Than, say, a tightly written report on a randomised trial.

the increasing
tendency for journals to include 'eXtra' (with the 'e' meaning 'online')
material in an Internet-accessible format is extremely encouraging. and
you should hunt such material down whenever it is available.

Question Seven: What were the main ndings?

For this question you need to return to you answer to Question Five
and nd the numbers (for quantitative outcomes) or the key themes (for
qualitative data), and ask whether and how these were signicant. Just as
in other study designs, 'signicance' in quality improvement case studies
is a multifaceted concept. A change in a numerical value may be clinically
signicant without being statistically signicantor vice versa (see section
'Probability and condence'), and may also be vulnerable to various biases.
For example in a before and after study, time will have moved on between
the 'baseline' and 'post intervention' measures and a host of confounding
variables including the economic climate, public attitudes, availability of
particular drugs or procedures, relevant case law, and the identity of the
chief executive, may have changed. Qualitative outcomes may be partic-
ularly vulnerable to the Hawthorne etfect (staff tend to feel valued and
work harder when any change in working conditions aimed at improving
performance is introduced. whether it has any intrinsic merits or
not)[16].
ln the DVT care pathway example, mean length of stay was reduced by 2
days (a difference that was statistically signicant), and nancial savings
were achieved of several hundred Euros per patient. Furthermore, 40 of
42 eligible patients were actually cared for using the new care pathway (a
further 18 patients with DVT did not meet the inclusion criteria), and 62%
of all patients achieved the target reduction in length of stay. Overall, 7 of
60 people experienced adverse events, and in only one of these had the
care pathway been followed. these gures, taken together, not only tell us
that the initiative achieved the goal of saving money but they also give us a
clear indication of the extent to which the intended changes in the process
of care were achieved and remind us that many patients with DVT are what
are known as exceptions-that is, management by a standardised pathway
doesn't suit their needs.

In the academic detailing example. the ndings show that of the 130
doctors in the target group, 78% received at least one visit and these
people did not differ in demographic characteristics (e.g. age, sex, whether
qualied abroad or not) from those who refused a visit. Only one person
refused point blank to receive further visits. but getting another visit
scheduled proved challenging, and barriers were 'primarily associated
with persuading ofce staff of the physician's stated intentions for further