Information For Authors

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Rutgers Medical Journal of QA/QI: Information for Authors

Our Rutgers Medical Journal of QA/QI has many unique features.  We accept manuscripts which are based upon retrospective chart review QA/QI studies or QI data base studies based on previously collected data, carried out at Rutgers.  We work with every author to produce a manuscript worthy of publication.  This is accomplished by our open review process whereby the reviewer/editor will interact with the authors, making suggestions if needed and help the authors accomplish the revisions.  The reviewer/editor will make the decision if the manuscript is ready for publication.  Soon after you submit your manuscript expect an email from your assigned reviewer/editor to begin this process.  Remember to include your email address of the contact author on the title page. 

The Rutgers Medical Journal of QA/QI (Journal) is an open peer reviewed Journal that strives to publish articles of high quality that report on or about retrospective, chart review QA/QI issues or QI data-based studies.  The Journal is divided into three sections by lead authors’ education level: students, residents, and faculty.  Our goal is to improve patient outcomes through encouraging QA/QI manuscripts. 

IMPORTANT:  IF YOU ARE A STUDENT OR RESIDENT AND MAY BE CHANGING YOUR SCHOOL/RESIDENCY EMAIL ADDRESS IN THE NEXT YEAR PLEASE USE ANOTHER EMAIL ADDRESS WHICH WILL NOT CHANGE--THIS IS IMPORTANT SINCE MANUSCRIPTS AND REVISIONS ARE ALL TRACKED BY EMAIL!

Before you begin please view this tutorial on submission of papers:  https://youtu.be/5ZUlgCS0vEc 

          

The reviewer will then make the decision to publish your manuscript.  We have therefore named the position "reviewer/editor".   Since the reviewer/editor will impact your manuscript please list this person on your title page as "Reviewer/Editor: XXX" following the authors listing. The Journal editor and section editors will oversee this process.  All manuscripts must be typed in Word with standard margins, 12 pitch, single spaced using Calibri font or Times New Roman. Manuscripts are encouraged to be no longer than 5 pages exclusive of tables, graphs and references. Please use standard Journal format.  In order to expedite the review and editing process you need to format your final "production ready" manuscript as seen in our published articles.

            Title Page:

            List each author, their degrees and affiliations, indicate the corresponding author, number of pages, and date originally submitted to the Journal.  Include the Reviewer/Editor for your manuscript following the authors.  Provide a few key words which will be used in indexing of your article.  We recommend use of Medical Subject Heading (MeSH) terms developed by the National Library of Medicine for use in Databases to properly catalog your work.  Please make sure you have included the contact author's email address so that the assigned reviewer/editor can begin the review process.

            Abstract:

            Each manuscript should include a brief abstract that captures the essence of the paper succinctly condensing each section of the manuscript.  Abstracts should be no longer than half a page.

            Body of the Manuscript:

                        Introduction: Setting the stage for the study.

The introduction should address the significance of the subject matter of the QA/QI—why is it important to conduct your QA/QI.  A very brief review of any previous QA/QI studies on this same subject or very closely related subjects should be included.

                        Methods: What you did to conduct your QA/QI? 

  • Each methods section must have as its first sentence a statement of either IRB determination or self-certification of non-human subject investigation.  We will provide authors with detailed instructions on how to apply for such a review and provide assistance if needed—see below. 
  • The guidelines and benchmarks used for this study should be detailed and referenced. Specifically, which guidelines are you assessing.  It is important to only collect data that directly addresses the guidelines under consideration. While it may be of interest to collect other data to answer related questions, a QA/QI IRB determination or a self-certification will not cover hypothesis testing or generating studies and your manuscript will not be considered further.  The editors encourage follow-up studies that do consider non-guideline data however this requires an entirely different IRB process and submission to other journals.
  • Remembering that all studies must be QI data base or retrospective chart review—It is critically important to know how the charts, used for data collection were selected—what was the random selection schema utilized to assure an un-biased sample? The validity of QA/QI studies rests upon the strength of the randomization process of chart selection.
  • What were the criteria used to determine the number (n) of charts or subjects to be collected? We suggest a minimum of 50 charts in most cases. Using the Confidence Interval (CI) statistic state approximately how wide a confidence interval was chosen as sufficient and the n associated with this CI.  Vassarstats is a very user-friendly internet CI calculator--Vassarstats--> proportions --> Confidence Interval of a proportion.  The reviewer/editors will provide mentoring on n determination and CI calculations as needed.

Results: What were the findings of your study?

Using paragraph form and/or tables or charts explain what was found by this study.  

                        Discussion: Putting the findings into broader context.

This section is where the authors explain, discuss and put into context each finding listed in the previous section (Results).  If a QI is being considered here is where the authors should discuss what they are proposing to remediate and why.  A limitation section of the study belongs towards the end of the Discussion and finally a very brief and succinct Conclusion subsection at the end of the Discussion should be written.

                        References: Cited literature.

See the following YouTube video to help you correctly format for references: https://www.youtube.com/watch?v=tuEb1RC1auw.

 

IRB and Self-Certification CONSIDERATIONS—

  • When applying for either IRB determination or self-certification for a QA/QI study you are only seeking a determination that your study does NOT meet the strict definition of human subjects’ research as defined by the federal government: Federal regulations 45 CFR 46.102:  Research means a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge. QA/QI studies are generally not considered human subject research since they do not directly contribute to generalizable knowledge—there is no hypothesis testing or hypothesis generating.
  • Use worksheet from Rutgers IRB hrp309—which is found at orra.rutgers.edu/hspp-toolkit to further assess your research as a QA/QI study.

 

The confidence interval (CI)

  • Testing to see if guidelines are being followed is a binary choice—yes, they are or no they are not being followed for each component of the guideline under question for each patients’ chart being abstracted.
  • To summarize your data, you have the total number of charts abstracted and the total number of “yes this component was done correctly”
  • These 2 number make up a ratio which is one of the key reporting statistics used with QA/QI studies
  • The confidence interval is a range using the above ratio to determine the range that we can be 95% confident that the true ratio, that is, the ratio that would be obtained if all charts were abstracted falls within.
  • The following illustration is using the notations for Vassarstats:  As the number of charts abstracted increases (n), the CI becomes narrower. An example: Abstracting 35 (n) charts it was found that 17 (k) of those charts that the component of the guideline was done correctly producing a ratio of 17/35 or 0.49 correctly done.  Confidence interval of a proportion calculated through Vassarstats that the lower limit of the 95% CI is 0.33 and the upper limit is 0.64.  Stated simply, we can be 95% confident that the true ratio of correct responses lies between 33% and 64%, or at worst guidelines are being followed 33% of the time and at best guidelines are being followed 64% of the time.  If the n increases by 10-fold the ratio remains the same, but the CI narrows to 0.43-0.54 or at worst guidelines are being followed 43% of the time and at best guidelines are being followed 54% of the time. If the n again increases by 10-fold, the ratio of course, remains the same—0.49 and the CI narrows yet again to 0.47-0.50.
  • The increasing n with the ratio remaining the same and only the CI narrowing is totally dependent on the random choice of charts for each sampling. Understanding this dynamic of the CI highlights the importance of random selection of charts to be abstracted
  • The random selection of charts to abstract is the most critical component of your research design and great care must be taken to assure random selection and our methods must reflect this! Given a rigorous random selection of charts the only consideration for determining the n to be sampled is having sufficient n to assure this random selection process—abstracting 30-60 charts will be a sufficient sample if, and only if, the selection was random!