• Your Paper Your Way
• Before You Submit Your Work
• Article Types
• Use of inclusive language
• Open access
• Submission Directions
• Submission Checklist
• Queries
• Double anonymized review
• Article Structure
• Color Artwork
• Supplementary Material
• Editing Services
• Research data
• Author's Ethical Responsibilities
• Authorship
• Submission Declaration and Verification
• Conflict of Interest
• Other Issues
• Proofs
• Offprints
• Offprints
• Press Release
• Copyright and Reuse

Your Paper Your Way

We now differentiate between the requirements for new and revised submissions. You may choose to submit your manuscript as a single Word or PDF file to be used in the refereeing process. Only when your paper is at the revision stage, will you be requested to put your paper in to a 'correct format' for acceptance and provide the items required for the publication of your article.
To find out more, please visit the Preparation section below.

The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with new ideas and information to improve the quality and safety of health care. The Journal invites manuscripts on the development, adaptation, and implementation of innovative concepts, strategies, methodologies, and practices in quality and patient safety.

The Journal's scope includes publications that are relevant for all types of health care organizations-health systems; hospitals; ambulatory care; behavioral health facilities; community health centers; nursing care centers; health plans and disease management programs; and home health care programs. We believe that publishing this breadth of articles will help disseminate ideas and improvement strategies across disciplines and sectors of our health care system. Our target audience is just as diverse: senior leaders in health care organizations, quality and patient safety managers, physicians, nurses, other health care professionals, information technology professionals, educators, and researchers, as well as health policy makers, health care researchers, business and government purchasers of care, and health insurers.

The Joint Commission Journal on Quality and Patient Safety is widely read and has a long history of publishing seminal articles. The articles we publish are frequently highlighted by The Agency for Healthcare Quality and Research's Patient Safety Network. Our publisher, Elsevier, highlights articles through the journal's website, social media and ScienceDirect. The Journal is a key component of The Joint Commission's mission to partner with organizations to improve quality and safety. The Joint Commission accredits and certifies more than 20,000 health care organizations, and the Journal is essential reading for professionals in these organizations who are looking for ways to improve care. We also offer tremendous support to authors. Our online system, Editorial Manager, makes it easy to submit articles for publication and ensures rapid reviews and decisions. Once accepted, articles will be published online as soon as proofs are available. We have adopted Elsevier's "your paper, your way" philosophy that allows authors to submit articles in a variety of formats. We do not have strict word limits, so authors can provide the detail necessary for readers to fully understand their work and put their research into practice to improve care.

We look forward to receiving your article!

Before You Submit Your Work

  • Ensure that your paper fits the mission and scope of the Journal. If you are not sure, contact the Editorial Office.
  • Use standard formats as described at Equator Network. For example, use CONSORT for randomized trials, STROBE for observational studies, SRQR or COREQ for qualitative studies, CHEERS for economic evaluations, and SQUIRE for quality improvement studies. Authors are strongly encouraged to use the checklists included in these guidelines, and those checklists may be requested during manuscript review to ensure completeness.
  • Make sure your manuscript is accurate and readable. Elsevier offers an English Language Editing service for those who may need it.
  • To clarify the chronological context and time frames of different steps in the study, please provide dates for important decisions and actions.
  • Indicate which authors (with author's initials, as applicable) were involved in specific study-related activities discussed in the methods (e.g., reviewing charts, assigning global rating of quality of care), where appropriate.
  • Include headings to break up major sections (Methods, Results) and subheadings as appropriate.

Article Types

Ensure that your submission follows the guidelines for the appropriate article type. If you are uncertain which is most appropriate, ask the editors to determine the article type in your cover letter. See the table below for guidance on word count, abstract, and appropriate article type to select when submitting in Editorial Manager.

1. Original Articles

Original Articles report work on any topic or issue relevant to the improvement of quality and patient safety. The manuscript text should be organized into Introduction, Methods, Results, and Discussion.

1A. Improvement Articles
Articles Improvement Articles should describe the implementation and evaluation of an improvement intervention (which need not be successful).

Authors are requested to use the SQUIRE 2.0 Publications Guidelines for reporting quality improvement studies. Authors should consider every SQUIRE item, but may not need to include every element. Please remember to use the full citation for SQUIRE in the manuscript references.

Articles should include the following sections and usually include the elements listed within each section:

Use the headings Background, Methods, Results, and Conclusions. The conclusions section should not simply repeat the study results.

