test of change in weight z score = 0, infants experienced significant negative change in weight z-score from birth to discharge.
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