The Difference Between Quality Improvement, Evidence-Based Practice, and Research

As healthcare institutions become ever more complex and our focus on patient experience expands, nurses are leading and participating in research studies (https://voice.ons.org/topic/cancer-research), evidence-based practice (EBP) projects, and quality improvement (https://voice.ons.org/topic/quality-outcomes) (QI) initiatives with a goal of improving patient outcomes. Research, EBP, and QI have subtle differences and frequent overlap (http://www.thehastingscenter.org/irb_article/an-instrument-to-differentiate-between-clinical-research-and-quality-improvement/), which can make it a challenge for nurses to identify the best option to investigating a clinical problem.

The first step is a comprehensive review of the literature with a medical librarian. This informs about the problem, what evidence has been reported, and what gaps exist in our knowledge of the problem. Then, synthesize the relevant literature and decide how best to proceed based on the outcome of the literature review, experience with previous projects, available resources, and staff time and effort.

Quality Improvement

QI projects typically don’t involve extensive literature reviews and are usually specific to one facility. The purpose of QI projects is to correct workflow processes, improve efficiencies, reduce variations in care, and address clinical administrative or educational problems (https://www.ahrq.gov/topics/quality-improvement.html). An example is assessing and implementing urinary catheter removal policies with a goal of removing catheters within a defined timeframe.

Evidence-Based Practice

EBP integrates the best available research evidence with clinical expertise and patient values (https://journals.lww.com/ajnonline/Fulltext/2010/01000/Evidence_Based_Practice__Step_by_Step__The_Seven.30.aspx) to improve outcomes. The process involves asking a relevant clinical question, finding the best evidence to answer it, applying the evidence to practice, and evaluating the evidence based on clinical outcomes. An example is implementing a new evidence-based clinical practice guideline at an institution to reduce or prevent chemotherapy extravasation for patients receiving vesicant therapy.

Research

If a literature review identifies gaps, you may conduct a study to generate new knowledge or to validate existing knowledge to answer a specific research question. Human subject approval is necessary (https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html) before conducting a research study. An example is a randomized controlled trial of two skin care regimens for patients receiving external-beam radiation therapy.

Nurses at all levels of care will be involved in asking and answering focused clinical questions with a goal of improving patient outcomes. It is important to be familiar with the similarities and differences between research, EBP, and QI. Each is an excellent method to improve clinical outcomes.

Research, Evidence-Based Practice, and Quality Improvement

	Definition	Impact on Practice
Research	A systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge (https://www.nih.gov/research-training).	Generates new knowledge for practice and adds to our professions’ knowledge base through the literature
Evidence-Based Practice	A lifelong approach to clinical practice (https://www.nih.gov/research-training) that integrates a systematic search, appraisal and synthesis of relevant research, clinical expertise, and patient preferences and values.	To translate knowledge with a goal of improving practice
Quality Improvement	The combined and unceasing efforts of everyone—healthcare professional, patients and their families, researcher, payers, planners, educators—to make changes that will lead to better patient outcomes, better system performance, and better professional development (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-).	To improve patient care processes and outcomes in specific healthcare settings