Introduction (no heading needed)
  • Statement of the problem
  • Summary of key literature on the problem or previous studies of interventions to address the problem
  • The study's objective(s) or key questions and how the study addresses previously unanswered questions

  • Methods
    This should include the information needed for the reader to assess the validity and generalizability of the study results. For example:
  • Study Design/Evaluation Methods
  • Ethical considerations (e.g., IRB approval or waiver)
  • Setting
  • Organizing for the Intervention: Who led the effort? Who was the champion and who were members of the intervention teams?
  • Intervention: the various steps involved in the intervention.
  • Study population, including eligibility and exclusion criteria
  • Data (measures) and data collection (sources)
  • Statistical analysis

  • Results
    This section should report the findings of the study. Findings should be presented simply and in objective language, without interpretation. Use meaningful statistics that are relevant to the problem stated in the Introduction. Data may be presented in Tables and Figures as well as in the text. All findings reported here should then be discussed in the Discussion section.
  • Tables should generally be used to present summary-level data. Long lists of raw data can be included as an Appendix.
  • Figures should be used to present data that lends itself to visual representation. Avoid presenting too much information in a single figure.
  • Tables and Figures should be interpretable on their own. Use titles that describe what is being presented. All abbreviations used should be defined in a footnote.

  • Discussion
  • Brief summary of key findings
  • Whether the intervention is still in place (and with what modifications, and why) and if data are still being tracked or an explanation of when and why it was discontinued
  • Comparison of these findings to previous studies in the literature, including possible reasons for differences
  • Discussion of unexpected findings
  • Weaknesses of the study (Limitations), including failure to prove sustainability of the intervention (in terms of processes and data)
  • Conclusions
  • Implications for research, improvement practices, practice (health care, organizations), and, if applicable, policy makers
  • Next steps (at the study site), including plans to achieve sustainability

  • Examples:

    Pronovost P, et al. Sustaining Reliability on Accountability Measures at The Johns Hopkins Hospital. (Feb 2016)

    Mermel, LA. Reducing Clostridium Difficile Incidence, Colectomies, and Mortality in the Hospital Setting: A Successful Multidisciplinary Approach. (Jul 2013)

    Richardson MG, Domaradzki KA, McWeeney DT. Implementing an Obstetric Emergency Team Response System: Overcoming Barriers and Sustaining Response Dose. (Nov 2015)

    1B. Research Articles
    Research articles are usually observational studies (e.g., studies of the accuracy of screening and diagnostic tests, quality measures, associations between quality measures and clinical outcomes, cost-effectiveness analyses and decision analyses, surveys, qualitative studies). Use the headings Background, Methods, Results, and Conclusions.


    Quillivan RR, et al. Patient Safety Culture and the Second Victim Phenomenon: Connecting Culture to Staff Distress in Nurses. (Aug 2016)

    Kozmic SE, et al. Factors Associated with Inpatient Thoracentesis Procedure Quality at University Hospitals. (Jan 2016)

    Joynt KE, et al. Challenges in Reducing Readmissions: Lessons from Leadership and Frontline Personnel at Eight Minority-Serving Hospitals. (Oct 2014)

    1C. Conceptual Articles
    These articles can present frameworks, models, methodologies, or approaches to problems. Descriptions of how they have been used in actual practice to help address quality and safety problems or to design improvement strategies is strongly encouraged. The abstract should included up to four headings of the author's choice that correspond to article sections.


    Approaches: Gould LD, et al. Clinical Communities at Johns Hopkins Medicine: An Emerging Approach to Quality Improvement. (Sep 2015)

    Models: Pines JM, et al. Procedural Safety in Emergency Care: A Conceptual Model and Recommendations. (Nov 2012)

    Frameworks: Hilligoss B, et al. Collaborating-or "Selling" Patients? A Conceptual Framework for Emergency Department-to-Inpatient Handoff Negotiations. (Mar 2015)

    Methodologies: Schottinger JE, et al. Using Literature Review and Structured Hybrid Electronic/Manual Mortality Review to Identify System-Level Improvement Opportunities to Reduce Colorectal Cancer Mortality. (Jul 2016)

    2. Improvement Briefs
    Improvement Briefs are shorter versions of Improvement Articles (See 1A above). They should follow the same basic structure for the abstract and headings. Generally, this is the appropriate article type when the improvement project:
  • Involves one simple intervention rather than a multifaceted or multiphase intervention
  • Involves one or a few clinical unit(s) rather than a systemwide intervention
  • Has straightforward outcome measures

  • Examples:

    Shieh, L. Assigning a Team-Based Pager for On-Call Physicians Reduces Paging Errors in a Large Academic Hospital. (Feb 2014).

    McKetta D, et al. Managing Disruptions to Patient Flow Capacity: Rapid-Cycle Improvement in a Pediatric Cardiac Procedure Complex. (Jul 2016)

    3. Innovation Reports
    Innovation Reports focus on the earlier phases of innovation, idea generation, and early-stage testing, which typically requires understanding of the context, problem definition, and rapid-cycle testing and experimentation. Innovation Reports are not intended for the evaluation of the effectiveness and safety of drugs or medical devices.

