***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To investigate the lifelong health effects , costs , and cost-effectiveness of a quality improvement collaborative focusing on improving diabetes management in an integrated care setting . Study Design and Methods : Economic evaluation from a healthcare perspective with lifetime horizon alongside a nonr and omized , controlled , before-after study in the Netherl and s. Analyses were based on 1861 diabetes patients in 6 intervention and 9 control regions , representing 37 general practice s and 13 out-patient clinics . Change in the United Kingdom Prospect i ve Diabetes Study score , remaining lifetime , and costs per quality -adjusted life year gained were calculated . Probabilistic life tables were constructed using the United Kingdom Prospect i ve Diabetes Study risk engine , a vali date d diabetes model , and nonparametric bootstrapping of individual patient data . Results : Annual United Kingdom Prospect i ve Diabetes Study risk scores reduced for cardiovascular events ( hazard ratio : 0.83 and 0.98 ) and cardiovascular mortality ( hazard ratio : 0.78 and 0.88 ) for men and women , respectively . Life expectancy improved by 0.97 and 0.76 years for men and women , and quality -adjusted life years by 0.44 and 0.37 , respectively . Higher life expectancy in the intervention group increased lifelong costs by & OV0556;860 for men and & OV0556;645 for women . Initial program costs were about & OV0556;22 per patient . The incremental costs per quality -adjusted life year were & OV0556;1937 for men and & OV0556;1751 for women compared with usual care costs . There is a probability > 95 % that the collaborative is cost-effective , using a threshold of & OV0556;20,000 per quality -adjusted life year . Conclusion : Optimizing integrated and patient-centered diabetes care through a quality -improvement collaborative is cost-effective compared with usual care Background and Purpose — Thrombolysis with intravenous recombinant tissue plasminogen activator is an effective treatment for acute ischemic stroke , but the number of treatable patients is limited . The PRomoting ACute Thrombolysis in Ischemic StrokE ( PRACTISE ) trial evaluated the effectiveness of a multidimensional implementation strategy for thrombolysis with intravenous recombinant tissue plasminogen activator in acute ischemic stroke . Methods — The PRACTISE trial was a national multicenter cluster-r and omized controlled trial with r and omization after pairwise matching . Twelve hospitals , both urban and community , academic and nonacademic , in the Netherl and s participated . All patients admitted with stroke within 24 hours from onset of symptoms were registered . The intervention included 5 implementation meetings based on the Breakthrough Series model . The primary outcome was treatment with thrombolysis . Secondary outcomes were admission within 4 hours after onset of symptoms , death or disability at 3 months , and quality of life . Results — Overall 5515 patients were included in the study ' 308 patients ( 12.2 % ) in the control centers and 393 patients ( 13.1 % ) in the intervention centers were treated with thrombolysis ( adjusted OR , 1.25 ; 95 % CI , 0.93 to 1.68 ) . Among the 1657 patients with ischemic stroke admitted within 4 hours from onset , 391 ( 44.5 % ) of 880 in the intervention centers were treated with thrombolysis and 305 ( 39.3 % ) of 777 in the control centers ; the adjusted OR for treatment with thrombolysis was 1.58 ( 95 % CI , 1.11 to 2.27 ) . Conclusions — An intensive implementation strategy increases the proportion of patients with acute stroke treated with thrombolysis in real-life setting s. An apparently pivotal factor in the improvement of the treatment rate is better application of contraindications for thrombolysis BACKGROUND The adherence to evidence -based treatment guidelines for acute myocardial infa rct ion ( AMI ) is still suboptimal . Therefore , we design ed a study to evaluate the effects of a collaborative quality improvement ( QI ) intervention on the adherence to AMI guidelines . The intervention used a national web-based quality registry to generate local and regular real-time performance feedback . METHODS A 12-month baseline measurement of the adherence rates was retrospectively collected , comprising the period July 1 , 2001 , through June 30 , 2002 . During the intervention period of November 1 , 2002 , through April 30 , 2003 , multidisciplinary teams from 19 nonr and omized intervention hospitals were subjected to a multifaceted QI-oriented intervention .  