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EBP-EAP: Quality Improvement and Program Evaluation

EBP-EAP · Work through your exam, one topic at a time.

All guide sections

Quality Improvement and Program Evaluation

What this domain tests

QI and program evaluation items ask you to design, measure, and interpret improvement work. You need to distinguish QI from research, choose measures, use PDSA cycles and control charts, and evaluate whether a program achieved its aims.

Core rules

  • QI improves local systems; research generates generalizable knowledge; EBP applies best evidence. They overlap but have different ethical and regulatory pathways. QI usually does not require IRB review, but publication or novel interventions may.
  • Model for Improvement: three questions (What are we trying to accomplish? How will we know change is an improvement? What changes can we make?) plus PDSA (Plan-Do-Study-Act) cycles.
  • Measures include outcome, process, and balancing measures. Include baseline data and repeated measures over time; run charts and statistical process control (SPC) distinguish signal from noise.
  • Small tests of change reduce risk. Scale up only after successive PDSA cycles show improvement.
  • Root cause analysis (RCA) and failure modes and effects analysis (FMEA) are safety tools; they are not the same as PDSA.
  • Program evaluation can be formative or summative; logic models link inputs, activities, outputs, outcomes, and impact. RE-AIM evaluates reach, effectiveness, adoption, implementation, and maintenance.

Worked example

A hospital wants to reduce CAUTI. Aim: reduce catheter days by 20% in 6 months. Process measure: daily catheter necessity review. Outcome: CAUTI rate per 1,000 catheter days. Balancing measure: urinary retention and incontinence-related skin harm. First PDSA: test a nurse-driven removal checklist on one unit for two weeks. Study: catheter days fell from 1,200 to 1,050, but retention calls rose. Adapt: add a bladder scanner protocol before removal. Sequential cycles and an SPC chart show whether the change is real.

Traps that cost marks

  • Starting without a baseline or a defined aim.
  • Using pre/post percentages without a control chart and claiming causation.
  • Measuring only outcomes and ignoring process or balancing measures.
  • Calling any project QI when it is research requiring consent.
  • Skipping the Study and Act phases of PDSA.