    Innovation Reports should generally have the same structure as Original Articles. However, other headings may be used if more appropriate. The abstract should include up to 4 four headings that correspond to article sections. Authors should consider addressing the following questions as part of the manuscript:
  • Problem Definition: Who is this problem affecting? What is the magnitude of the problem?
  • Context: In which clinical setting is this occurring? Who are the key participants and stakeholders?
  • Initial Approach: What was the initial idea and hypothesis?
  • Iteration and Pivots: What was actually tested? What changed about the solution?
  • Outcomes: What outcomes were measured? (could include earlier-stage metrics, such as usage, experience, and perception)
  • Key Insights and Surprises: What was interesting and unique about this process?
  • Next Steps: What happens next to learn more about whether this innovation will work? (can include documentation of failures and areas that should not be pursued)

  • Example:

    Wyskiel RM, Weeks K, Marsteller JA. Inviting families to participate in care: a family involvement menu. (Jan 2015)

    4. Research Letters
    Research Letters are similar to Research Articles (1B), but they should not exceed 600 words of text (not including acknowledgment, tables, figures, or references) and six references. They may include up to three tables and/or figures. Online supplementary material is not allowed. Research letters may have no more than seven authors. In general, Research Letters should be divided into the following sections: To the Editor (which serves as an introduction), Methods, Results, and Discussion.


    Roh J, et al. Quality of Septic Shock Care in the Emergency Department: Perceptions vs. Reality. http://www.jointcommissionjournal.com/article/S1553-7250(16)30111-8/pdf

    5. Tool Tutorials
    This article type is designed to showcase new tools and preliminary experience using them. The tool should be available for use by readers in their own organizations and should be sufficiently described to enable implementation. Evaluations of proprietary tools that require licensing or other fees for use will not be considered.

    Articles should include the following sections:

    Quality or safety need, as represented in the literature.

    Tool Development:
    How, when, why, was it developed, with what resources and feedback, testing, and so on.

    Tool Description:
    Narrative description of components, with illustrations.

    How To:
    Step-by-step process for tool use - generic supported by example(s), walking the reader through its use.

    Results and Lessons:
    Data on extent of use of the tool and an evaluation plan or evaluation, if data is not readily available and further development or refinement in use of tool on the basis of the evaluation; what results have been achieved and what has been learnt through use of the tool. Specifically address potential pitfalls, if any (e.g., specific cautions to be noted, alerts based on experience with the tool, practical tips).

    Summary and Next Steps:
    Summary of tool and impact, next steps in its evaluation, refinement, spread of use, and so on.


    Morvay S, et al. Medication Event Huddles: A Tool for Reducing Adverse Drug Events. (Jan 2014)

    Kuzniewicz MW, et al. Development and Implementation of an Early-Onset Sepsis Calculator to Guide Antibiotic Management in Late Preterm and Term Neonates. (May 2016)

    6. Review Articles
    Reviews on clinical topics or improvement methodologies provide an update on current understanding and improvement topics. Headings should be the same as for Original Articles. The Methods section should include a subheading for "Search Strategy and Selection Criteria," that states the sources (including databases, MeSH and free-text search terms and filters, and reference lists from journals or books) of the material covered and the criteria used to include or exclude studies. Authors should describe how their findings add value to the existing evidence and should state the implications for clinical or improvement practice and future research.

    6A. Narrative Reviews
    Narrative reviews should address a problem or issue by combining expert opinion with a thorough and balanced review of available evidence. Narrative reviews are appropriate when the question of interest is too broad, the body of evidence too sparse, or the topic too new or controversial for a systematic review. The review should put the topic into the context of the literature and interpret the evidence to help solve the problem for the reader.


    Battersby M, et al. Twelve evidence-based principles for implementing self-management support in primary care. (Dec 2010)

    6B. Systematic Reviews
    Systematic reviews (or meta-analyses) should follow the guidelines in the PRISMA statement. Authors will be required to submit the PRISMA checklist and flow diagram along with their manuscript. Although PRISMA focuses on randomized trials, the PRISMA Statement can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions.


    Jones EL, et al. How Well Is Quality Improvement Described in the Perioperative Care Literature? A Systematic Review. (May 2016)

    Ong MS, Coiera E. A Systematic Review of Failures in Handoff Communication During Intrahospital Transfers. (Jun 2011)

    7. Conference Reports
    Conference reports summarizing proceedings at a conference on quality and patient safety issues. Authors interested in submitting a conference report should contact the editors prior to submission.