Another 19 hospitals , unaware of their status as controls , were matched to the intervention hospitals . During the postintervention measurement period of May 1 , 2003 , through April 30 , 2004 , a total of 6726 consecutive patients were included at the intervention ( n = 3786 ) and control ( n = 2940 ) hospitals . The outcome measures comprised 5 Swedish national guideline -derived quality indicators , compared between baseline and postintervention levels in the control and QUICC intervention hospitals . RESULTS In the control and QI intervention hospitals , the mean absolute increase of patients receiving angiotensin-converting enzyme inhibitors was 1.4 % vs 12.6 % ( P = .002 ) , lipid-lowering therapy 2.3 % vs 7.2 % ( P = .065 ) , clopidogrel 26.3 % vs 41.2 % ( P = .010 ) , heparin/low-molecular weight heparin 5.3 % vs 16.3 % ( P = .010 ) , and coronary angiography 6.2 % vs 16.8 % ( P = .027 ) , respectively . The number of QI intervention hospitals reaching a treatment level of at least 70 % in 4 or 5 of the 5 indicators was 15 and 5 , respectively . In the control group , no hospital reached 70 % or more in just 4 of the 5 indicators . CONCLUSIONS By combining a systematic and multidisciplinary QI collaborative with a web-based national quality registry with functionality allowing real-time performance feedback , major improvements in the adherence to national AMI guidelines can be achieved OBJECTIVE To test a quality improvement intervention , a learning collaborative based on the Institute for Healthcare Improvement 's Breakthrough Series methodology , specifically intended to improve care and outcomes for patients with childhood asthma . DESIGN R and omized trial in primary care practice s. SETTING Practice s in greater Boston , Mass , and greater Detroit , Mich. PARTICIPANTS Forty-three practice s , with 13 878 pediatric patients with asthma , r and omized to intervention and control groups . Intervention Participation in a learning collaborative project based on the Breakthrough Series methodology of continuous quality improvement . MAIN OUTCOME MEASURES Change from baseline in the proportion of children with persistent asthma who received appropriate medication therapy for asthma , and in the proportion of children whose parent received a written management plan for their child 's asthma , as determined by telephone interviews with parents of 631 children . RESULTS After adjusting for state , practice size , child age , sex , and within- practice clustering , no overall effect of the intervention was found . CONCLUSIONS This method ologically rigorous assessment of a widely used quality improvement technique did not demonstrate a significant effect on processes or outcomes of care for children with asthma . Potential deficiencies in program implementation , project duration , sample selection , and data sources preclude making the general inference that this type of improvement program is ineffective . Additional rigorous studies should be undertaken under more optimal setting s to assess the efficacy of this method for improving care AIMS Improvement collaboratives consisting of various components are used throughout health care to improve quality , but no study has identified which components work best . This study tested the effectiveness of different components in addiction treatment services , hypothesizing that a combination of all components would be most effective . DESIGN An unblinded cluster-r and omized trial assigned clinics to one of four groups : interest circle calls ( group teleconferences ) , clinic-level coaching , learning sessions ( large face-to-face meetings ) and a combination of all three . Interest circle calls functioned as a minimal intervention comparison group . SETTING Out-patient addiction treatment clinics in the United States . PARTICIPANTS Two hundred and one clinics in five states . MEASUREMENTS Clinic data managers su bmi tted data on three primary outcomes : waiting-time ( mean days between first contact and first treatment ) , retention ( percentage of patients retained from first to fourth treatment session ) and annual number of new patients . State and group costs were collected for a cost-effectiveness analysis . FINDINGS Waiting-time declined significantly for three groups : coaching ( an average of 4.6 days/clinic , P = 0.001 ) , learning sessions ( 3.5 days/clinic , P = 0.012 ) and the combination ( 4.7 days/clinic , P = 0.001 ) . The coaching and combination groups increased significantly the number of new patients ( 19.5 % , P = 0.028 ; 8.9 % , P = 0.029 ; respectively ) . Interest circle calls showed no significant effect on outcomes . None of the groups improved retention significantly . The estimated cost per clinic was $ 2878 for coaching versus $ 7930 for the combination . Coaching and the combination of collaborative components were about equally effective in achieving study aims , but coaching was substantially more cost-effective . CONCLUSIONS When trying to improve the effectiveness of addiction treatment services , clinic-level coaching appears to help improve waiting-time and number of new patients