After methodological standards on PDSA projects were developed in 2007 new standards become available, the Quality Improvement Guide (QIG) . This article reports on methodological rigor of 78 improvement projects published in medical scientific journals between 2007-2015. For the purpose of this study the authors chose a strict set of criteria for performing PDSA cycles and for reporting quality. The set of criteria was based on the PDSA methodological recommendations which include: planning, setting a specific aim, conducting the PDSA cycle (pre, action, post) and reporting the data in a specific way [2, 4]. After the initial check list of available criteria for assessing individual methodological aspects within these reports was completed it was still possible to find additional criteria. These were also included in the quality assessment. Finally a summary score of the methodological quality of each improved measurement outcome within each PDSA project was given based on their compliance with each quality dimension using a scale from 1 point (poor compliance) to 7 points (excellent compliance).
The purpose of this study was not only to thoroughly assess the methodological rigor of the 78 PDSA projects testing measurement instruments or evaluating interventions but to also analyze the origins of each project. In addition a systematic search on the impact on the use of the PDSA cycle from the effect of quality assessments in the scientific literature was done. In this review the majority of the 78 projects reported a decay in methodological rigor within the course of the improvement project. Between 2007 and 2015 there was a significant increase in reports with missing data and problems with the use of the PDSA cycle. Over the same time span the use of the QIG increased, possibly due to its dissemination amongst practitioners. This may explain the increase of PDSA projects reporting the use of the QIG. However the majority of the projects did not make use of the QIG and therefore the methodological quality of their reported PDSA projects might have been significantly lower than projects using the QIG, which contributed to fewer comments from journals. When considering the number of projects that were published between 2007 and 2015 we compared it with three other reviews [10, 28, 29]. These reviews are also based on 78 PDSA projects between 2004 and 2013. Therefore we can confirm the increase of the use of the PDSA cycle for QI projects in medical science. d2c66b5586