    Sokas R, et al. Frontline hospital workers and the worker safety/patient safety nexus. (Apr 2013)

    Fairbanks RJ, et al. Resilience and resilience engineering in health care. (Aug 2014)

    8. Commentary
    Commentaries may address virtually any important topic in quality and patient safety and should be focused on a particular problem or issue. They can include personal vignettes but should still address a known issue, such as patient-centered care, patient engagement, or patient-physician communication.


    Kirby, TJ. In Search of Water: South Carolina Hospitals Apply High Reliability Thinking to Protect Patients in the Midst of Flooding. (Sep 2016)

    Buist M. Patient-Centered Care: Just Ask a Thoughtful Question and Listen. (Jun 2016)

    9. Editorials
    Editorials are solicited by the Editors and comment on articles published in the same issue.

    10. Letters to the Editor
    We welcome correspondence on content published in the Journal or on other topics of interest to our readers. Letters are not peer reviewed, but the Journal may invite the authors of the article of interest to respond in the same issue. Some Letters might be chosen for online-only publication.

    Article Type Summary
    Article Type Suggested Word Limit Abstract
    Original Articles 4,000 Yes, structured, 250 words
    Improvement Briefs 2,500 Yes, structured, 250 words
    Innovation Reports 2,500 Yes, structured, 250 words
    Research Letters 600 No
    Tool Tutorials 4,000 Yes, unstructured, 100 words
    Reviews 4,000 Yes, unstructured, 250 words
    Conference Report 4,000 No
    Commentary 2,500 No
    Editorial 1,200 No
    Letters to the Editor 500 No

    Use of inclusive language

    Inclusive language acknowledges diversity, conveys respect to all people, is sensitive to differences, and promotes equal opportunities. Content should make no assumptions about the beliefs or commitments of any reader; contain nothing which might imply that one individual is superior to another on the grounds of age, gender, race, ethnicity, culture, sexual orientation, disability or health condition; and use inclusive language throughout. Authors should ensure that writing is free from bias, stereotypes, slang, reference to dominant culture and/or cultural assumptions. We advise to seek gender neutrality by using plural nouns ("clinicians, patients/clients") as default/wherever possible to avoid using "he, she," or "he/she." We recommend avoiding the use of descriptors that refer to personal attributes such as age, gender, race, ethnicity, culture, sexual orientation, disability or health condition unless they are relevant and valid. When coding terminology is used, we recommend to avoid offensive or exclusionary terms such as "master", "slave", "blacklist" and "whitelist". We suggest using alternatives that are more appropriate and (self-) explanatory such as "primary", "secondary", "blocklist" and "allowlist". These guidelines are meant as a point of reference to help identify appropriate language but are by no means exhaustive or definitive.

    Open access

    Please visit our Open Access page for more information.

    Submission Directions

    To ensure timely processing of manuscripts, the Journal only accepts manuscripts online via our online submission system, Editorial Manager. Editorial Manager guides you stepwise through the process of entering your article details and uploading your files. The system converts your article files to a single PDF to be used in the peer review process. Editable files (e.g., Word, LaTeX) are required to typeset your article for final publication. All correspondence, including notification of the Editor's decision and requests for revision, is sent by e-mail.

    Submission Checklist

    Ensure that the following have been completed:

    One author has been designated as the corresponding author with contact details:
    • E-mail address (also for admin assistant, if available)
    • Direct phone number (also for admin assistant)
    • Full postal address
    All necessary files have been uploaded, and contain:
    • Word count for abstract and text
    • Page numbers (but no line numbers)
    • Keywords
    • All figures (including title and legend, which comments on what is shown and spell out any abbreviations)
    • All tables (including title, abbreviation spell-outs, footnotes)
    Further considerations
    • Manuscript has been checked for spelling and grammar
    • Manuscript includes a Conclusion section
    • References are accurate and in the correct format for this journal
    • All references mentioned in the Reference List are cited in the text (in the correct order and format), and vice versa
    • Permission has been obtained for use of copyrighted material from other sources (including the Internet)
    • Grant support and any conflicts of interest have been disclosed


    For questions about the editorial process (including the status of manuscripts under review) or for technical support on submissions, please visit our Support Center.

    Cover Letter

    All manuscripts must be accompanied by a cover letter. This should include:
    • A brief manuscript overview (manuscript title, type, design, contribution, and relevance of the manuscript for the journal). As necessary, include additional context to help the editors and reviewers assess this submission.
    • A statement that all authors listed on the manuscript have contributed sufficiently for the project to be included as authors
    • A statement that the work has not been published elsewhere and is not being considered for publication elsewhere
    • Description of any related articles published from the same project
    • Previous presentations or publication in abstract form
    • Description of any commercial associations or other situations that might pose a conflict of interest in connection with the submitted article OR a declaration that none of the authors have a relevant conflict of interest
    • The funding source and the role of the funding source in the work (if any)

    Double anonymized review

    This journal uses double anonymized review, which means the identities of the authors are concealed from the reviewers, and vice versa. More information is available on our website. To facilitate this, please include the following separately:
    Title page (with author details): This should include the title, authors' names, affiliations, acknowledgements and any Declaration of Interest statement, and a complete address for the corresponding author including an e-mail address.
    Anonymized manuscript (no author details): The main body of the paper (including the references, figures, tables and any acknowledgements) should not include any identifying information, such as the authors' names or affiliations.