while other components of improvement collaboratives ( interest circles calls and learning sessions ) do not seem to add further value Abstract Objective To test a multifaceted collaborative quality improvement intervention design ed to promote evidence based surfactant treatment for preterm infants of 23 - 29 weeks ' gestation . Design Cluster r and omised controlled trial Setting and participants 114 neonatal intensive care units ( which treated 6039 infants of 23 - 29 weeks gestation born in 2001 ) . Main outcome measures Process of care measures : proportion of infants receiving first surfactant in the delivery room  , proportion receiving first surfactant more than two hours after birth  , and median time from birth to first dose of surfactant . Clinical outcomes : death before discharge home , and pneumothorax . Intervention Multifaceted collaborative quality improvement advice including audit and feedback , evidence review s , an interactive training workshop , and ongoing faculty support via conference calls and email . Results Compared with those in control hospitals , infants in intervention hospitals were more likely to receive surfactant in the delivery room ( adjusted odds ratio 5.38 ( 95 % confidence interval 2.84 to 10.20 ) ) , were less likely to receive the first dose more than two hours after birth ( adjusted odds ratio 0.35 ( 0.24 to 0.53 ) ) , and received the first dose of surfactant sooner after birth ( median of 21 minutes v 78 minutes , P < 0.001 ) . The intervention effect on timing of surfactant was larger for infants born in the participating hospitals than for infants transferred to a participating hospital after birth . There were no significant differences in mortality or pneumothorax . Conclusion A multifaceted intervention including audit and feedback , evidence review s , quality improvement training , and follow up support changed the behaviour of health professionals and promoted evidence based practice Context Multi-institutional quality improvement collaboratives are popular , but are they effective ? Contribution This controlled study evaluated an HIV care Breakthrough Series program that emphasized provider teams , sessions on quality improvement theory and techniques , and report backs about implementing quality improvement . A review of the medical records of 9986 HIV-infected patients showed no important differences in  quality of care ( viral load suppression , pneumocystitis prophylaxis , and screening for tuberculosis and hepatitis ) between the 44 intervention clinics and the 25 control clinics . Caution s Patient adherence and satisfaction were not measured , and some control clinics may have used quality improvement techniques similar to those recommended by the collaborative program . The Editors In the pastdecade , tremendous improvements have occurred in measuring and monitoring the quality of medical care in the United States . Despite these advances , striking problems with quality persist ( 1 , 2 ) . The quality of care for patients with HIV infection is of particular concern . Substantial evidence shows that obtaining medical services and treatment for patients with HIV infection may lead to longer survival and better quality of life ( 3 , 4 ) , yet serious quality -of-care problems and striking disparities in quality by race and social class have been documented ( 4 - 6 ) . In the 1980s , continuous quality improvement techniques were introduced into health care ( 7 , 8) . These strategies emphasize that most quality problems are a result of system failings rather than problems with individual practitioners ( 9 ) . In 1995 , the Institute for Healthcare Improvement introduced the concept of the Breakthrough Series , which brings together health care organizations dedicated to improving the quality of care in particular clinical areas through the application of continuous quality improvement techniques ( 10 ) . These techniques ( known as Plan/Do/ Study /Act or PDSA cycles ; Figure 1 ) first identify deficiencies in quality , next repeatedly implement small-scale interventions and measure changes , and then refine and exp and interventions to improve processes of care ( 11 , 12 ) . Typically , each Breakthrough Series collaborative is composed of 20 to 40 participating health care organizations and a faculty with expertise in the clinical area and quality improvement methods ( 
    Output:
    
Collaboratives reporting success generally addressed relatively straightforward aspects of care , had a strong evidence base and noted a clear evidence - practice gap in an accepted clinical pathway or guideline .
Conclusions QICs have been adopted widely as an approach to shared learning and improvement in healthcare .
Overall , the QICs included in this review reported significant improvements in targeted clinical processes and patient outcomes .