    Use of word processing software

    It is important that the file be saved in the native format of the word processor used. The text should be in single-column format. Keep the layout of the text as simple as possible. Most formatting codes will be removed and replaced on processing the article. In particular, do not use the word processor's options to justify text or to hyphenate words. However, do use bold face, italics, subscripts, superscripts etc. When preparing tables, if you are using a table grid, use only one grid for each individual table and not a grid for each row. If no grid is used, use tabs, not spaces, to align columns. The electronic text should be prepared in a way very similar to that of conventional manuscripts (see also the Guide to Publishing with Elsevier). Note that source files of figures, tables and text graphics will be required whether or not you embed your figures in the text. See also the section on Electronic artwork.
    To avoid unnecessary errors you are strongly advised to use the 'spell-check' and 'grammar-check' functions of your word processor.

    Article Structure

    Manuscripts should be double-spaced, in Times New-Roman, with 1-inch margins at top, bottom, and sides, and in 12-point type. The order of items in the manuscript is the title page, acknowledgments, abstract, text, references, tables, figure legends, and figures. All pages should be numbered.

    Title Page. Include the title of the article, lead author's address and contact information (e-mail address and direct phone number; authors' (no more than 10) names and titles, affiliations, and, if different, the affiliation when the article was written. Authors should list only a primary and secondary affiliation. Grant support that requires acknowledgement must be mentioned on the title page.

    Acknowledgments. You must obtain permission to reprint or adapt any illustrations or tables published previously. A copy (PDF) of the original signed letter granting such approval must accompany the manuscript. All material reprinted or adapted from previously published literature must be accompanied by the name of the original author, title of the article, title of the journal or book in which it appears, date of publication, and publisher's city and name.

    Abstract. Please see the description of the specific article type for instructions on abstract requirements. See also, Article Type Summary, Including Word Length Limit and Abstract, above.

    Text. Use standard abbreviations and acronyms as much as possible. If a non-standardized abbreviation is used, spell out fully at first use and use the short version thereafter. Use generic names for drugs whenever possible. If using brand names, put in parenthesis after first citing generic names.

    References. Number references consecutively as they are cited (in superscript following punctuation), as in the following examples:

    Patient handovers (also termed handoffs) following surgery have often been characterized by poor teamwork, unclear procedures, unstructured processes, and distractions.1

    Such tools serve as building blocks for Robust Process Improvement capability and sometimes even overlap with Robust Process Improvement methods.29-39

    Cite page sources for quoted text:
    … "patient-centered care," which the IOM defined as "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions,"1(p. 6) we use the term personalized care.

    Each reference should be assigned only one number. The examples of citations for periodicals show the International Committee of Medical Journal Editors (ICMJE) uniform requirements, also known as the Vancouver style, for periodicals. Vancouver should be used for periodical sources only. Please note that these examples show full page ranges and use of et al. when there are 4 authors with only first author listed, which are deviations from the Vancouver style. (See also http://www.nlm.nih.gov/bsd/uniform_requirements.html.)

    Author Name(s). Title of article. Journ abbrev. Year abbreviated month day if known; volume:inclusive page numbers. Include issue number if page numbers are not continuous from issue to issue.

    Data references. This journal encourages you to cite underlying or relevant datasets in your manuscript by citing them in your text and including a data reference in your Reference List. Data references should include the following elements: author name(s), dataset title, data repository, version (where available), year, and global persistent identifier. Add [dataset] immediately before the reference so we can properly identify it as a data reference. This identifier will not appear in your published article.


    Simpson KR, et al. Michigan Health and Hospital Association Keystone Obstetrics: A statewide collaborative for perinatal patient safety in Michigan. Jt Comm J Qual Patient Saf. 37:544-552.
    Shekelle PG, et al. The top patient safety strategies that can be encouraged for adoption now. Ann Intern Med. 2013 Mar 5;158:365-368.
    Maynard G. Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement, 2nd ed. Rockville, MD: Agency for Healthcare Research and Quality, 2015. Accessed Aug 3, 2016. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-esources/resources/vtguide/index.html.
    Shekelle PG, et al. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. AHRQ Pub No. 13-E001-EF. Rockville, MD: Agency for Healthcare Research and Quality, 2013. Accessed Aug 3, 2016. http://www.ahrq.gov/research/findings/evidence-based-reports /ptsafetyuptp.html.
    Centers for Medicare and Medicaid Services. Electronic Health Records (EHR) Incentive Programs. (Updated: Jul 14, 2016.) Accessed Aug 3, 2016. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentive Programs/.
    Mistry KP, et al. Using Six Sigma methodology to improve handoff communication in high-risk patients. In Henriksen K, et al., editors: Advances in Patient Safety: New Directions and Alternative Approaches, vol. 3: Performance and Tools. Rockville, MD: Agency for Healthcare Research and Quality, 2008.
    [dataset] Oguro M, et al. Mortality data for Japanese oak wilt disease and surrounding forest compositions, Mendeley Data, v1; 2015. http://dx.doi.org/10.17632/xwj98nb39r.1.

    Tables and Figures. Cite tables and figures (for example, Table 1, Figure 1) consecutively in the text. All tables and figures should have titles that can be easily understood. Figures should also have short legends that comment on the information in the figure.

    Tables may be submitted as a separate file or may be included in the manuscript file.

    Electronic artwork

    General points
    • Make sure you use uniform lettering and sizing of your original artwork.
    • Embed the used fonts if the application provides that option.
    • Aim to use the following fonts in your illustrations: Arial, Courier, Times New Roman, Symbol, or use fonts that look similar.
    • Number the illustrations according to their sequence in the text.
    • Use a logical naming convention for your artwork files.
    • Provide captions to illustrations separately.
    • Size the illustrations close to the desired dimensions of the published version.
    • Submit each illustration as a separate file.
    • Ensure that color images are accessible to all, including those with impaired color vision.

    A detailed guide on electronic artwork is available.
    You are urged to visit this site; some excerpts from the detailed information are given here.
    If your electronic artwork is created in a Microsoft Office application (Word, PowerPoint, Excel) then please supply 'as is' in the native document format.
    Regardless of the application used other than Microsoft Office, when your electronic artwork is finalized, please 'Save as' or convert the images to one of the following formats (note the resolution requirements for line drawings, halftones, and line/halftone combinations given below):
    EPS (or PDF): Vector drawings, embed all used fonts.
    TIFF (or JPEG): Color or grayscale photographs (halftones), keep to a minimum of 300 dpi.
    TIFF (or JPEG): Bitmapped (pure black & white pixels) line drawings, keep to a minimum of 1000 dpi.
    TIFF (or JPEG): Combinations bitmapped line/half-tone (color or grayscale), keep to a minimum of 500 dpi.
    Please do not:
    • Supply files that are optimized for screen use (e.g., GIF, BMP, PICT, WPG); these typically have a low number of pixels and limited set of colors;
    • Supply files that are too low in resolution;
    • Submit graphics that are disproportionately large for the content.

    Color Artwork

    Please make sure that artwork files are in an acceptable format (TIFF (or JPEG), EPS (or PDF), or MS Office files) and with the correct resolution. If, together with your accepted article, you submit usable color figures then Elsevier will ensure, at no additional charge, that these figures will appear in color online (e.g., ScienceDirect and other sites) regardless of whether or not these illustrations are reproduced in color in the printed version. For color reproduction in print, you will receive information regarding the costs from Elsevier after receipt of your accepted article. These costs may be waived if color is deemed essential. Please indicate your preference for color: in print and/or online only. Further information on the preparation of electronic artwork.

    Preprint references

    Where a preprint has subsequently become available as a peer-reviewed publication, the formal publication should be used as the reference. If there are preprints that are central to your work or that cover crucial developments in the topic, but are not yet formally published, these may be referenced. Preprints should be clearly marked as such, for example by including the word preprint, or the name of the preprint server, as part of the reference. The preprint DOI should also be provided.

    Supplementary Material

    Supplementary material such as additional figures and tables, applications, images and sound clips, can be published with the online version of your article, to enhance it. Supplementary materials of any size or length will be considered; however, these materials should be chosen judiciously and the content should be clearly relevant and useful for the reader.

    Submitted supplementary items are published exactly as they are received (Excel or PowerPoint files will appear as such online). Please submit your material together with the article and supply a concise, descriptive caption for each supplementary file. If you wish to make changes to supplementary material during any stage of the process, please make sure to provide an updated file. Do not annotate any corrections on a previous version. Please switch off the 'Track Changes' option in Microsoft Office files as these will appear in the published version.

    Editing Services

    Please be careful to write your text in with correct English grammar and spelling (American or British usage is accepted, but not a mixture of these). Authors who feel their English language manuscript may require editing to eliminate possible grammatical or spelling errors and to conform to correct scientific English may wish to use the English Language Editing service available from Elsevier's WebShop.

    Research data

    This journal encourages and enables you to share data that supports your research publication where appropriate, and enables you to interlink the data with your published articles. Research data refers to the results of observations or experimentation that validate research findings. To facilitate reproducibility and data reuse, this journal also encourages you to share your software, code, models, algorithms, protocols, methods and other useful materials related to the project.

    Below are a number of ways in which you can associate data with your article or make a statement about the availability of your data when submitting your manuscript. If you are sharing data in one of these ways, you are encouraged to cite the data in your manuscript and reference list. Please refer to the "References" section for more information about data citation. For more information on depositing, sharing and using research data and other relevant research materials, visit the research data page.

    Data linking

    If you have made your research data available in a data repository, you can link your article directly to the dataset. Elsevier collaborates with a number of repositories to link articles on ScienceDirect with relevant repositories, giving readers access to underlying data that gives them a better understanding of the research described.

    There are different ways to link your datasets to your article. When available, you can directly link your dataset to your article by providing the relevant information in the submission system. For more information, visit the database linking page.

    For supported data repositories a repository banner will automatically appear next to your published article on ScienceDirect.

    In addition, you can link to relevant data or entities through identifiers within the text of your manuscript, using the following format: Database: xxxx (e.g., TAIR: AT1G01020; CCDC: 734053; PDB: 1XFN).

    Data statement

    To foster transparency, we encourage you to state the availability of your data in your submission. This may be a requirement of your funding body or institution. If your data is unavailable to access or unsuitable to post, you will have the opportunity to indicate why during the submission process, for example by stating that the research data is confidential. The statement will appear with your published article on ScienceDirect. For more information, visit the Data Statement page.

    Author's Ethical Responsibilities

    The publication of an article in a peer-reviewed journal is an essential building block in the development of a coherent and respected network of knowledge. It is a direct reflection of the quality of the work of the authors and the institutions that support them. Peer-reviewed articles support and embody the scientific method. It is therefore important to agree upon standards of expected ethical behavior for all parties involved in the act of publishing: the author, the journal editor, the peer reviewer, the publisher and the society of society-owned or sponsored journals. For full information on this topic, please see our pages on Ethics in publishing and Ethical guidelines for journal publication.

    If your work involves the use of human subjects, the author should ensure that the work described has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. Reporting should follow the Uniform Requirements for Manuscripts Submitted to Biomedical journals.

    Informed Consent

    Manuscripts reporting the results of experimental investigation on humans must include a statement that informed consent was obtained and that the appropriate institutional committee or review board (IRB) approved the protocol, or that an IRB approved a waiver of informed consent.

    Waiver of Informed Consent
    A waiver of informed consent is often appropriate for improvement research. Baker and Persell have recommended three criteria to judge appropriateness of a waiver of informed consent (Baker DW, Persell SD. Criteria for waiver of informed consent for quality improvement research. JAMA Intern Med. 2015;175:142-143). First, the research must be minimal risk. Although this seems self-evident for most quality improvement projects, it should not be taken for granted. There is always a risk of loss of confidentiality, and for some sensitive topics, such as human immunodeficiency virus care or substance use treatment, the risk of loss of confidentiality must be weighed against the advantages of conducting a study with a waiver of consent. In addition, IRBs should consider the risk to the control and usual care groups that will not receive a promising intervention, including (1) plans to provide the intervention to the control group after trial completion if it is successful and (2) whether the likelihood of benefit is high enough that it threatens equipoise and it would be unethical to conduct a traditional randomized clinical trial, in which case an alternative study design (eg, stepped wedge, time series) should be recommended. The second criterion is that it would not be possible to obtain informed consent without threatening the validity of the trial. This clearly applies when the process of obtaining consent would make a person aware that she needed a clinical service, eg, telling a patient that she is eligible for a study of outreach to improve colorectal cancer screening because she had not been screened. But, it is also appropriate to request a waiver of consent for effectiveness studies, which would be invalid if only a minority of eligible patients consented to participate. Third, all data for the study should be collected as part of routine care, including patient demographics, comorbidities, and outcomes. If additional data are needed from patients, informed consent should be obtained for the part of the study that requires these data (e.g., a survey of patients knowledge, attitudes, and behaviors related to the study aim). Remember also that health care providers are often a subject of quality improvement research, and it may be appropriate to obtain informed consent from them even if a waiver of consent from patients is approved. Using these principles, we believe it is possible to conduct large, rigorous, generalizable quality-improvement research while maintaining stringent protection for human participants. Because of the subtleties in judging whether these criteria are met, we believe the decision regarding a waiver of informed consent is best left to an IRB.

    Use of Patient Images or Case Details
    Studies on patients or volunteers require ethics committee approval and informed consent, which should be documented in the paper.


    All authors should have made substantial contributions to all of the following, as specified in the International Committee of Medical Journal Editors: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted, and (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    Where there are a large number of investigators, they can be listed as part of a named research or work group, and the entire list can be included at the end of the text.

    The contribution of individuals contributing to the manuscript, but not meeting authorship criteria, should be included in the Acknowledgments. Anyone, including freelance writers and writers from communication and education companies, who contributes to reviewing the literature or drafting a manuscript, can be listed either as an author or in the Acknowledgments.

    All authors share collective responsibility and accountability for the results, which is reflected in provision of a cover letter with a statement that all authors listed on the manuscript have contributed sufficiently for the project to be included as authors.

    Changes to Authorship
    Authors are expected to consider carefully the list and order of authors before submitting their manuscript and provide the definitive list of authors at the time of the original submission. Any addition, deletion or rearrangement of author names in the authorship list should be made only before the manuscript has been accepted and only if approved by the journal Editor. To request such a change, the Editor must receive the following from the corresponding author: (a) the reason for the change in author list and (b) written confirmation (e-mail, letter) from all authors that they agree with the addition, removal or rearrangement. In the case of addition or removal of authors, this includes confirmation from the author being added or removed.

    Only in exceptional circumstances will the Editor consider the addition, deletion or rearrangement of authors after the manuscript has been accepted. While the Editor considers the request, publication of the manuscript will be suspended. If the manuscript has already been published in an online issue, any requests approved by the Editor will result in a corrigendum.

    Submission Declaration and Verification

    In submitting the article, the authors are expected to attest that the work described has not been published previously (except in the form of an abstract or as part of a published lecture or academic thesis or as an electronic preprint), that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. To verify originality, your article may be checked by the originality detection service CrossCheck.

    Conflict of Interest

    All authors must disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding received by the authors or family members.

    Other Issues

    Originality and plagiarism. The authors should ensure that they have written entirely original works, and if the authors have used the work and/or words of others (including material that is closely copied summarized, or paraphrased), that this has been appropriately cited or quoted. In addition, authors occasionally "re-use" sections of their previous publications on similar topics. This is acceptable in the methods section of manuscripts on different topics based on the same research project. However, we strongly discourage verbatim re-use of sections from the introduction or discussion sections of previously published manuscripts.

    Data access and retention. Authors may be asked to provide the raw data in connection with a paper for editorial review and should be prepared to provide public access to such data.

    Multiple, redundant, or concurrent publication. An author should not in general publish manuscripts describing essentially the same research or improvement work in more than one journal or primary publication, even if the manuscript updates previous data. However, if the manuscript represents an expansion of previous work, please provide an accompanying statement on the reuse of material. Overlap between patient groups described in serial manuscripts must be acknowledged, and references to previous publications that include the same patients must be provided. Authors uncertain as to whether specific data represent prior or repetitive publication should alert the Editor in the cover letter and include copies of the publication(s) in question.

    The Journal does not view the following uses of a work as prior publication: publication in the form of an abstract; publication as an academic thesis; publication as an electronic preprint. These publications, as well as presentation of material on which part or all of the manuscript is based at meeting (name and place, of meeting and exact name and date of presentation), must all be disclosed and provided.

    When submitting a manuscript, the author is expected to report and provide copies of published or in-press articles or any related manuscripts to enable the editors and reviewers to judge the uniqueness of the submission. The redundancy and inefficiency involved in splitting up a single study or body of work to increase the quantity of submissions poses an unreasonable burden on readers, editors, and reviewers.

    Elsevier Supports Responsible Sharing. Find out how you can share your research published in Elsevier journals.

    Role of the Funding Source. You are requested to identify who provided financial support for the conduct of the research and/or preparation of the article and to briefly describe the role of the sponsor(s), if any, in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. If the funding source(s) had no such involvement then this should be stated.

    Funding Body Agreements and Policies on Open Access. Elsevier has established a number of agreements with funding bodies which allow authors to comply with their funder's open access policies. Some funding bodies will reimburse the author for the Open Access Publication Fee. Details of existing agreements are available online.

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    The corresponding author will, at no cost, receive a customized Share Link providing 50 days free access to the final published version of the article on ScienceDirect. The Share Link can be used for sharing the article via any communication channel, including email and social media. For an extra charge, paper offprints can be ordered via the offprint order form which is sent once the article is accepted for publication. Both corresponding and co-authors may order offprints at any time via Elsevier's Author Services. Corresponding authors who have published their article gold open access do not receive a Share Link as their final published version of the article is available open access on ScienceDirect and can be shared through the article DOI link.

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